Caty Borum Chattoo

    This Mother’s Day, Take a Tour of the World’s Best and Worst Places to be a Mother

    Posted May 3rd, 2011 by Caty Borum Chattoo

    Each Mother’s Day, I celebrate the two most miraculous, deliriously happy days of my life – the days I gave birth to my two children.  What I counted on during my birth experiences:  health care, a safe and sanitary environment, and trained birth personnel.   What would have never occurred to me, a resident of the United States having a baby in a very typical way in a wealthy nation:  the day I become a mother is the most dangerous and deadly day I will face.

    But in many parts of the developing world, the day a woman becomes a mother is a day too often obscured by terrible tragedy and danger.  She will face losing her baby and losing her own life – on a day and occasion that we commemorate with cards and flowers as Mother’s Day here in the United States.

    According to international development organization, Save the Children, “around the world, more than 350,000 women die each year from complications of pregnancy and childbirth, and millions more develop some kind of disability. When a mother dies, her children are much more likely to be poor, to drop out of school, and to die before age five.”  The ripple effect is dramatic.

    To take a deeper look into the lives of the world’s mothers, I was fortunate to have the opportunity to work with independent non-profit broadcaster, Link TV, and Save the Children to co-produce a new half-hour documentary that takes viewers on a global tour of the best and worst places in the world to be a mother.

    Based on Save the Children’s just-released 2011 “State of the World’s Mothers” report, the special – ViewChange:  The Mothers Index takes viewers on an international journey to learn what it takes for global mothers and their children to thrive, introducing us to young moms and spotlighting programs that are changing the odds.  In a unique collaboration in “global development storytelling,” the show – part of Link TV’s ViewChange.org project that combines global development progress stories and direct action – includes stories from the ONE campaign’s Living Proof series.

    (Conspicuous plug:  You can view online at www.SavetheChildren.org/world-mothers or www.ViewChange.org beginning on May 3, or watch the broadcast on Link TV on Friday, May 6 or Tuesday, May 10. Check time and channel info.)

    So, what’s the data behind the stories?  For its 2011 report, Save the Children conducted a comprehensive study of 164 countries, and compiled a “Mothers’ Index.”  At the top of the index, women have access to excellent health services, skilled health workers, and opportunities for education and advancement.  But the gap between the top- and bottom-ranked countries is dramatic.  At the bottom of the list, one in three children suffers from malnutrition, and one in 30 women will die from pregnancy-related causes.    Afghanistan is located at the very bottom of the list, while Norway sits in the top spot.  (See the full report at www.SavetheChildren.org/world-mothers.)

    Is the U.S. at the top of the list?  Actually, according to the report, the U.S. is not among the top 10 list as a “best place to be a mother” due to maternal and under-five mortality rates, low levels of preschool enrollment (relative to other industrialized nations), a maternity leave policy that’s not as generous as other wealthy nations in terms of pay and duration, and comparative lack of political status of women, relative to other industrialized nations.  This year, the United States ranks 31st of 43 developed countries, dropping three spots from last year’s rankings.

    When you watch the documentary, you’ll be struck – as I was – when you hear the story of one young mother who had buried eight babies and prayed that the ninth would live to see his first birthday.   And you’ll hear from a 19-year-old mother in Nepal, nine months pregnant, as she matter-of-factly states, “My last baby was breech-born, and this time, I just might die.”

    But the terrible odds are not the whole story.  The other part of the story is the incredible strength and spirit of these mothers around the world – and the importance of institutional solutions and government programs that are changing the statistics in preventable scenarios.

    For example, we learn about the commitment from Sierra Leone’s government, which has just implemented a new program to provide free health care for pregnant women and children under five.

    In Malawi, grandparents and village elders are now being trained as community health workers – a tremendous program that’s contributing to Malawi’s breathtaking success in under-five child mortality over the past 20 years.  Since 1990, Malawi has cut its under-five mortality rate in half thanks to its government’s commitment to programs like this – a feat that seems even more remarkable considering that 40 percent of the Malawi population lives in poverty.

    In rural Bangladesh, empowering girls through education will change the cycle of poverty, creating a ripple effect that will impact future generations.  And in India, one mother observes that “if you are uneducated, it is as if you have only one eye.”  The simple act of giving bicycles to girls – to allow them to travel to school – is changing the lives of young women in some of the poorest parts of the country.

