Survival of women and newborns in crisis

The following post was written by Kate Kerber and Ribka Amsalu.

Imagine you are eight months pregnant with your third child with two other young children at home. The ground starts moving violently beneath you and panic sets in. You flee your collapsing home with your children. The aftershocks are intense and dramatic. You have lost family members and friends in the chaos and confusion. The earthquake devastates the healthcare system, leaving you no choice but to deliver your baby alone, or if you are fortunate, in a mobile or temporary clinic.

Natural and man-made disasters grab the attention of the masses, and individuals from all walks of life are compelled to donate their time and money to rebuilding efforts. The last twelve months have seen an unprecedented number of natural disasters in high income countries (earthquakes in Japan and New Zealand, tornados in the US, flooding in Australia). These events, no matter where they occur, are destabilizing. In the poorest countries an emergency event - be it conflict, earthquake, or flood – usually leads to humanitarian crisis that can be devastating to the health, safety, security and wellbeing of a community or whole country. Those who are most vulnerable to natural and man-made disasters are pregnant women and newborns who are dependent on access to reliable, skilled care.

Solange has just given birth to her 10th baby at the maternity clinic set up in the grounds of the largest displacement camp in Côte d’Ivoire, in the Western town of Duékoué. About 27,000 people have sought refuge here after fleeing heavy fighting. Last month 100 babies were born in this classroom turned into a makeshift maternity clinic. Photo: Laurent Duvilier / Save the Children. 

Public health in complex emergencies is an increasingly important area of work. Over the last decade experts have demonstrated priority actions, including how to measure the severity of a crisis and how to evaluate the effectiveness of humanitarian response. However, reproductive health – particularly ensuring care during childbirth – has only been recently recognized as a key gap and priority in these settings.

Of the top 10 countries with the highest risk of newborn death, 8 have had recent major destabilizing events. Similarly, out of the “10 worst places to be a mother” according to Save the Children’s Mother's Index, 6 are also suffering the world’s worst humanitarian crises (Afghanistan, Central African Republic, Chad, Democratic Republic of Congo, Sudan, and Yemen) according to Médecins Sans Frontières.

It is no coincidence that countries affected by humanitarian crisis and conflict are the riskiest for mothers and babies. Essential factors such as access to care before, during and after pregnancy in these settings are severely restricted. Survey data from conflict settings have at-times shown a twofold increase in under-five mortality from baseline rates. But it’s not necessarily the conflict itself that is harming mothers and their babies – women in Afghanistan are 200 times more likely to die during childbirth than from bullets or bombs. In Afghanistan on average 1 woman in 11 will eventually die from pregnancy-related causes.

So what can be done?

Information – reproductive health and mortality surveys in emergency settings should use standardized definitions and data collection methodology that capture pregnancy and newborn indicators.  Surveys in emergency settings tend to concentrate on measles vaccination coverage, mortality, or nutrition, but are generally lacking in coverage of antenatal, childbirth and postnatal care, as well as indicators that reflect quality of health services provided or the strength of the health system. This discrepancy can lead to a misinterpretation of the relative importance of reported indicators versus unreported indicators. 

Implementation – The global health cluster that is lead by the World Health Organization has agreed on the Minimum Initial Service Package for reproductive health in crisis situations. The joint CDC and Save the Children Emergency Health and Nutrition toolkit establishes best practices around when and how to act to save the lives of women and their newborns.

Innovation – Robust, fit-for-purpose technology for delivering care and gathering and using real-time data is crucial. Clean birth kits is a key intervention that needs continued testing and refinement for different settings. It has been shown that women do use emergency obstetric services when they are available – Save the Children has successfully supported these services in crisis settings in Pakistan and Sudan. Novel methods of bringing skilled care closer to home in complex emergencies should be prioritized for operational research.

Ten worst places to be a mother: 

1.  Afghanistan*⁺
2. Niger*⁺
3. Guinea-Bissau⁺
4. Yemen*
5. Chad*
6. Democratic Republic of the Congo*⁺
7. Eritrea
8. Mali⁺
9. Sudan*
10. Central African Republic*