Photo: Save the Children
Midwife Hawa Yusuf takes the blood pressure of Hodan, who is 9 months pregnant and lives in an IDP camp next to the Xingod Health Centre in the Karkaar region of Puntland, Somalia. This health centre provides cost-free maternal and child health services, including emergency obstetric and neonatal care.
Through a multi-origanizational project, thirty health facilities, nine maternal health centres and one hospital, in Karkar, are supported that in total target 200,000 beneficiaries. Training village health workers in thirty remote settlements and equipping them with basic health kits enable them to screen, treat and refer young children through integrated case management at community level.
"Midwives and others with midwifery skills are the single most important cadre for preventing maternal, neonatal deaths and stillbirths."
Health workers are the backbone of a health care system. More specifically, midwives and midwifery personnel play an essential role in reducing mortality, morbidity and stillbirths by providing essential care to women and babies during the antenatal, childbirth, and postnatal period. There is a global recognition that a global shortage of midwives is one of the factors inhibiting the reduction of newborn deaths in high-burden settings.
The 2011 State of the World's Midwifery report stated that 38 countries face a critical shortage of midwives. While scaling up the number of educated, equipped and supported midwives is vital, several upcoming reports will push harder for a more comprehensive approach to reducing newborn and maternal deaths with midwives.
Also, the launch of the Every Newborn action plan at the Partners Forum in June in Johannesburg will offer countries a roadmap for change that sharpens existing national health sector plans to improve care at the time of birth with the help of midwives and other health workers. It as well builds on the recommendations and furthers the objectives of A Promise Renewed for Child Survival, the UN Commission on Life-saving Commodities as well as the goals and targets set during the Family Planning 2020 summit.
We hope you'll join the Healthy Newborn Network, the International Confederation of Midwives and Save the Children in honoring a champion midwife for the 2014 International Midwife Award by nominating one by the March 17th deadline. Please visit our special section to find out about eligibility and the nomination process. Two deserving winners will attend the ICM Congress in Prague to receive their award and be honored for their commitment to helping women and babies during the most critical time of life, the time of birth.
Photo Credit: Lynsey Addario/ Save the Children
Every hour of each day in the Philippines, a mother gives birth to a child who does not live to see the next day.
In 2011, more than 10,000 Filipino babies died on the day they were born, according to Save the Children’s State of the World’s Mothers report, Surviving the First Day. The high number of first day deaths illustrates the need to make newborn care a top health priority.
Accordingly, the Philippine government is committed to helping save newborn lives, and has undertaken a series of activities and interventions to prioritize and address newborn health in the country.
Consider the management of premature and low birth weight newborns, which alone accounts for 40% of newborn deaths in the Philippines. The country is one of the pioneers in the region in piloting and building local evidence on Kangaroo Mother Care (KMC), a cost-effective, simple and effective practice that involves mothers, fathers and other family members to keep their babies warm through skin-to-skin contact, promotes a sustained breastfeeding practice thereby enhancing growth, and due to early discharge from the hospital, decreases the incidence of health-care related sepsis and decreases over-all cost of care for the family.
Since the introduction of KMC began at the Dr. Jose Fabella Memorial Hospital in Manila nearly 15 years ago, such care has now been documented to be a valuable life-saving measure for all premature and low birth weight babies in the Philippines. After only two years, the Fabella Hospital experience which showed a significant impact on the hospital’s neonatal mortality, training for implementation was expanded to seven (7) key hospital facilities in Metro Manila. Skills training was subsequently cascaded to all the Lying-in clinics of the Manila City health department by 2004. In 2008 the Bless-Tetada Kangaroo Mother Care Foundation Philippines was established to develop, monitor, and accredit KMC centers across the country. As of September 2013, three KMC centers of excellence have been accredited and four other centers are in the implementation stage, in various regions across the country.
With over 2.3 million births per year and a population of more than 98 million, the Philippines is one of the most populated countries in Southeast Asia and the world. In 2011, a Filipino mother gave birth to the world’s 7th billionth person, Danica May Camacho. She was one of the nearly 350,000 babies who is born preterm every year in the Philippines; yet thanks to skilled health workers who knew that preterm babies need extra care, Danica became a symbol of progress in accessible health services.
The troubling reality however, is that not all our newborns receive the same care from skilled professionals at health facilities in the Philippines. The government however is committed to changing that situation.
