Pulitzer Center projects – India Casts a Light on Mothers Long in the Dark

Reporter Hanna Ingber Win will travel with boat clinics along the Brahmaputra River to visit remote villages that do not have electricity, toilets or roads, let alone health services.

In Muslim island villages, families marry off their daughters as young as 12 years old, taking them out of school, isolating them from their support services and increasingly the likelihood of domestic violence and high fertility rates. Girls under the age of 15 are five times more likely to die in childbirth than those in their 20s. In tribal villages on the other end of the river, impoverished families have been displaced from their homes by land erosion time and again.

These geographically and socially isolated island families depend on boats to access services. If the water levels are too high or low, if night falls or if a boat needs repair, no pregnancy or postpartum emergency can overcome the dictates of the river. The mothers must wait. But not all have the luxury of time.

via Pulitzer Center projects – India Casts a Light on Mothers Long in the Dark.

About | CommonHealth.in

During the three years since its formation, CommonHealth has implemented a wide range of activities to further its objectives. While maintaining maternal and newborn health and safe abortion as its focus, the activities undertaken within these themes have varied in response to the situation at hand. For example, activities around maternal health were mainly around local advocacy and capacity-building, while activities around safe abortion have combined campaigning at the national level with local advocacy and capacity-building.

via About | CommonHealth.in.

Visible Embryo Home Page

The Visible Embryo is a visual guide through fetal development from fertilization through pregnancy to birth. As the most profound physiologic changes occur in the “first trimester” of pregnancy, these Carnegie stages are given prominence on the birth spiral.

The shape and location of embryonic interal structures and how they relate and are connected to each other is essential to understanding human development. Medical professionals create a mental picture of this process in order to determine how well the fetus is progressing. It is also the basis of knowing how and when errors in development occur and if a possibility exists for a corrective intervention.

It is equally important for expectant parents to understand the relationship of these internal structures and how their infant develops through pregnancy.

Creating the images for The Visible Embryo, included capturing data from slides and three dimensional structures on fetal anatomy in The National Institutes of Health, Carnegie Collection of embryos, as well as from 3D and 4D ultra sound images.

via Visible Embryo Home Page.

A very nice graphic resource.

The Fate of Our Mothers: A Maternal Health Crisis | RHRealityCheck.org

According to Women Deliver, a conference and initiative launched earlier this year to mark the 20th anniversary of the Safe Motherhood Initiative (PDF), maternal mortality is defined as “the death of a pregnant woman during her pregnancy or within 42 days of pregnancy termination.” And there has been very little decline in the rate of maternal mortality worldwide over the last fifteen years. Despite the Safe Motherhood Initiative’s global commitment, government promises and the inclusion of maternal mortality in the “Millennium Development Goals” (a set of agreed upon goals crafted by the United Nations member states and international organizations that include reducing poverty, reducing child/newborn mortality, and fighting AIDS around the world), we have not been able to save our mothers.

via The Fate of Our Mothers: A Maternal Health Crisis | RHRealityCheck.org.

I have just encountered the SAFE MOTHERHODD INITIATIVE document for the first time here and it makes for useful reading.

The Sentinel

The 108 services were launched in Assam with a fleet of 20 ambulances on November 6, 2008 following an agreement between the GVK EMRI and the Assam Government on July 8, 2008. At present, 280 GVK EMRI ambulances cover various districts of the State. The EMT pilots have demanded that their jobs be made permanent and salaries increased. They have also alleged that there have been financial anomalies in implementation of the EMRI scheme in the State.

Addressing a press conference today, AAEOEPA members said they would stop the EMRI 108 services, if GVK EMRI chief executive officer Venkat Changavalli did not give them a written assurance that their demands would be met in one week. The AAEOEPA also urged upon the State Government to intervene in the matter. The EMRI pilots said they were made to work for 12 to 24 hours a day despite the fact the they were supposed to have 25 working days of 8 hours each in a month. They also said some EMRI officers were using them for their “personal work”.

“We should have 25 working days of 8 hours each in a month, but we are made to work for 12 to 24 hours a day. Some EMRI officers also use us for their personal work. It is unfortunate that we don’t get extra remuneration for extra work. No accommodation is provided for us. Whenever we take up our problems with the EMRI authorities, they threaten to sack us”, said the EMRI pilots.

via The Sentinel.

