Environment

Water Is Key to Reducing Maternal Mortality

Thursday, November 5, 2009

Improving water quality and access can help lower maternal mortality rates, say advocates. Now a new fellowship program is being launched to explore various solutions to the maternal health problem in the world's poorest nations.



Water Is Key to Reducing Maternal Mortality(WOMENSENEWS)--Knowledge has long been cited as the tool most needed to lower maternal mortality rates, but Global Water, a volunteer organization based in Oxnard, Calif., says what women in developing countries also need to combat this problem is water.

"Not having the proper amount of water on a daily basis puts stress on the body, which affects a woman's life span," said Ted Kuepper, the organization's executive director, in a telephone interview. "It also affects their ability to further their education and break out of poverty."

To help disrupt this cycle, the New York-based international reproductive health organization EngenderHealth is launching a fellowship program with Ashoka, an organization of social entrepreneurs with headquarters in Arlington, Va., to focus on improving maternal health in the world's poorest nations. The initiative will concentrate on parts of the world with the highest maternal and child mortality rates, says Tim Thomas, senior advisor of the Maternal Health Task Force at EngenderHealth.

"The rates are highest in Africa and South Asia," he said in a telephone interview, but added that "we're not committing to any particular countries at this point."

That's because EngenderHealth and Ashoka--who plan to recruit 32 candidates through its Changemakers online competition--are seeking proposals that focus on applicants' areas of interest. Those selected for the program will spend nine months working on a tangible solution to a specific maternal health challenge, starting in September 2010.

Water Use Soars

Water use has grown at more than twice the rate of the world's population over the past century, mostly for agricultural purposes, according to the 2009 United Nations Millennium Development Goals Report. This has left 884 million people at risk for--or already facing--a water shortage. The situation poses a huge threat to maternal health, but Thomas said it's not the only contributing factor.

"There's a panoply of factors that contribute to maternal mortality--everything from (the drug) misoprostol not being available to treat postpartum hemorrhage to the insufficient distribution of magnesium sulfate for preeclampsia in rural clinics," he said. "This is where research is needed to coalesce and bring consensus, and that's one of the jobs of the task force."

Grace Lusiola, director of the EngenderHealth office in Dar es Salaam, Tanzania, works in conjunction with the government on strategies like the One Plan, a federal campaign unveiled in April 2008 to reduce maternal and child deaths. The campaign's contributions to policy development include providing post-abortion care.

"Unsafe abortion is the leading cause of maternal death in Tanzania," Lusiola said in an e-mail interview. "We're increasing the number of facilities at the community level where women who have had unsafe abortions can go for medical care. Being able to get emergency care locally and not having to travel (long distances) saves lives."

Water-Based Solutions

Another way to improve maternal health is through building latrines and hand-washing stations. Global Water assembles such facilities for elementary schools in rural areas, working with the Peace Corps to promote good hygiene and halt the spread of waterborne illnesses such as cholera, diarrhea, hepatitis and typhoid fever. On one visit to a village in Guatemala, Kuepper said, volunteers taught children about hygiene--despite lacking the basic tools.

"Those schools didn't have any water, so they had the students pretend to wash their hands and brush their teeth," he said. "It was an amazing sight."

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Vis-à-vis this article, water may be the key to reducing maternal mortality rates in developing countries but not in the US. In the US, we have a number of other problems, which cause us to rank 35th in the world vis-à-vis maternal mortality. Laura Gilkey and I had a program in Sarasota, FL, on this very subject on November 1.

On that afternoon, residents of Sarasota, FL, had a unique opportunity to learn about maternal health care issues and available resources in Sarasota County, Florida, and the U.S.—and about 250 of them took advantage of that opportunity.

Starting at 3:00 p.m. and for two hours afterwards, Laura Gilkey, vice-president, Florida Friends of Midwives, and I presented a top-notch panel of experts on Maternal Health Care in the 21st Century: Sarasota and Beyond in the ballroom of the Sarasota Hyatt Regency. Our panelists were: Ina May Gaskin, the most renowned midwife in the United States; Dr. Washington Hill, Maternal-Fetal Medicine Director, Sarasota Memorial Hospital; Jennifer Highland, executive director, Healthy Start Coalition of Sarasota County; and Representative Keith Fitzgerald, who represents Sarasota in the Florida House of Representatives. The panel was moderated by Kelly Kirschner, vice-mayor of Sarasota.

After the formal presentations, there was a question-and-answer period followed by refreshments. Available to all attendees was a 28-page Program and Resource Guide containing a glossary of terms, a listing of resources available in Sarasota, a list of people with expertise available at the program, and a list of recommended readings. Our program was sponsored by the Sarasota-Manatee chapter of NOW (National Organization for Women), SCSW (Sarasota Commission on the Status of Women), and FFOM (Florida Friends of Midwives). All at no cost to the attendees. That was made possible by the generous donations in money and in-kind by Sarasota businesses, organizations, and individuals.

Laura and I made this educational program available because the U.S. ranks 35th in maternal mortality and 33rd in infant mortality in the world. The U.S. spends more money on mothers’ health than any other nation in the world, yet in America women are more likely to die during childbirth than they are in most other developed countries.

We learned a great deal from our panelists. We learned about the problems caused by women in poor health, and those who are smokers, alcoholics, and drug addicts, becoming pregnant. We learned about the problems caused by induced labor and the performance of unnecessary Cesarean sections. We learned that statistics and other information on the incidence of induced labor, the rate of Cesareans, and maternal deaths in our community by obstetrician and hospital are not readily available. We learned about the success of special interest groups in preventing the passage of needed legislation in the Florida Legislature and the U.S. Congress. We learned about the system of postnatal care in The Netherlands where every new mother in the first eight to ten days after the birth of her baby is entitled to the services of an assistant, who will aid in the recovery of the mother and provide her with advice and assistance to care for her newborn. We learned that the maternal death rate in the US has not gone down since 1982 and the rate for African-American women has been three to four times higher than for whites since 1940.

As if to point up the timeliness of our program, two days later, on November 3, The New York Times published an article entitled “Premature Births Worsen US Infant Death Rate.” The article referred to the fact that about 1 in 8 U.S. births are premature and that early births are much less common in most of Europe. Among the reasons given for the high rate of prematurity in the U.S. were some of the very reasons discussed by our panelists, including the induction of labor and the overuse of C-sections.

Because of what we’ve learned, Laura and I now plan to build on this panel discussion and form an advocacy group to address these issues for Sarasota County, Florida, and the U.S. We welcome participation by anyone interested in working with us to achieve the goal of a healthy mother and a healthy baby in the case of every pregnancy.

Sonia Pressman Fuentes
e-mail: spfuentes@comcast.net
website: http://www.erraticimpact.com/fuentes

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