Today, I call for urgent funding to meet the reproductive health needs of women and mothers in Guinea, Liberia and Sierra Leone.
As these nations fight the devastating impact of Ebola, pregnant women face a double threat, dying from Ebola or dying from complications of pregnancy and childbirth.
UNFPA Liberia Assistant Representative and Officer in Charge Dr. Philderald Pratt and midwives at the JFK Memorial Hospital maternity center in Monrovia. Photo credit: UNFPA Liberia
Women are affected in another way too. They are the primary caregivers of those who are sick and suffering, and they are responsible for burial preparations for lost loved ones.
In the three most affected countries, UNFPA, the United Nations Population Fund, estimates that there are more than 800,000 women who will give birth during the next 12 months. Yet during their time of need, they face profound fear and a severe shortage of health services and health professionals.
Health services are buckling under the sheer volume of patients seeking treatment. Many health workers are becoming infected, hundreds of them are dying, and countless health facilities have been forced to close. As a result, women’s access to maternal health and family planning is extremely limited or inaccessible.
We estimate that 120,000 of these pregnant women will face complications during pregnancy and childbirth, and could die if the required life-saving emergency obstetric care is not provided.
The steady but fragile progress made in recent years by the Governments of Liberia, Sierra Leone and Guinea, with the support of UNFPA and others, has been wiped out in the last four months alone.
We are back to square one in crucial areas such as delivering better emergency maternal and newborn care and distributing reliable supplies of modern contraceptives.
Officer in Charge, UNFPA Liberia Dr. Philderald Pratt inspects the consignment of reproductive health kits along with the Director of the Family Health Division, Ministry of Health and Social Welfare Dr. Caullau Jabbeh-Howe. Photo credit: UNFPA Liberia
UNFPA is working in close partnership with the governments to restore health services, particularly to expectant and new mothers. We are setting up mobile clinics and recruiting retired midwives for delivery care at the community level. We are providing emergency clean delivery kits for women without access to clinics. We have delivered disinfectants, hand-washing equipment, and protective equipment, such as heavy-duty aprons and medical gloves, to facilitate safe delivery while protecting health workers from possible infection. We are also providing information to reduce fear and promote health seeking behavior.
UNFPA estimates that $64.5 million is needed to provide reproductive and maternal health services during the coming three months in Liberia, Sierra Leone and Guinea. So far, only $3 million has been provided. We stand ready to serve Ebola’s most vulnerable victims: pregnant women.
We stand ready to serve Ebola's most vulnerable victims: pregnant women.
Dr. Babatunde Osotimehin is United Nations Under-Secretary-General and the Executive Director of UNFPA, the United Nations Population Fund, a position he has held since January 2011. A renowned physician and public health expert, he was previously Nigerian Minister of Health and Director-General of the country's agency on AIDS. At UNFPA, Dr. Osotimehin supervises efforts to promote sexual and reproductive health and the rights and abilities of young people to build a better world.
Guinea's Donka National Hospital in the capital of Conakry. Photo: AMCGuinea
The idea of founding a non-profit organization was to help reduce newborn, infant and maternal mortality rates with a focus on premature babies. In Guinea 80% of premature babies die within days after birth. Sometimes 3 to 5 premature babies are kept in 1 incubator and in case of an infection or disease such as Ebola, all the babies could then be affected.
I was born as a preemie, weighing only 2 lbs, and I barely survived my first few weeks of life in the country’s only neonatal intensive care unit (NICU) located in Donka Hospital, in the capital Conakry.
In 2010, I became the mother of a premature baby who was born at 29 weeks and weighed a mere 2 lbs 4oz. Unlike myself, my daughter received top notch care of Maryland’s Holy Cross Hospital in the United States.
After my daughter’s release from the hospital, I decided to create an organization to help improve healthy newborn survival rates in Guinea. Since 2010 AMCGUINEA (Assistance to Maternity Centers of Guinea) has been speaking out and raising awareness of preterm birth in Guinea and the national government is now more involved in the care of newborns than ever before.
Preterm babies at the NICU at Donka National Hospital in Conakry, Guinea. This is the only NICU in all of Guinea. Photo: AMCGuinea
AMCGUINEA, in partnership with LittleBigSouls International Charity and in collaboration with Guinean Ministry of Health, celebrated World Prematurity Day for the first time on November 17th 2013 in Guinea. This was an important milestone in Guinea’s efforts to focus more attention on improving maternal and newborn survival.