Emergency Ambulance ‘EMRI’ hit Satyam Scam?

Those who have been crying foul against various state governments patronising the ‘108’ EMRI ambulance service have now lodged a fresh police complaint alleging theft of public money by the Rajus through EMRI. The ‘108’ ambulance service has curiously been patronised by 12 state governments across the country, with eight handpicking it without even floating tenders.

via Emergency Ambulance ‘EMRI’ hit Satyam Scam?.

Assam – aspects of health investment

Innovative initiatives in the health sector were appreciated. These include boat clinics in riverine areas, 108 ambulance services, private-public-partnerships with the tea gardens for providing health services in the gardens, mobile clinics in inaccessible areas, evening OPDs, and the 2 new schemes – Mamoni for pregnant women and Majoni for the first 2 girl children in a family.

via The Assam Tribune Online.

Tata Winger Variants –Standard, Deluxe & Luxury Passenger Vehicles

New Winger Ambulance from Tata Motors is a single stretcher ambulance that offers extra safety, a smooth drive, and a ‘within budget’ price. It gives you the freedom to redesign the interiors, for your own Hospital-on-Wheels. And it comes in two variants – Flat Roof and High Roof.

via Tata Winger Variants –Standard, Deluxe & Luxury Passenger Vehicles.

Preliminary Research

May-June 2010, Notes re Alexandra Gartrel

Background: I encountered the problem – then communicated to me as PPH and began working upon finding out more in Late December 2009. In February 2010 I travelled to India and interviewed/ had conversations with key stakeholders (stakeholder organisations). I came back and continued my literature survey. I am by this time reasonably knowledgeable about the area of maternal health and feel competent enough to construct projects/ interventions. I have many different answers to what can be done.

As the project is being constructed – it is emerging that the tenure of the project will be 2010-2015. The location is almost certainly a state in India. The scoping out of the project – will go on for a bit longer.

Expressions of Interest: Through the project process – I began going to difefrent people to speak to them about the project. An early expression of interest came from Nursing and Midwifery (RMIT). Then from Media and Communication (RMIT). I still have a long way to go with the process of seeking expressions of interest. Potentially NOSSAL Institute, Melbourne University, Vic Health and Midwiefry Australia. The principle of using Expressions of Interest as an engine relies on the fact that different people and agencies would love to channel their energies into this project – and thus helping me construct a multidimensional and rich project.

Stakeholder Mapping: The maternal health system in India has numerous stakeholders – often the stakeholder interests can be organised as an agency-approach combination which links with academic disciplines and perspectives. But first the task is to list key agencies and stakeholders in the system.

Report: I have begun a preliminary report of findings. The report exists as a 35 slide presentation and a one page abstract of recommendations. It is my aim to develop a concise and clear report – that will serve as a base defining the start of the project.

Literature Survey: I have been reading up on the area and have a collection of literature, the bibliography of this I post to the blog. My aim is to do a take on the key issues being dealt with literature in the field.

Making Sense of New Maternal Mortality Numbers: Four Take-Aways for Policy and Research Action | Nandini Ooomman | Global Health Policy

Personally, I’m tired of reading the same old rants about policy and planning and what governments and donors should do to reduce maternal deaths. Other than more and better evaluation to find out how and why packages of interventions work, why not try something new like the COD Aid idea from my colleagues at CGD? As I think through (with several colleagues in and outside of CGD) the possibility of applying this fresh thinking to maternal and neonatal mortality, the many challenges about addressing maternal mortality—weak health systems for service delivery and measurement—loom large.

via Making Sense of New Maternal Mortality Numbers: Four Take-Aways for Policy and Research Action | Nandini Ooomman | Global Health Policy.

Another nugget from the same post – this time highlighting the diversity of perspectives from essentially a centre to periphery, or top to bottom – which then raises the issue of local action being about something else entirely. The normal local practice – will be about managing individuals and communities – for health outcomes.

