Category Archives: Maternal Health

Childbirth in Africa – a Life or Death Situation

By Kimberly Ryng, Institutional Relations Intern
By Kimberly Ryng, Institutional Relations Intern

Childbirth is often referred to as bringing new life into the world. As a woman in the United States, I’ve always subscribed to the bright halo of possibility that surrounds the arrival of a new baby.

However, since beginning my internship at AmeriCares, I’ve faced the dismal reality of maternal and child health in the developing world. Elikem Tomety Archer, AmeriCares director of Middle East and Africa partnerships, shattered my comfort zone with a simple remark: [inlinetweet prefix=”” tweeter=”@AmeriCares” suffix=”~Elikem Archer”]“Childbirth in Africa is a life or death situation.”[/inlinetweet] The truth is, women and children are dying every day.

Elikem explained to me that in rural areas of Africa there are woman who “have no concept” that they need to see a doctor when going into labor. I was shocked to learn that in Liberia, 75 percent of women give birth outside of the health system, exponentially increasing the risk of complications. For example, obstetric fistula, a hole in the birth canal, is a common complication for immature or malnourished mothers who experience prolonged labor without proper medical attention.

Before my internship I had never heard the word fistula, nonetheless considered that a hole in the birthing canal could be a consequence of giving birth without a trained assistant. Lack of education, proper nutrition and medical care plague not only maternal health, but child health as well. Elikem recently returned from Ghana where she was visiting AmeriCares One Child One World™ program. One Child One World aims to upgrade the nutritional status of 30 orphan homes in Ghana.

When AmeriCares began the program in 2011, 27 percent of the children in the homes suffered from malnutrition and 50 percent of deaths under the age of five could be contributed to malnutrition. One Child One World offers nutritional training to the caregivers of the homes, in addition to medicines and nutritional supplements, to improve the health of the children under their care. Since AmeriCares began the program, more than 200 caregivers have received nutritional training.

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Doctors, health facilities, and even transportation are basic functions of health care in the United States, yet are often considered luxuries in other parts of the world. Women and children in developing countries are dying because of preventable issues such as malnutrition and obstructed labor. I only hope that with more attention to maternal and child health, and the continued good work of organizations like AmeriCares, that progress will be made and pregnancy will no longer be a matter of life or death.

International Day to End Fistula

Surgery repairs fistula and restores dignity and hope. Photo: David Synder

Today is International Day to End Fistula.  I’m glad that the international community is coming together to bring global focus on an issue that affects about 2 million women in developing countries, with 100,000 new cases each year.  The sad truth is, fistula is completely preventable with the right access to maternal care, trained birth attendants and availability of emergency obstetric care – in most cases a simple C-section.

When I think about fistula, I think about a young woman who received care in the AmeriCares fistula repair project at Bugando Medical Centre in Tanzania, with gift-in-kind support from Ethicon, part of the Johnson & Johnson family of companies.

Mercy* was 18 years old when she arrived at the hospital with a fistula she had acquired after 2 days of labor without medical intervention. Mercy lost her baby, but developed a fistula – a hole in her birth canal — which left her incontinent.  As a domestic worker earning less than $2 a month, Mercy could not afford curative surgery. But after learning about our project at Bugando Medical Centre which offers free care and a transportation fund to help impoverished patients like her, she was able to have her fistula reversed and her dignity restored.

This video, produced for Johnson & Johnson, was filmed in Ethiopia and Tanzania in March of 2013.

Mercy’s story is a common one in sub-Saharan Africa: a young girl living in poverty with no access to family planning gets pregnant and endures long hours of labor without the presence of a trained birth attendant.  Because most of these young girls have bodies not completely ready for birth, their babies have difficulties getting through the birth canal and often die – leaving the mother not only childess, but ostracized and stigmatized.  Many girls and young women just like Mercy suffer with this condition for years — even a lifetime — because of the lack of local awareness that fistulas can be reversed.

Today and every day, AmeriCares is working to change that.

In Tanzania, public service announcements on local radio get the word out that fistulas ARE reversible, and that care is available free of charge at Bugando.  We are also taking the message to the rural areas with outreach campaigns that not only inform the community about the cost-free curative surgery, but bring qualified doctors to conduct those surgeries to the local district hospital.

So one Mercy at a time, we’re providing hope and restoring dignity to fistula patients in Tanzania — something to celebrate on this International Day to End Fistula.

Learn more about our work in Tanzania here.

*Name changed

On being a mother…

My career in global health parallels my journey into motherhood.  I was heavily pregnant when I started working at AmeriCares and my first son was born six days after my first day on the job. I took my first trip to the field, visiting our partner in rural Malawi, my son was only seven months old.

Because of this parallel, I often see my work in the field through the eyes of a mother. On that first trip to Malawi, I saw a little boy about 18 months old who was severely malnourished. As a result, he was about the same size as my seven-month-old son. I understood the anguish of the mother who had walked several miles to the hospital with her son in her arms seeking care – for as a mother, I’d do the same.

Last year, on a trip to Liberia, the land of my birth, my heart was pierced when I heard wailing coming from the maternity ward – a wailing that only meant one thing: a mother had lost her baby. Having gone through the prospect of losing my son a day after he was born, I walked away haunted by that piercing cry and the thought that this mother could have been me.

For you see, the difference between me having two healthy sons and that woman crying in the maternity ward most likely lies in the fact that my son had access to emergency neonatal care. In the United States, four neonates die per 1,000 live births, while in Liberia, about 11,000 babies are dying within the first month of life. Think for a moment about how many mothers cannot celebrate Mother’s Day in Liberia without a hole in their heart because of this staggering number.

