During the month of May, IMPACT will be highlighting USAID’s work in Global Health. From May 11-17, we will be featuring the important role of mothers and partnerships in Global Health.
With memories of Mother’s Day in the U.S. this past weekend still fresh in the mind—family gatherings, celebrations, festive meals, presents, flowers, and more—attention turns to the estimated 287,000 maternal deaths that occur each year, mostly in developing countries.
During this week, USAID is focusing on mothers and on how maternal health is critical to achieving its global health goals. Partnerships between the private sector and NGOs, foundations, associations, and others have allowed USAID to maximize its health impact around the world.
The death of a mother profoundly affects the health and well-being of her children. When a mother dies, her children are less likely to survive. If a mother dies in childbirth, her child is 10 times more likely to die before reaching age one.
A mother and her child in India. Photo credit: USAID
While maternal mortality remains unacceptably high throughout the developing world, a number of USAID-assisted countries have achieved significant reductions in maternal deaths from pregnancy-related causes. For example, several countries have already achieved Millennium Development Goal (MDG) 5 (PDF)—reducing maternal mortality by three-quarters between 1990 and 2015—including the following countries in which USAID works:
- Romania (achieved an 84% reduction, from 170 to 27 maternal deaths per 100,000 live birth)
- Equitorial Guinea (81% reduction, from 1,200 to 240 maternal deaths per 100,000 live births)
- Nepal (78% reduction, from 770 to 170 maternal deaths per 100,000 live births)
- Vietnam (76% reduction, from 240 to 59 maternal deaths per 100,000 live births)
Several countries are also on track to achieving MDG 5, including Bangladesh (with a 5.9% average annual decline in maternal mortality) and Egypt (6% annual decline).
Nevertheless, even with the global decline of maternal mortality by 47% since 1990, the level is far short of the 2015 target and developing regions still have maternal mortality rates 15 times higher than developed regions.
During the 24 hours of Mother’s Day, some 720 women—one every two minutes—died in pregnancy or childbirth—and about 8,000 newborn babies died. The 24-hour period of labor and delivery and the first day of life for babies, in particular, is the most dangerous time period for mothers and babies. Most maternal and newborn deaths during this time period could be prevented, however, with critical, lifesaving interventions, including:
- Strengthening the capabilities and number of skilled birth attendants
- Promoting access to and use of low-cost products, such as applying chlorhexidine (a common antiseptic) to the umbilical cord stumps of newborns—which has the potential to prevent 500,000 global neonatal deaths each year
- Meeting unmet need for family planning could prevent more than 100,000 maternal deaths annually by giving couples the ability to decide when and how many children to have. Expanding access to family planning will help women bear children at the healthiest times so that mother and child are more likely to survive and stay healthy.
USAID programs work to ensure women have access to a wide range of voluntary family planning methods ranging from CycleBeads® (a natural family planning method) to oral contraceptives and other short term as well as long-acting methods, from which a woman can choose. Expanding access to long-acting reversible contraceptives and permanent methods (LARCs and PMs) is particularly important. An article published in the Global Health: Science and Practice Journal (co-published by USAID and the K4Health Project at the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs) explains that if 1 of 5 women in sub-Saharan Africa who were currently using pills or injectables switched to contraceptive implants, more than 1.8 million unintended pregnancies would be averted in 5 years, resulting in 10,000 fewer maternal deaths. Although use of implants worldwide remains low, they are increasingly popular and in high demand when they are actually available in family planning programs.
Not surprisingly, many programs are focusing on increasing access to family planning in countries with low contraceptive prevalence, such as in Africa where modern method use is at 23%. But family planning programs in countries with relatively high contraceptive prevalence also could have the potential for improvement. For example, women in Indonesia have, on average, 2.6 children, and modern method use is at 58%. However, contraceptive prevalence has been stagnant since the 1990s and the method mix is skewed toward short-acting methods, even though Indonesian couples are more likely to want to limit births. Nearly 8 in 10 modern method users rely on injectables and pills. Meanwhile, use of IUDs has dropped dramatically over the years, from 13% in the early 1990s to only 4% today, and use of implants and sterilization is at about 3% each.
The K4Health Project is implementing the Improving Contraceptive Method Mix (ICMM) Project to better understand the situation on the ground. Why has use of certain long-acting methods, such as IUDs, dropped over time? Do women know about LAPMs? Are they interested in using these methods?
This information will help inform the design of an integrated advocacy and knowledge management intervention—informed by Advance Family Planning-Indonesia’s advocacy methodology—in 6 districts in East Java and West Nusatenggara. ICMM will support the availability of a broader range of contraceptive methods for women and couples, with the ultimate goal of improving maternal health in Indonesia. The innovative project, funded jointly by USAID and AusAID and implemented by K4Health in collaboration with the Cipta Cara Padu Foundation, the Center for Health Research at the University of Indonesia (CHR-UI), the Indonesia Ministry of Health, and the National Population and Family Planning Board (BKKBN), is a unique partnership that leverages valuable resources and complementary skills and capabilities of various stakeholders.
With knowledge partnerships such as these and others designed to save mothers and babies through family planning, combined with improved services for pregnant women, perhaps Mother’s Day celebrated in the U.S. will one day become an international celebration event for women all around the world, if not in name, then at least in practice.
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