Maz & Kilgore

Published in the Huffington Post September 23, 2009

By Ann Pettifor and Maz Kessler, Advocacy International

President Clinton was on Larry King the other night, reminding us with typical directness that people die simply because they can’t get medicine. This is particularly true for poor women and their newborn babies.

Women - mothers - are still dying in pregnancy and childbirth, all over the world, for want of cheap, standard medicines that we take for granted.

But today a new article is published in The Lancet that could transform the attitudes of donors and decision makers and potentially save millions of women’s lives.

Dr. Christina Pagel and Professor Anthony Costello of UCL model three different interventions for reducing the number of mothers’ deaths. One of these interventions - delivering medicines to mums both in clinics and in the home - could potentially reduce mortality by as much as one third. One third! It’s important to understand how significant this number is in light of the last 20 years. Over these 2 decades the number of women dying in childbirth has scarcely budged, and in some regions has gotten worse.

A result coming anywhere close to such a reduction would be a stunning breakthrough.

Richard Horton, the editor of the Lancet rightly notes that Dr. Pagel and Professor Costello’s proposal/model “has the potential to transform our attitudes to maternal health. We might now contemplate donor-funded drug-delivery programmes akin to those for HIV-AIDS and TB - in addition to health-facility strengthening.”

Of course it’s clear that the safest births take place in well-stocked facilities with trained health workers to care for mothers and their newborns. There are antibiotics for infection. Medicine to stop post-partum hemorrhage, and equipment for emergency care - including the ability to perform C-sections. Providing this for all mothers must be our long-term goal.

But in the meantime, something must be done - urgently.

Because whether we like it or not, over the next 10 years 400 million of the world’s poorest women will deliver their babies at home, often on mud floors, in modest huts. 10 million of these women will die unnecessarily, many from infection and hemorrhage - both of which are easily treated with affordable, standard medicines. As a result of their deaths children will die, families will suffer and go hungry, and communities will be impoverished.

How can these deaths be prevented?

The answer is straightforward - as Clinton suggests - increased access to cheap standard medicines. To this we would emphatically add training for an army of women health workers able to care for mothers and newborns in their homes and villages. As a bonus, this training will lay the foundations for a strengthened health system.

When we first looked at this challenge two years ago, Professor Costello reminded us of our own history both in the UK and the US: that women stopped dying in childbirth in large numbers only when antibiotics came widely into use.

However when discussing women in poor countries we tend to forget this history. Instead we have convinced ourselves that in Africa and Asia the issues are too complicated to begin to address with straightforward Clinton-style approaches — or too complicated to invite the public to back a massive campaign (like AIDs campaigns for ARVs, or distributing bed nets for Malaria).

They’re not.

The public - particularly the immensely powerful constituency of women and mothers worldwide - would jump at the chance to be involved in such a campaign. But only if there is an effective, affordable solution to rally around, such as the bed net, antiretrovirals or vaccinations. Fortunately, thanks to Pagel and Costello we now have the findings to justify investing in such a solution and campaign.

It’s time to stop agonizing. It’s time to stop believing that this issue is too complicated to be solved.

It’s time to give mothers a break.

Viva Mama!

At last! Today I was lucky enough to see an advance version of a much anticipated study on maternal survival. Coming out of UC London (and currently in peer review), the study compares different strategies for treating mothers, using mathematical modeling.

This brilliant work goes straight to the heart of the discussion about “in the meantime” solutions for saving mother’s lives that has been reverberating through the maternal health community all year. We’ve been advocating for drug distribution and treatment at the community level by community health workers and women volunteers as an immediate solution… acknowledging that more than 50% of mothers in the developing world still deliver at home, and facility delivery for all these mothers just cannot realistically be achieved any time soon. (See our previous post “A complimentary approach to saving mother’s lives?”) It’s incredibly exciting to see statistical models that demonstrate how community delivery of medicines could increase maternal survival significantly - particularly in the poorest quintile! A pro-poor solution indeed.

The study compares the impact on maternal survival of 3 approaches - Health facility strengthening alone, Health facility strengthening PLUS antenatal care and community health workers, and both of the above PLUS women volunteers in villages able to provide access to drugs and treatment.

Here’s an excerpt from the study:

“Provision of life-saving drugs to prevent or treat hemorrhage and sepsis might be possible through antenatal clinics, community health workers, or even women community volunteers at the village level, in the same way that child survival has improved through community distribution of anti-malarials and antibiotics.”

Absolutely! And of course - the medicines under consideration are antibiotics and misoprostol… I’ll post a pdf of the study as soon as it’s available.

I’ve been working on Debtonation with Ann Pettifor for several months. For those who don’t know her work, Ann is one of the very few economists who accurately predicted the current global financial meltdown. As early as 2003 she warned of an Anglo-American debt-deflationary crisis - not exactly a popular position at the time, and she continues to call it right. So check out Debtonation for independent and forthright analysis of the incredible mess we’re in. Here’s an excerpt:

“It is hard to over-state the gravity and extent of the collapse of the global economy. I can barely find the words to fill a blog that I fear you, dear reader, may weary of.  It is even harder to find an economy escaping the carnage, or to avoid politicians dashing for the cover of bail-outs.  But one can still encounter economists confident and chipper in the face of such massive, global destruction – and the threat of sustained economic failure.”

While developing the campaign for mothers, we kept coming back to the question “Why is public awareness currently so low?”, and more specifically, “Why don’t women everywhere know about this issue?” There is clearly a vast and powerful global community ready to be mobilized on behalf of mothers – a worldwide constituency of women, mothers and grandmothers. Women in high-income countries have the potential to play a similar role to the part played by US AIDS activists who directly supported grassroots African advocacy and helped mobilize massive US funding for ARV treatment. There is general agreement that huge untapped reservoirs of public support exist for mothers – they just need to be mobilized. Yet for the last 20 years “Josephine Public” has been almost entirely missing from the maternal advocacy landscape. Why?

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“The standard recommendation to a woman who needs medical attention is, ‘Go to the hospital’ - but in rural parts of India there are so few doctors that this is like telling her, ‘Do nothing.’ We decided to follow Gandhi’s message to go to the villages. Instead of waiting for people to come to us, we found a way to take the care to the people.“  Abhay Bang, SEARCH

More than 50% of mothers in low-income countries still give birth in the home, far from health facilities, medicines and trained professionals .

Why? These women often live in remote and inaccessible rural areas. And even if health facilities and trained professionals are within reach, many women confront insurmountable cultural and religious obstacles in accessing that healthcare and inevitably give birth at home.  Plus, their governments face significant economic challenges, made worse by the exodus of trained medical staff to rich countries.
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For all those interested in what’s happening with mobile phones and development, advocacy and global poverty, two reports are very interesting. The first was written by Sally-Jean Shackleton of Women’s Net in South Africa and commissioned by UNICEF. It’s titled Rapid Assessment of Cell Phones for Development and aims to provide baseline data that will inform a strategy to launch a new generation of cell phone technologies to address underdevelopment and in particular HIV/AIDS as a development issue.

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In some of the world’s poorest countries, women still die in pregnancy and childbirth at what is essentially the same rate as the Middle Ages. Nature seems to have given odds of around 16 to 1 of successfully making it through pregnancy and childbirth without any medical help or modern advances in hygiene. Unbelievably, women in the poorest countries still face this same risk TODAY when entering each pregnancy. Read the rest of this entry »