The need to address neonatal mortality in Liberia and across sub-Saharan Africa has become a matter of urgency. World Bank President Jim Kim recently said, “For most poor people, a good job is the key to escaping poverty. To get those jobs, they’ll need good skills, a quality education, and years of good health as they’re growing up and when they’re adults.” Kim is right, because children all over the world are born with the same potential.

I’ll never forget little Kofi* — a boy I met two years ago at a children’s home in Tamale, Ghana. He was about four years old then. Kofi was introduced to the iPhone by a visitor to One Child One World™  — a program which aims to reduce the incidence of malnutrition in 30 homes around the country. Within minutes, Kofi was flipping through the phone, looking at pictures and was as engaged as any child of his age here in the United States with a smartphone. In that moment, the potential that lay in Kofi was clear to me and everyone present. The question that remained unanswered as we left that home was whether he will in his lifetime have the opportunity to realize it. 

Kofi’s chance to get out of poverty depends on, among other things, years of good health. A journey that begins at birth and with a mother having the access to the health services needed to take him home healthy after delivery. That this isn’t the reality for most mothers in developing countries should give us pause on this Mother’s Day.

*name changed

Why We Wear White When Babies Are Born

I remember my aunties coming home after having a baby – they always wore white beautifully designed slit and kaba – the traditional outfits in Ghana.  Then seven days after the baby is born, there’s a naming ceremony where the baby is ‘outdoored’ or formally introduced to the world and given a name.  Before that the baby is referred to as ‘it’.  Everyone is in white at this ceremony and there’s a lot of celebration – drinking, eating and dancing.  One day, I asked my grandmother why we wear white after a baby is born and why we wait seven days before giving a baby a name.  Her response was that the white symbolizes victory – victory over death.  As the laboring mother had faced death and prevailed.  And we wait seven days to give a baby a name because we wanted to make sure the baby had decided to stay among the living before we gave it a name.

As a girl, I never understood the full impact of my grandmother’s words.  It wasn’t until several years later working in global health that I came to understand the perils of childbearing in Africa – and why it is indeed true that every time a mother in Africa comes home with a new baby, she has indeed faced death and triumphed.  The WHO has named maternal deaths in Africa as “Africa’s silent epidemic” and Africa has the highest rates of maternal deaths and infant mortality globally.  The sad truth is, for every woman in Africa who dies giving birth, there are 30 more who live with debilitating diseases like fistula due to complications during the birthing process.

There are a number of factors driving this:  lack of adequately equipped health facilities, lack of trained medical birth attendants, lack of medicines like oxytocin. There are also simple solutions that have proven successful such as working with traditional birth attendants to identify risk factors, quickly referring mothers to trained birth attendants, using community health workers to follow up on pregnant mothers in rural communities, and using cost-effective and sustainable techniques like Kangaroo care to provide needed warmth to low birth weight babies.

Africa’s story often starts and ends with the challenges, but today on International Women’s Day, I want to wear a white slit and kaba and celebrate with all the brave women I meet on the continent every day:  The HIV positive mother in rural Malawi who walks over an hour to get to the hospital each week to make sure her baby is receiving the ARVs needed to ensure that the disease is not passed on, the grandmother taking care of the double-orphaned child and tending the small garden so she has enough food to feed the child, the midwife who delivers five children a day with gloves she has to reuse because she doesn’t have a choice, and the pediatrician in Kumasi, Ghana working around the clock to save neonates.  I salute all these women because it is their commitment and dedication that ensure that countless women in Africa who face death every day in childbirth can leave the hospital wearing white.  So today, I wear my white slit and kaba too.



Giving Birth to Life

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While “Royal Baby” fever swept through the world,  countless other babies were born in less comfortable – and often dangerous — environments.

Dying to give birth

In Afghanistan, an impoverished country ravaged by years of war and violence, nearly 85 percent of women give birth with no access to medical services. As a result, 1 in 6 Afghan women dies in childbirth. Babies do not fare much better — infant mortality rates in the country are the third highest in the world.

This alarming statistic has not gone unnoticed by AmeriCares.  Our work to help mothers and babies has helped save lives.

Simple items reduce the danger

Because it is quite difficult for many impoverished women in Afghanistan to get to a hospital to deliver their babies, AmeriCares has partnered with American Medical Overseas Relief to donate clean birth kits to Afshar Hospital in Kabul.

The birth kits provide necessary resources to ensure a safe and healthy delivery at home. They include hand sanitizer, bulb syringe for mucus extraction, two sets of gloves, and under pad, a cord clamp, and a scalpel. The hospital’s Community Outreach and Patient Education (COPE) program reaches out to the most impoverished and isolated communities near to Kabul. Along with providing the birth kits, the organization connects home health workers with expectant moms to educate and raise awareness the significant health concerns and opportunities to ensure a safe birthing experience.

Outreach, delivery, and post-natal care

During the outreach process, COPE’s health workers encourage each expectant mother to attend the clinic for prenatal check-ups. For the first visit, the expectant mom and the hospital health worker exchange contact information.  The mother-to-be contacts the health work when labor begins, and the health worker travels to the woman’s home with a clean birth kit to assist with delivery. Both mother and child return to the clinic within the first week of delivery for a postnatal check-up and further services if necessary.

Through this process, AmeriCares expects to reduce neonatal mortality by 15 percent and maternal mortality by 5 percent.

In England, Prince George came into this world in a renowned hospital with the help of skilled medical professionals.  Here in the United States, we don’t give a second thought to the fact that we are able to give birth in sanitary, fully equipped hospitals with the help of doctors, nurses or midwives. In Afghanistan and many other countries, women face less than ideal circumstances, delivering their babies on dirt floors with no light and no medical help if something were to go wrong.

Working with partners in Afghanistan to deliver these kits and connect mothers with medical resources, AmeriCares has brought a better opportunity for birth, safety and life to women and the children they love.