    What’s the hope and mission of a project like this?  To learn, of course, and to be inspired by the universal strength of mothers in all parts of the world – and to take action and support programs that are working.   For more information and actions you can take, visit www.ViewChange.org, click on the show, and consider the actions in the “take action” section of the video player.

    Happy Mother’s Day.

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    1 Comment

    May 14, 2011 at 1:16 pm by Jennifer Yourkavitch

    Did you know that Washington, DC has the highest maternal mortality rate in the U.S.? The National Women’s Law Center reports D.C.’s rate at 34.9 per 100,000 live births–nearly three times higher than the national rate. Since the federal government does not mandate the reporting of maternal deaths, and neither do most states, these rates probably underestimate the true number. Experts believe that most maternal deaths are preventable. This is both a national and a local crisis.
    According to Amnesty International’s 2010 report “Deadly Delivery: The Maternal Health Care Crisis in the USA,” there are five main medical causes of maternal death in the U.S: embolism, or blood clot; hemorrhage, or severe blood loss; pre-eclampsia and eclampsia, associated with high blood pressure; infection; and cardiomyopathy, a heart muscle disease. In most cases, deaths from these causes can be traced back to women’s lack of access to high-quality care during pregnancy, delivery, and the post-partum period, which is up to six weeks after delivery.
    There is widespread systemic discrimination in our healthcare system—gender, racial, economic, and language. Data show that black women are nearly four times more likely to die than white women. Prenatal care and hospitalization are expensive; costs are prohibitive for uninsured women. There is a lack of standardized protocols to guide healthcare providers during the maternal period—so the quality of care differs not only by state, but by facility. Even during labor women encounter bureaucratic barriers related to policies and paperwork that restrict access to care. There is a shortage of healthcare staff to provide continuous, high-quality care during the entire maternal period. There is a lack of family planning, health education, and access to information for women and their families. Finally, most states do not have a committee that reviews maternal deaths, so there is little chance of learning from errors and creating evidence-based prevention protocols.
    As shocking as the mortality estimates are, the rate of severe morbidity—usually due to hemorrhage or eclampsia–may be 50 times greater than the mortality rate. These “near misses” can require an extensive recovery period, which may take place at home with little support outside of a woman’s family and friends. There is a dearth of information on less severe morbidities like lacerations, postpartum depression, and breastfeeding challenges.
    Despite the seemingly overwhelming complexity of this problem, there are a few things we can do:
    Policy: On March 3 Rep. John Conyers (D-MI) introduced the Maternal Health Accountability Act of 2011, which provides grants to states for mandatory reporting of pregnancy-related deaths and establishing maternal mortality review committees, among other things. This bill still needs a Senate sponsor! Encourage your friends and family with voting representation in Congress to contact their representatives about this bill. Locally, lobby the mayor and council members to pay attention to the risk of maternal death and demand programs to address the specific causes in DC. You might begin with DC’s Department of Health, although since I called more than two weeks ago, I’m still waiting to hear why the maternal mortality rate is so high. If more people show concern, something will be done. Of course, we can continue to advocate for voting representation for DC at the federal level and for local control over local budgeting issues.
    Community: About 55% of maternal deaths occur in the postpartum period. While this time is very special for a family, it can also be risky for mothers. Inadequate postpartum care means that complications can be missed. You can support mothers in your community during this time. If your neighbor recently had a baby, deliver a meal to her; ask how she’s doing and how you can help her. Mow the lawn, rake leaves, or shovel snow. Simple acts of kindness are important.
    Personal: If you are pregnant, know that you have a right to information about your health and about how you will be cared for. Research provider and facility policies related to prenatal, labor and delivery, and postpartum care. Create a birth plan and talk to your provider about the kind of care you want to receive. Work with a birth advocate or doula, either private or facility-based. Seek help for issues that arise during the maternal period, including breastfeeding issues. Encourage your pregnant relatives, friends, and neighbors to do the same.
    Maternal mortality hit an all-time low in the U.S. in 1987. Since then it has doubled, and continues to rise. The increase may be due in part to improved reporting. Regardless, there are 40 countries with a better rate. The US spends more on healthcare than any other country. It’s time to do something about maternal mortality.

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