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.

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Still, good hygience practices are not common in many countries. A 2009 study published in the journal Health Education Research found that only 29 percent of 802 women surveyed in Kenya washed their hands with soap after using the bathroom, often due to lack of time and energy. (Washing one's hands with just water is the norm throughout the country.)

"Key motivations for hand washing were disgust, nurture, comfort and affiliation," wrote lead author Valerie Curtis of the London School of Hygiene and Tropical Medicine. "Fear of disease generally did not motivate hand washing," as 43 percent of the women polled felt that diarrhea "is a normal part of growing up."

Contaminated water is also commonplace in developing countries. The World Health Organization, or WHO, and the United Nations Children's Fund issued a report in 2004 that found the definition of "safe water" varied from region to region. WHO has issued guidelines for maintaining water quality around the world since 1982, but leaves it up to each country to implement their own standards. Such inconsistency is why Global Water bypasses the government when it comes to installing water treatment systems.

"We're trying to fill a void that's been created by the leaders of the developing world themselves," Kuepper said. "There's a real lack of concern among these leaders to take care of their own people."

Slow Progress

The U.N. Millennium Development Goals Report indicates that at the global level maternal mortality rates fell by less than one percent annually between 1990 and 2005--far below the 5.5 percent annual improvement needed to reach the world body's 2015 target. Of the eight Millennium Development Goals--U.N. benchmarks to reduce poverty and improve health--originally set in 2000, it's the area that has seen the least amount of progress.

"Women's health and empowerment is at the heart of all the development goals. I don't think any of them can be achieved unless we scale up a full range of reproductive health services and policies for women in every part of the world," Thomas said. "There's such great momentum around maternal health because the crux of women's reproductive health and rights is the saving of lives of women who are dying needlessly because of pregnancy or childbirth."

Improving women's access to clean water is directly linked to increasing their life expectancy. For example, a 2006 WHO survey found that women in countries such as Tanzania were only expected to live to the age of 51; one of the causes of death was consuming excessive levels of fluoride found in contaminated water. Those who do survive in countries with unsafe water have to deal with side effects like stiff joints.

"The body acclimates to some degree to accommodate the level of contamination in the water," Kuepper said. But he pointed out that such adaptation only applies to microorganisms like bacteria and viruses, not minerals like fluoride and arsenic. Since water contamination remains an environmental hazard to women and children in the world's poorest nations, he doesn't envision the development goals being fulfilled within the next six years.

"I don't see anything on the horizon to fix the problem. There's not enough funding efficiently being spent in water-short areas of the world," he said.

Latrice Davis is a freelance journalist based in New York.

For more information:

EngenderHealth
http://www.engenderhealth.org/our-work/maternal/index.php

Global Water
http://www.globalwater.org/

2009 United Nations Millennium Development Goals Report (PDF)
http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf

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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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