Pregnancy and childbirth should be occasions to celebrate life and hope. Yet for millions of women in the developing world, pregnancy and childbirth pose major risks of disability or death. Each year in Rwanda and Malawi, for example, one woman out of every 200 who deliver a baby will die in pregnancy or childbirth, as compared to one of 8,000 women in the United States.
Worldwide, the number of women dying as a result of pregnancy is declining, with maternal mortality decreasing by 47 percent from 1990 to 2010, according to the World Health Organization. However, Millennium Development Goal 5, which aims to reduce global maternal mortality by three-quarters by the year 2015, is still the furthest off track. Nearly all maternal deaths could be prevented with targeted interventions at the community, clinic, and hospital level.
PIH strives to address these lethal inequalities by expanding access to innovative women's health services in the countries where we work.
We provide access to basic health services proven to lower maternal death rates: family planning, comprehensive antenatal care, adequate nutrition, and medical care for childbirth and pregnancy. We also offer antiretroviral treatment for pregnant women living with HIV as a way to improve health and prevent mother-to-child transmission of the virus during childbirth.
Family planning is among the most effective tools for reducing maternal mortality. Women who receive education and contraceptive options are more likely to delay childbearing, have fewer children, and reduce their risk for obstetrical complications. Nevertheless, an estimated 41 percent of all pregnancies worldwide are unplanned or unwanted, accounting for nearly 230,000 new pregnancies every day, according to a 2010 article in the journal Studies in Family Planning.
Women in poor communities too often lack access to family planning tools. Clinics are too far away, fees for obtaining medical care are too high, and transportation costs are beyond their means. If family planning services were available to all women who want them, maternal mortality in poor countries could be reduced by an estimated 70 percent, according to the Guttmacher Institute.
Haiti, each of PIH’s clinics has a full-time nurse trained in sex education and reproductive health counseling. Staff in Haiti have been offering free condoms and contraception for more than 15 years. In 2003, we began training and mobilizing community health workers who specifically promote family planning and women’s health. These ajan fanm—women's health agents—travel throughout the countryside, teaching people about sexually transmitted infections, including HIV, and contraceptive methods. They also distribute condoms and oral contraceptives and refer pregnant women to clinics. This successful model is being replicated at PIH sites in Rwanda, Malawi, and Lesotho.
Skilled obstetric care for pregnancy and childbirth
Each year in developing countries, 42 percent of all births occur without help from a skilled attendant, and 35 percent of pregnant women have no contact at all with health personnel before delivery, according to the United Nations Population Fund. Yet potentially fatal complications occur in 15 percent of all births. Because of this, it is critical that women deliver in or very near facilities capable of providing basic emergency obstetrical and newborn care.
At PIH’s clinics in Haiti, high-quality obstetric care for pregnancy, childbirth, and emergency complications is available to all pregnant women. Each of PIH’s 12 facilities in Haiti is supported by six full-time obstetrician/gynecologists and 13 midwives who work across all sites.
PIH’s staff works with matrons and traditional birth attendants to ensure that pregnant women receive the safest and most efficient obstetric care possible. At the women’s health clinic at Rwinkwavu Hospital in rural Rwanda, specialized nurses are trained in prenatal counseling and delivery as well as family planning.
In June 2009, PIH/Lesotho began training specialized community health workers to educate and accompany pregnant women to health centers, ensuring they receive care from skilled health professionals. In 2010, 70 percent of reported deliveries in PIH/Lesotho’s Bobete Health Center catchment area occurred at the Health Center, a 350 percent increase in facility-based deliveries, according to published research.
Preventing mother-to-child transmission of HIV
Ninety percent of the 2.5 million children living with HIV became infected during childbirth, according to UNAIDS. So did the vast majority of more than 257,000 children who die of AIDS each year. Yet a simple and effective treatment for prevention of mother-to-child transmission of HIV (PMTCT) has been available since 1994.
In 1995, PIH began providing antiretroviral treatment for PMTCT to HIV-positive pregnant women in rural Haiti. Since the PMTCT program was introduced, the HIV infection rate of newborns born at PIH clinics has fallen to levels rivaling those in developed countries. This model for prevention has since been expanded to Rwanda, Malawi, and Lesotho.