Making Sense of New Maternal Mortality Numbers: Four Take-Aways for Policy and Research Action | Nandini Ooomman | Global Health Policy

Maternal Mortality Data and Measures 101

We only have ESTIMATES—yes, that’s what they are—because we don’t have the actual maternal death data from vital registration systems in most countries. Because many developing countries lack the capacity to accurately gather, analyze, disseminate and report data on a regular basis, we can’t express maternal mortality accurately either as absolute numbers or as rates (i.e. the number of maternal deaths in a specific time interval /total number of women of reproductive age in a specific time interval). So, the next best option is estimating the number of maternal deaths from different data sources—vital registration, household surveys, census, health service records and specific studies on reproductive-age mortality (RAMOS). These estimated numbers of maternal deaths are also expressed as a ratio of 100,000 live births to calculate a different measure of mortality: Maternal Mortality Ratio (MMR). MMR is the MDG Goal 5 indicator, and measures the risk associated with each pregnancy (i.e. obstetric risk). While monitoring MMRs is particularly useful for policy making and decisions regarding the accessibility to and the quality of prenatal and obstetric care, it does not allow us to determine whether these deaths are due to direct or indirect causes (see below).

via Making Sense of New Maternal Mortality Numbers: Four Take-Aways for Policy and Research Action | Nandini Ooomman | Global Health Policy.

Making thereby a case for better data – and this sits in well with a vision for a technology project (possibly mobile phone based) that gathers data simultaneously – with giving care. This infact is a vision for a Episurveyor/Datadyne like technology (though now based upon smart phones) to be deployed in clusters.

Maternal Deaths Decline Sharply Across the Globe – NYTimes.com

For the first time in decades, researchers are reporting a significant drop worldwide in the number of women dying each year from pregnancy and childbirth, to about 342,900 in 2008 from 526,300 in 1980.

The findings, published in the medical journal The Lancet, challenge the prevailing view of maternal mortality as an intractable problem that has defied every effort to solve it.

via Maternal Deaths Decline Sharply Across the Globe – NYTimes.com.

Safe Motherhood

This is a snapshot of a Safe Motherhood Project with a focus upon India.

Context

  1. 20% of all Maternal deaths globally occur in India.
  2. Majority of deaths among the poor, rural and remote.
  3. The largest cause of death is Post Partum Hemorrhage.
  4. Of the 28 states, many states have low MMR and 18 have high MMR.

Ongoing work in MMR reduction in India

MMR – Maternal Mortality Rate

  1. Indian Government has a program called the Janani Suraksha Yojana (Safe Motherhood Program). The program is a component of the National Rural Health Mission (NRHM). The focus of the program is upon 18 states with high MMR.
  2. There are case studies of dramatic reduction in MMR – Gujarat has an example of social focus that has reduced MMR by 40%, and Tamil Nadu is an example of a well designed and operated system. These case studies serve as models for best practice.
  3. The NRHM is a well designed and funded program. 92 % of the funding is by the Government of India. 8 % is international funding. The Govt of India has limited international funding to 6 sources (US, Canada, UK, Japan, Sweden, EU).

Options for Intervention

  1. There are two modes of participation in the ongoing project of MMR reduction in India: the Inquiry led mode and the Direct mode.
    1. The inquiry led mode is a focus upon capacity development from an institutional base.
    2. The Direct mode is in the form of relief – that is providing supplies, equipment and infrastructure – from an aid focus.

Mother & Child Health Research

Mother & Child Health Research (MCHR) is a multidisciplinary public health research centre in the Division of Health Research in the Faculty of Health Sciences at La Trobe University. Established in 1991, MCHR has built a strong program of research addressing issues of major public health importance for mothers and children.

via Mother & Child Health Research.

Global Health Magazine | Guest Blog

Unsafe abortion is the only cause of maternal death that is almost entirely preventable, and it is not technically difficult to prevent. But the barriers to safe care are highly political. Making sure that all women have access to family planning – a sub-goal of MDG 5 – will dramatically reduce unplanned pregnancies that cause women to seek abortions. For this reason, all maternal health initiatives must make access to contraception a priority. However, we also must ensure access to safe abortion services. Even if contraception is available, it is not 100 percent effective. Moreover, women’s health and family circumstances can change dramatically during the course of a wanted pregnancy. To prevent tens of thousands of maternal deaths every year, abortion services must always be safe whenever they are needed.

via Global Health Magazine | Guest Blog.

The Doula Project – What is a Doula?

The word doula is an ancient Greek term that translates into “caregiver” or “woman of service” and has been used over the past several decades to describe a woman who provides various non-medical support measures such as emotional support, pain management and relaxation techniques, and information to pregnant people. Support can consist of anything from recommending books about pregnancy to helping make a birth plan to offering a hand to hold or giving a massage during labor or an abortion procedure. Having a doula can provide pregnant people with the tools to self-advocate in a medical setting and ensure that their experiences are honored and that they are safe. In addition, doulas are there to help validate the women’s experiences and choices surrounding their pregnancy outcomes, on their terms.