Marking World Prematurity Day on November 17, 2013 in Guinea. Photo: AMCGuinea
Recently, however, the Ebola health crisis in Guinea has threatened to undermine these efforts. Pregnant women have been deeply affected by the 2014 outbreak of the Ebola virus. Even before Ebola, pregnant women were afraid to go in healthcare facilities where the management of complications surrounding childbirth is not always adequate. Now Ebola is deepening their fears, and not without reason.
Hundreds of health care workers in West Africa have also been impacted with Ebola recently, and many have been infected by the patients they treat. Rick Sacra, one of the American doctors who contracted Ebola and later made a full recovery, was treating pregnant women in Liberia when he became infected. In Guinea, it has been reported that Dr. Youssaouf Diallo Nabanio, a neonatologist who worked at the country’s only neonatal intensive care unit, contracted Ebola and died several days later.
Health workers and civilians should all be involved in preventing the spreading of the Ebola virus in West Africa for a healthier population globally.
AMCGUINEA is dedicated to its mission to save preterm babies in Guinea and is seeking more assistance, not only to save them but also to prevent the infection of Ebola in the neonatal departments. Newborns are more vulnerable to any disease, especially when they are very viral such as Ebola.
For more information, please visit us at: www.amcguinea.org.
Dr. Lava Abdul Rahman works with Syrian refugees at the UNFPA maternity clinic in Domiz Camp in northern Iraq. Photo: UNFPA/Millat Horiri
DUHOK, Iraq – "The clinic is always crowded," said Lava Abdul Rahman, a gynaecologist at the UNFPA maternity clinic in Domiz, a refugee camp in northern Iraq.
Each day, between 30 and 35 pregnant women come to the clinic for antenatal care, she noted.
More than three years into the Syrian crisis – a catastrophe that has forced hundreds of thousands to flee to Iraq, including more than 3,800 pregnant women – refugee camps have become simply a fact of life for many.
“I am in the ninth month of pregnancy”
Ruqaya, 36, is nine months pregnant, living in
Domiz camp. Photo: UNFPA/Millat Horiri
In the Domiz Camp, in the Duhok Governorate of Iraq, the sea of temporary shelters is slowly transforming into a city. Concrete houses are replacing tents and prefabricated caravans. Shops have sprouted up everywhere.
Syrians there say they have not, and will not, lose hope that peace can be restored in their home country. But for now, life in the camp has settled into a rhythm. Weddings are held every other day, and scattered cries of newborns can be heard as one walks through the camp.
"Despite the hardships and difficulties in making a living, other aspects of life go on normally," said Ruqaya, 36, as she left the UNFPA maternity clinic.
When she and her four children fled their home in Qamishli, Syria, she could not imagine having another baby. But "life goes on," she said. “I am in the ninth month of pregnancy now."
Ruqaya was not alone. The clinic was crowded with other pregnant women.
Faster, more convenient care
The UNFPA clinic here was established when the Domiz Camp was set up in 2012. Since then, more than 60,000 Syrians have arrived.
But until recently, deliveries had to be conducted in hospitals outside the camp. Getting there was timely and required money for transportation.
The clinic now has had the capacity to safely perform deliveries. Between 4 August and 20 September, some 200 deliveries took place there.
“Most of pregnant women want to deliver here if they do not have any pregnancy complications or need a C-section,” Dr. Rahman said. When complications arise, mothers are referred to hospitals, she added.
"We only conduct normal deliveries here," she said.
Having a maternity clinic in the camp is a relief, said Natja, a 25-year-old refugee.
"My daughter is two-and-a-half years old now,” she told UNFPA. “My husband wanted another baby last year, but I was resistant to the idea due to being in refuge, and I was afraid I would not receive good healthcare.”
But after speaking to other women who had become pregnant while living in the camp, she felt assured she would receive proper care from the maternity clinic.
She is now four months pregnant.
Wael Hatahet, UNFPA’s humanitarian coordinator in Iraq, said UNFPA provides the clinic with medics, equipment and reproductive health kits. The cost of Caesarean sections performed in referral hospitals is also covered by UNFPA, which also supports a number of maternity hospitals in the Governorate.