The “Unang Yakap” program, meaning First Embrace, is a campaign of the Philippines’ Department of Health (DOH), in cooperation with the World Health Organization (WHO), to adopt the Essential Intrapartum and Newborn Care (EINC) guidelines for the safe and quality care of mothers and their newborns. It stresses the importance of delayed bathing and thorough drying of a newborn, early skin-to-skin contact with the mother, early and exclusive breastfeeding, and properly timed cord clamping. With over 60% of births in the Philippines now being attended by a skilled health worker, implementing the EINC protocol ensures that quality and timely care is provided by all skilled birth attendants, so that all mothers and newborns receive the best possible care during pregnancy and childbirth.
To achieve that end, the Philippines is in the process of developing clinical guidelines and standards for addressing the leading causes of neonatal mortality, and will work with health professionals (midwives, nurses, social workers, physicians) other key stakeholders and partners including community-based health and nutrition workers and local government units (LGUs) to ensure all the relevant cadres of health service providers in the country are equipped with the right knowledge, attitudes and skills to save more newborn lives.
And there is more good news. In August of 2013, the DOH hosted experts from local and international groups including UNICEF and WHO to focus on ways to improve newborn and maternal health by identifying the remaining barriers standing in the way of our goals. The national consultation was part of a global effort to develop Every Newborn, an action plan to save newborn lives.
The consultation offered everyone the opportunity to share experiences, lessons learned and renew our commitment to parents and caregivers across the Philippines.
In November 2013, the strongest typhoon and storm surge devastated the Eastern Visayas region of the country with many lives lost and infrastructure destroyed. Health services suffered a big blow and the regional hospital in Tacloban City (Eastern Visayas Regional Medical Center) was not spared. Incidentally, this is the regional center for training and excellence in KMC. Although the process of rebuilding and healing is in full swing, thanks to the huge outpouring of aid and assistance from all over the world, one cannot but pray and remain hopeful that there is always a way through which all of our efforts for the mother and her newborn will help sustain the nations’ future generation.
We consider the day a child is born to be a crucial day of critical and significant importance. It is our mandate to make sure that every hour of every day is a time of joy for mothers, their newborns and their families, no matter what.
Find more information on newborn health in emergencies on the Newborn Health in Emergencies Resource Page and the blogs below:
- Unang Yakap, A Hug to Remember - Philippine’s Initiative for Mothers and Babies and the Essential Intra-Partum and Newborn Care (EINC) Training Package by Maria Tsolka
- Typhoon Haiyan leaves newborns at greatest risk by Kate Kerber
Photo: USAID ASSIST Project
March 8th marks International Women’s Day, and offers an excellent opportunity to reflect on contributions and progress made to improve the lives of women and girls in the past year, identify where inequalities still prevent women and girls from realizing their full potential, and advocate for further changes to increase equal opportunities. As a physician, I know that newborn survival is closely aligned with women’s empowerment and gender equality, and that improving nutrition, family planning and education opportunities for girls and women are the most effective interventions to prevent high-risk pregnancies and to save mothers’ and babies’ lives. When couples have the ability to decide how many children they have and space their pregnancies adequately, they tend to have fewer children, and their newborns are more likely to be healthy.
I have spent my entire career working to help women, men, boys, girls and newborns have opportunities to live healthy lives and to achieve what they aspire for; I studied medicine, worked as a physician and a clinician in refugee camps, led global health projects, and now, as the founder and President of Women WI-HER LLC (Influencing Health, Education, and Rule of Law) and senior gender technical advisor on the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. I look back on the past year and a half of the USAID ASSIST project, and how we have worked to improve the lives of women and girls, with pride and excitement. In close partnership with our field offices, we have begun to spark change and improve health outcomes in many countries and communities.
The USAID ASSIST approach involves systematically identifying and analyzing gender-related gaps in outcomes and norms that influence risk factors, access to care, care-seeking behavior and equality of treatment among beneficiaries. The approach addresses those gaps and norms in concert to generate shifts in thinking at the individual, household, and community levels. In Ukraine, the project works to decrease alcohol and tobacco use among pregnant women. This improves the health of the pregnant women and also directly benefits the health of their babies. In Uganda, we are working to improve the quality, accessibility and utilization of HIV services by women in the antenatal and postnatal periods. In Botswana and India, our project works specifically to improve maternal survival rates through quality improvement interventions and in Mali and Niger, our project works to empower women through family planning service delivery. In Tanzania, we are working to improve the quality of antenatal care (ANC) which directly affects newborn health, since mothers who do not receive high-quality ANC and childbirth care are more likely, along with their newborns, to suffer childbirth complications and serious consequences.