Doulas offer continuous encouragement and reassurance to their clients and have traditionally worked with pregnant people who plan to give birth. In recent years, however, some doulas and reproductive health and justice activists have expanded the term to include women across the entire spectrum of pregnancy, including birth, abortion, and fetal loss.

via The Doula Project – What is a Doula?.

Advances in Maternal Health: Fetal Heart Rate Monitor | AshokaTECH: Technology, Invention and Social Entrepreneurship

One story that sticks in my mind is hearing from a doctor in a primary care hospital in Yucatan. They do not have the equipment to conduct ulatrasounds on pregnant women, so they must send the women to a larger hospital.

Now, although a fetal heart rate monitor does not provide all of the capability of an ultrasound, considering that the fetal heart rate is an indictator of fetal stress, the metric can provide information for rural health workers, clinics and even hospitals lacking equipment, so that they can make informed decisions about when a woman needs to seek more advanced care.

Besides the rugged and simple to use nature of the Freeplay Fetal Heart Monitor, the device can be powered by winding the handle. Each minute of winding the device results in 10 minutes of monitoring time. When grid power is available, the batteries can be charged and will provide continuous power for several hours.

Freeplay and Powerfree Education & Technology have partnered to develop and test a wide range of medical technologies for use in low-resource settings, all of which are power-free.

via Advances in Maternal Health: Fetal Heart Rate Monitor | AshokaTECH: Technology, Invention and Social Entrepreneurship.

Amnesty International Calls on President Obama to Establish Office of Maternal Health to Lead Government Effort to Reduce Appalling U.S. Death Rate for Women Having Babies | Earth Times News

“This country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful,” said Larry Cox, executive director of Amnesty International USA. “Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies.”Cox said: “Mothers die not because the United States can’t provide good care, but because it lacks the political will to make sure good care is available to all women.”Amnesty International’s new 101-page, national report, Deadly Delivery: The Maternal Health Care Crisis in the USA, reveals the following disturbing findings:+ severe pregnancy-related complications that nearly cause death — known as “near misses” — are rising at an alarming rate, increasing by 25 percent since 1998; currently nearly 34,000 women annually experience a “near miss” during delivery;+ discrimination is costing lives. Opportunities to save women’s lives and reduce complications are being missed, in large part because women face barriers to care, especially women of color, those living in poverty, Native American and immigrant women and those who speak little or no English.

via Amnesty International Calls on President Obama to Establish Office of Maternal Health to Lead Government Effort to Reduce Appalling U.S. Death Rate for Women Having Babies | Earth Times News.

Studio Soumitri

I was away from work for three weeks. This seemed like an ideal time to start converting a large shed into a studio.Two actually – one side was a writing studio (mine), and the other was a design, craft and music studio (Sophie, Raya and Iain – in that order). We were fortunate to get a glass wall with a door – which defined the separation. The rest is for a conversation …

Now thanks are due:

1. A&R for recycled materials, the glass partitions.

2.Michael at Mahoneys timber for the timber and ply.

3. The Outlook Centre for the new 35$ oatmeal carpet.

4. IKEA for the accents, the lovely prints

5. Fab India for the rug

6. Makita for the awesome tools they make.

No I haven’t left out Bunnings. Thats just life support.

More soon …

UCSF Bixby Center for Global Reproductive Health

The UCSF Bixby Center for Global Reproductive Health was formed in 1999 to address the health, social, and economic consequences of sex and reproduction through research and training in contraception, family planning, and STIs. The Bixby Center strives to develop preventive solutions to the most pressing domestic and international reproductive health problems.

via UCSF Bixby Center for Global Reproductive Health.

Why are so many women still dying in childbirth? Chris Brazier explains how they could be saved. | March 2009 | New Internationalist

It is a while before Mama realizes that blood is still pumping out of Habibu, forming a widening crimson pool on the mat and the floor. She uses the rags to try to staunch the flow; to no avail. There is no sign of the placenta being delivered, as would normally happen within minutes of birth. Mama waits in hope for further precious minutes before realizing that the blood flow is not going to stop and that there is serious danger. Alarmed now, she summons her son, who sets out on his bicycle to try to contact the nurse at the government clinic 12 kilometres away.