On 18th July, I was part of a team from Save the Children and Mukono district that visited Mukono HCIV to provide support supervision to health workers whom Save the Children had trained in the Helping Babies Breathe Plus (HBB+) package.
When we arrived at the health centre, we met Norah Nakimuli, a Nursing Officer and registered midwife, moving quickly to the HBB+ corner, a newborn baby in her arms. We followed her to see what was going on, and she explained, “This baby has just been delivered in the theater and I have been resuscitating it.”
Norah puts the baby on oxygen
Norah said that the baby’s mother, 30-year-old Margaret Kizza of Seeta Bukerere, had been admitted at 3:00am that morning with labour-like pains which had begun the previous day. This was her fourth pregnancy. Although Margaret’s condition was generally good and she was in active labour, the fetal heart rate was low. At 5:30am, her membranes ruptured with meconium-stained liquior grade 2 and signs of face-to-pubis presentation. The doctor was informed and he ordered an emergency cesarean section.
After the operation, Norah received the baby, who failed to breathe. She wrapped and rushed it to the resuscitation corner in the theater. She positioned it well, cleared the airway using the penguin sucker and dried and rubbed its back. In spite of all this, the baby was still not breathing.
“While praying in my heart, I got hold of the ambu bag and started ventilation as I had learned in the HBB+ training,” says Norah. “Immediately the baby sneezed. The score was 3/10 at one minute, then advanced to 5/10 at five minutes and finally progressed to 7/10 at 10 minutes.” Norah was one of the participants in the HBB+ training that was conducted by Save the Children.
Norah says that all of this was done while maintaining warmth to the baby. The baby eventually started breathing and she transferred it to the labour ward for continuous monitoring as its mother recovered from general anesthesia.
“I felt very good because I saved the life of a baby who will be useful in this world,” said Norah. Margaret’s relatives were not around because she had come alone to the hospital, but Norah believed that they would be happy when they heard the story of the newborn’s survival.
She explained that Margaret would be kept in the health unit for three days on observation since she had undergone a caesarian birth. The doctor ordered antibiotics and dextrose 50% to be given to the baby and oxygen. Norah also gave the baby Vitamin K and tetracycline eye ointment.
Photo: Susan Warner/Save the Children
This post is part of the Maternal and Newborn Health Integration Blog Series, "Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting.
The World Health Organization (WHO) welcomes the revitalized interest in integration of maternal and newborn health care as integration is the key to success for both improving maternal health and for ending preventable newborn deaths.
This is the very reason why WHO, together with UNICEF, UNFPA and the World Bank, have been promoting, already since 2000, Integrated Management of Pregnancy and Childbirth (IMPAC). This is the package of guidelines and tools, which respond to key areas of maternal and perinatal health programmes. IMPAC sets standards for integrated maternal and neonatal care. However, integration is not an end in itself, but should serve the purpose of improving quality and efficiency of health care services provided.
One important element of integration of health care services is that they should be centred around the mother-baby dyad, their needs and preferences. It is important that health care services are organized in a way that this will happen. For a normal pregnancy, childbirth and postnatal period this care can and should be provided by midwifery personnel with the necessary skills. Sometimes, however, the mother or the baby needs special attention and services that can only be provided by health care workers with specialized skills. But even in those cases, addressing the needs of the mother and the baby in an integrated way, remains key for success.
For example, early and exclusive breastfeeding is important for the survival, growth and development of the baby and should not be disrupted by separating the baby from her mother, if this is feasible – and in most cases this is feasible. So-called vertical health programmes, such as the expended programme of immunization (EPI) or the prevention of mother-to-child-transmission (PMTCT) have been successful in addressing certain public health priorities as they provide the necessary focus to make things happen. Sometimes they are perceived as disruptive, however, there are good examples how these programme interventions can be successfully integrated into maternal and newborn care services. Again, IMPAC provides guidance on how best to achieve this integration.
Finally, it will be important to promote a truly perinatal approach, which goes beyond highly specialized health care settings, but which will be based on the principles that only good pregnancy and childbirth care will lead to better neonatal outcomes. In conclusion, maternal and newborn health care should be as integrated as possible and as “vertical” as necessary to achieve high coverage and quality of health interventions for the mother and her baby. In the coming months WHO, UNICEF, UNFPA and partners will be working on a Every Mother Every Newborn initiative to improve the quality of integrated maternal and newborn care.
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