But empowering women and girls and improving newborn survival cannot be as impactful without involving male partners. Gender is relational, and without working to transform traditional gender roles of men and boys, we will not fully be able to empower women and men and to achieve improved health outcomes for mothers and newborns. Through ASSIST, we work to engage male partners to attend ANC visits and PMTCT programming. Involving fathers in maternal health has been shown to improve health outcomes among mothers and newborns. Involving men in PMTCT services has been shown to improve retention of mother baby pairs, and by offering HIV testing for male partners at ANC and PMTCT appointments, the USAID ASSIST project empowers both men and women to know their HIV status and enter into treatment programs, which leads to a decrease in HIV positive newborns.
I am proud of what we have been able to accomplish in the past year and a half to improve the health outcomes and lives of women, girls and their families. I look forward with even greater excitement to this coming year, knowing that, with the strong commitment of our field offices, senior leadership and all staff to integrate gender across the USAID ASSIST Project, we will capture lessons learned and best practices to integrate gender into improvement, and we will continue our deep commitment to improve health outcomes for women, men, boys, girls and newborns.
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- M. Koblinsky. Reducing Maternal and Perinatal Mortality Through a Community Collaborative Approach: Introduction to a Special Issue on the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) (pages S1–S5)
- L.M. Sibley, S. Tesfaye, B.F. Desta, et al. Improving Maternal and Newborn Health Care Delivery in Rural Amhara and Oromiya Regions of Ethiopia Through the Maternal and Newborn Health in Ethiopia Partnership (pages S6–S20)
- A.G. Gobezayehu, H. Mohammed, et al. Knowledge and Skills Retention Among Frontline Health Workers: Community Maternal and Newborn Health Training in Rural Ethiopia (pages S21–S31)
- M.M. Dynes, R. Stephenson, C. Hadley, et al. Factors Shaping Interactions Among Community Health Workers in Rural Ethiopia: Rethinking Workplace Trust and Teamwork (pages S32–S43)
- D. Barry, A.H. Frew, H. Mohammed, et al. The Effect of Community Maternal and Newborn Health Family Meetings on Type of Birth Attendant and Completeness of Maternal and Newborn Care Received During Birth and the Early Postnatal Period in Rural Ethiopia (pages S44–S54)
- S. Tesfaye, D. Barry, A.G. Gobezayehu, et al. Improving Coverage of Postnatal Care in Rural Ethiopia Using A Community-based, Collaborative Quality Improvement Approach (pages S55–S64)
- B.F. Desta, H. Mohammed, D. Barry, et al. Use of Mobile Video Show for Community Behavior Change on Maternal and Newborn Health in Rural Ethiopia (pages S65–S72)
- L.M. Sibley, S.A. Spangler, D. Barry, et al. A Regional Comparison of Distribution Strategies and Women's Awareness, Receipt, and Use of Misoprostol to Prevent Postpartum Hemorrhage in Rural Amhara and Oromiya Regions of Ethiopia (pages S73–S82)
- S.A. Spangler, A.G. Gobezayehu, T. Getachew, et al. Interpretation of National Policy Regarding Community-Based Use of Misoprostol for Postpartum Hemorrhage Prevention in Ethiopia: A Tale of Two Regions (pages S83–S90)
- K.E. Stover, S. Tesfaye, A. H. Frew, et al. Building District-Level Capacity for Continuous Improvement in Maternal and Newborn Health (pages S91–S100)
- S.A. Spangler, D. Barry and L. Sibley. An Evaluation of Equitable Access to a Community-Based Maternal and Newborn Health Program in Rural Ethiopia (pages S101–S109)
- M.M. Sisay, R. Yirgu, A.G. Gobezayehu, et al. A Qualitative Study of Attitudes and Values Surrounding Stillbirth and Neonatal Mortality Among Grandmothers, Mothers, and Unmarried Girls in Rural Amhara and Oromiya Regions, Ethiopia: Unheard Souls in the Backyard (pages S110–S117)
This blog was originally published by the EveryOne Campaign. Written by Devendra Tak.