By the time the nurse arrives, two hours have passed and it is too late for Habibu, whose life has drained away with her blood. There is nothing the nurse can do for the woman. Instead she tends to the newborn baby, while cursing under her breath the fees she has to charge for attending a birth at the clinic – fees that mean so many women opt to go it alone. She knows she could easily have saved her – an injection of oxytocin, perhaps, or a manual delivery of the placenta – but knows just as clearly that this desperate experience will be repeated on many other nights and days over the months and years to come.

via Why are so many women still dying in childbirth? Chris Brazier explains how they could be saved. | March 2009 | New Internationalist.

Maternal Mortality, Slavery, Fistula Fill Half the Sky by Elayne Clift

But what really packs a punch is that each chapter, from “Emancipating Twenty-First-Century Slaves” to “Maternal Mortality – One Woman a Minute,” shares the story of real women whose faces we see in photographs, whose tragedies we cannot ignore, whose courage and intelligence we must applaud, whose lives we must help change.

Half the Sky: Turning Oppression into Opportunity for Women Worldwide
by Nicholas D. Kristof and Sheryl WuDunn (Random House 2009; paperback June 2010).

via Maternal Mortality, Slavery, Fistula Fill Half the Sky by Elayne Clift.

Maternal Mortality in Kerala

The aim of the present study is to analyse the level of maternal mortality in Kerala and to explore in-depth the causes of maternal deaths. During the period of study, the value of Maternal Mortality Ratio number of maternal deaths per 100000 live births in Kerala fluctuated between 48.19 and 26.33. District wise analysis showed that the districts of Alappuzha, Ernakulam and Thrissur had values of MMR below the state average almost throughout the period of study and also the fluctuation of MMR was slight in these three districts. In Kollam, Kottayam, and Kannur MMR was below the state average most of the period with a slight fluctuation.  In Kozhikode, Malappuram and Kasaragod the values of MMR remained slightly above the state average most of the period of study, especially during the latter half. But in the hilly districts of Wayanad, Idukki and Palakkad MMR was high and widely fluctuating throughout the period.  Even though the fluctuation was high in Pathanamthitta, the values of MMR for the recent years dropped below the state average. In general, higher values of MMR and high fluctuations were seen in the hilly districts of Kerala. Maternal deaths reported in Thiruvananthapuram district during 2006-2007 were also analysed in-depth, using the report from the DMO office. According to the report, about 71 percent of the deceased women were from rural area. Major reasons for death were embolism, respiratory diseases, hemorrhage and cardiac diseases

via PRC.

Karen Grepin’s Global Health Blog: More on “Does Safe Motherhood Save Lives?”

The study I blogged on in China, claims that the SM approach reduced rates of maternal mortality by encouraging more women to delivery in hospitals – that is to have an institutional delivery, which is a more aggressive approach than has generally been adopted in most developing countries where the focus has been on the professionalization on rather than the institutionalization of deliveries (that is ensuring that they are supervised by trained medical personnel, regardless of where the births take place).  Encouraging more women to deliver in a hospital would only really improves outcomes if we felt those hospitals would be adequately equipped and prepared to deliver the life saving interventions (c-sections, blood supply, other surgical procedures) that we think are needed to reduce maternal mortality.  But what is the evidence on this?

via Karen Grepin’s Global Health Blog: More on “Does Safe Motherhood Save Lives?”.

Karen Grepin’s Global Health Blog: Does Safe Motherhood save lives?

A new study, published this month in Health Economics, attempts to shed some light on this question by evaluating the impact the rollout of a SM program in China during the early 2000s. The program was targeted to some of the counties with the highest levels of MMR as well as those with the greatest capacity to implement the program. Unlike other attempts to reduce MMR through the SM approach, the Chinese program appears to have really focused on getting women into hospitals to give birth. I don’t know much about the Chinese context, but my guess is that access to family planning was already very high – given what I know about Chinese fertility rates. This is a much more aggressive strategy than has been adopted in most developing countries, where the focus has been on “supervised deliveries” whether institutional or not. Therefore, we may not be able to generalize these results too broadly and we may wish to question the belief that ensuring that a birth is supervised is enough.

via Karen Grepin’s Global Health Blog: Does Safe Motherhood save lives?.