It never ceases to amaze me how much the world says it wants to save children's lives and how rarely it tries to do the one thing that has been proven to protect more youngsters than anything else--keeping their mothers alive. (Maybe if it was called "orphan prevention?") That is why I was so pleased to hear that Tanzania's efforts to expand skilled medical care to all women during labor and delivery have started to pay off. Dying during childbirth--typically from bleeding, high blood pressure or infection--is one of the most common causes of mortality for women in the poorest regions of the world--despite the fact that death in these situations is largely preventable.
The president of Tanzania, Jakaya Kikwete, spoke on October 2 at the United Nations in New York about the encouraging results of a pilot program designed to safeguard the lives of pregnant women in the remotest parts of the country--far from any hospital or major medical center. He began, however, by reciting a few sobering statistics. Currently, about 454 pregnant women die for every 100,000 live births of children in Tanzania. That ratio translates to about 8,500 women dying during or shortly after childbirth each year in Tanzania (population 46 million). Or another way of looking at it, 23 women die during childbirth each and every day there. By contrast, the maternal death rate in the U.S. was 12.7 deaths per 100,000 live births in 2007, or 548 women across the country annually .
The main idea for improving the maternal death rate in Tanzania (or any other poor country) is simple to explain and supported by solid evidence--although the logistics for putting it into place can be daunting. However it takes some getting used to--and a bit of background information--for people who are used to living in the richest parts of the world.
First, the background information. Ideally, when a pregnant woman develops an infection, has a worrisome increase in blood pressure or starts bleeding excessively, you'd like to treat the cause--with antibiotics, antihypertensives or anti-clotting medication, as needed. But these medications or, more often, the people with the knowledge needed to administer them correctly during pregnancy are often not available in the poorest areas of the world. On the other hand, delivering the baby right away, via cesarean section, can frequently solve the immediate problem and save both the mom's and child's life or simplify their subsequent treatment.
Now, you might think that correctly giving medication is easier than performing surgery, but in fact, that is not always the case. It can actually be easier and safer to train nurses and clinical officers (individuals who are trained to give basic medical care in many poor countries but who are not medical doctors) to perform cesarean sections in many areas of the world where access to sophisticate medical care is simply unavailable.
And so that is what Tanzania did. With support from Bloomberg Philanthropy, the government's Ministry of Health expanded access to emergency obstetric care in a few health care districts by training non-physicians to perform cesarean sections and upgrading rural health centers so that the operations could be performed there.
The results were so promising that the country is expanding its efforts, this time with $8 million in support from Bloomberg Philanthropy and another group called the H & B Agerup Foundation. As announced at the October press conference, the rate of women dying during childbirth in one coastal Tanzanian health district where cesarean sections were more widely available fell by 32 percent in two years. That may not seem like a lot when the burden is so great, but it gives reason to hope that the trend can be turned around--even under very difficult circumstances. After all, as President Kikwete said, "It is not fair for a woman to die for giving birth, for giving life to another human being."
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© 2012 ScientificAmerican.com. All rights reserved.
© 2012 ScientificAmerican.com. All rights reserved.