Posts tagged ‘interventions’

November, 2013

‘A Life Worth Saving?’ By Amie Wilson, Midwife and Doctoral Researcher

In 2013 do we live in an age of equality? Do men and women have equal human rights? Equal pay? Equal social standing? This is a topic that is still heavily debated. On the radio this morning I heard how toy stores are going to have gender labels removed from the toy departments, no longer will we see ‘Girls Toys’ or ‘Boys Toys’. Although this is important in some schools of thought, I fear that we as a globally society sometime forget the problems faced by others in less developed countries.

In many countries across the world women are faced with a very different dilemma, this is summed up eloquently in this quote from Prof. Mahmoud Fathalla: “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.”

Professor Fathalla is talking about the silent tragedy of maternal mortality. I say silent because every year 287,000 women die due to pregnancy or birth related complications. That is 1 woman every 90 seconds. Around 800 women are dying every day, 800 mothers, sisters and wives. But these deaths do not make headlines, we do not hear about them on the radio, in fact many deaths do not even appear on death registers, they simply occur, silently.


What’s more, these deaths are not due to diseases that we cannot cure, they are not due to conditions that require complex medicines and treatment, instead almost all of these deaths could be prevented. Most of these women could be saved with low cost and simple interventions.

With this in mind I ask the same questions again. In 2013 do we live in an age of equality? Do men and women have equal human rights? Equal social standing? Would society permit 287,000 men to die needlessly each year?

We have looked to the global society to help tackle the issue of preventable maternal death, and although the tide is changing there is still a long way to go before we reach Millennium development goal 5 and reduce maternal death by 3/4th but whose responsibility is it to tackle the injustice of maternal mortality? The government’s? The World Health Organisations? Mine? Yours?

One woman who sees this as her responsibility is Dr Sophia Webster, an obstetrician and a pilot from Newcastle, who is flying a small aircraft across Africa stopping at the countries with the highest maternal death rates, to raise awareness of the tragedy of preventable maternal death. She has visited some of the most “dangerous” places in Africa on her journey, receiving enormous amounts of press attention in her campaign.  aiming to give a voice to the many voiceless pregnant women in sub-Saharan Africa.

But our actions do not have to match this. No matter how small we believe our voice is, we still have a voice. We can all make a stand. We can all lobby. We can all campaign. We can all support women who are unable to speak up about the injustice that they face. But first we must answer one question…..can we as a global society make the decision that so many women’s lives are worth saving?

Further links:

Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Hogan et al.:

Maternal mortality: who, when, where, and why. Ronsmans & Graham:

Too far to walk: Maternal mortality in context. Thaddeus & Maine:

The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity – Bulletin of the WHO

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November, 2013

‘Don’t throw the baby out with the bath water’ – the importance of training in a low resource setting, by Miss Sadia Malick, Consultant Obstetrician and Gynaecologist & ammalife trustee

Training in the management of Obstetric emergencies is essential to prevent unnecessary disability and death in women. It is very important that all training is tailored and targeted for the group of healthcare workers being trained. All skilled birth attendants in the UK received skills updates every year.

In Pakistan, this is often not the case. There are three main groups of maternity healthcare providers. Firstly the trained doctors who are not working in hospital settings and do not take part in mandatory Clinical professional development programmes. These doctors remain on front line duties facing Obstetric emergencies all the time but unfortunately do not initiate or are part of programmes where they have to keep their knowledge up to date. Some NGO’s are involved with this cadre to improve and update skills with an aim to reduce maternal mortality and morbidity.

The second group are the trained nurses or midwives who provide midwifery care to women. These health care professionals usually work in district general hospital or smaller hospitals where they do not have the support of trained doctors’ majority of time. They have their experience and knowledge of working in obstetrics for many years but unfortunately have no formal training programmes to either update their skills or to learn new skills which would help them improve their care for the women they deliver. Some NGO’s are also involved with improving skills of this cadre.

The third group is that of the traditional birth attendants. This group is largely controversial and due to their lack of regulated training is blamed by the above mentioned group for the majority of the complicated cases that arrive too late in the hospitals, and present in a moribund state. The reality is that the services offered by TBAs are the most commonly used healthcare provider used by women, particularly in rural areas. This is due to many reasons, such as social (many women are not permitted to attend hospital to give birth for fear of exposure), financial (expensive, unaffordable healthcare, financial bribes by staff, or costly transportation to hospital) and a lack of any other service available (an absence of healthcare staff at the facility, as there is a global shortage of nurses, midwives and doctors).

Published research (Wilson et al, 2011, BMJ) suggests that engaging more with this group, by training and supporting them to detect and refer women experiencing signs of obstetric complications can improve outcomes for women and their babies.

Until societies decide that saving women is an absolute priority (economically and socially) and increase the numbers of skilled birth attendants to allow every pregnant woman to have a skilled birth attendant, like here in the UK. We should look to TBAs to fill the gaps. Evidence has shown that they can be effective, we should not ignore this. If there are interventions that work then we should use them. We cannot not ignore evidence; we should support TBAs until we have the optimal intervention to reduce maternal death – a skilled birth attendant such as a midwife or a doctor.

Useful links:

WHO maternal death

MME org

Pakistan maternal mortality

Maternal info world bank

Perinatal deaths

Obstetric care Pakistan

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