The Aanganwadi Centre (for government-sponsored child-care and mother-care) in Uttar Pradesh’s Gangapur village in Varanasi district has probably never received such a frenzy of attention. A group of community-based women journalists from U.P. and Bihar have dropped in to check the status of child care, especially related to newborns. There are three children who are under treatment for Severe Acute Malnutrition (SAM) at this Centre, two of whom are present at the Centre at the time of the visit of these journalists representing Khabar Lahariya, a pioneering decade-old newspaper for communities with local news in local languages.
Kusum, the mother of Ankita (who was born prematurely and is suffering from Severe Acute Malnutrition), looks visibly relieved with the attention she is receiving and says that she is grateful for the support of Save the Children-led Karuna Project. The project reaches 100 villages in U.P. and Jharkhand in its fight for nutrition and child survival; and is made possible by donations from His Holiness the Dalai Lama. Amazingly, Kusum did not even know that she was pregnant till six months: by when she had missed out on essential care for herself and the yet-to-be-born Ankita. “As soon as we determined that she was pregnant, we got the Centre to support Kusum with counseling, additional nutrition, food supplements and other medical support, but it was probably a bit late,” informs Rakesh Choubey, nutrition counselor from the Karuna Project. He adds, “It is a real problem that expecting mothers are not brought to the Centres regularly for check-up during their pregnancy.”
The other child, Rhimjhim, who is over 1 year old now, moved from the SAM to MAM (Moderate Acute Malnutrition) status just a month ago. When questioned, Gulabchand, her father (a labourer at a brick kiln) puts the blame squarely on the fact that his wife was away at his in-laws (as is the tradition in these parts) for the delivery and initial months of the baby’s life for any slackness in taking Rhimjhim for regular health-checkups. “My wife and I are regularly visiting the Centre now to ensure that Rhimjhim recovers fully and stays healthy,” he says.
From SAM to MAM to OK – the journey of newborns in India is riddled with conundrums that can be likened to a game of Russian roulette in their race for survival. India has the highest number of newborn deaths, many of whom do not survive the very first day of their life. Over 300,000 children die in India on the 1st day of birth and more than 700,000 in their 1st month. More than half of these newborn deaths occur within the crucial first week of birth – and most of these deaths can be saved by simple and economical methods of preventive care that can be accessed by all young mothers and their newborns. Save the Children’s ‘Ending Newborn Deaths’ Report (launched on 25 February) undoubtedly offers more perspectives to help guide policy makers to make the right decisions, which becomes even more relevant in India when we are facing the possibility of a new government following the upcoming General Elections.
Shashi Kala, the local Auxiliary Nurse Midwife (ANM), provides an update on the Centre’s services: “We have an immunization camp every third Wednesday of the month. For children who are SAM or MAM we provide nutrition supplements twice a month.” Choubey adds that the Karuna Project even takes care of the transportation of affected children to the Centre or the Public Health Centre (located at the district headquarter), if that is required for children in a critical situation.
While the ANM mentions that there are several issues in running the Centre smoothly, she is grateful for the support of the Karuna Project and hopes that this will pave the way for sustainable methods to be adopted by the state administration once the Karuna Project ends its 3 year foray. One of her biggest grouses is that there are times when the regular funds from the government arrive much later than expected, leaving her and other staff and volunteers to cope with their own resources. “Health services have to go on without any break and that is what we attempt to provide,” she says proudly.
The National Rural Health Mission Implementation Framework mandates states to undertake district planning exercise, whereby local problems can be identified and addressed through systems by due allocation of budget. Hopefully, the district would take lessons from the processed adopted by the Karuna Project, which is now a year old. A comprehensive strategy of Block Operational Plan identifying convergence point among 8 departments -- which are key to ensuring nutrition security -- has made this intervention a successful one. The learning from this project will provide evidence for the Government to adopt policy changes while designing larger interventions on nutrition security.
Choubey affirms that much needs to be done to ensure systematic health care but feels that progress is being made. “Health workers are often criticized and even attacked when they are not able to do more than what is physically possible, but yet each one of us goes on knowing that saving every newborn more than makes up for the challenges that have to be overcome.” The Neonatal Mortality Rate graph is now showing a decline, and there are states where this has been very good, and the Government has the RMNCH+A Approach, and a slew of programme and guidelines have been developed and launched, to tackle the challenges of working in a culturally, economically, geographically and politically diverse nation as India.
Across India steady progress is being made to ensure the survival of newborns and of course there are gaps, many of them related to the issue of inequality, urban health issues and also the quality of service delivery but we can be hopeful that – with initiatives such as the Karuna Project chipping in – that our future generations may be secured.
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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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