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Maternal Health in Crisis: Health Workers on the Frontline

2011 September 22
by Amy Boldosser-Boesch

Amy Boldosser is Senior Program Officer, Global Advocacy, at Family Care International.

On Sept. 20, 2011, while world leaders met across the street in the United Nations, leaders from the field of maternal health came together in New York City for the standing room-only event, Maternal Health in Crisis: Health Workers on the Frontline. Co-sponsored by Family Care International with Every Mother Counts, the International Confederation of Midwives, Jhpiego, The Lancet, Merck, and Save the Children, the event drew attention to the critical role of frontline health workers in achieving Millennium Development Goal (MDG) 5, to improve maternal health.

Across the developing world, many countries are experiencing a dramatic — and life-threatening — shortage of health workers. The World Health Organization estimates that 3.5 million additional health workers are needed globally, including 350,000 midwives and one million community health workers. Midwives and other health workers with midwifery skills are critical to getting women and newborns safely through pregnancy, delivery, and the postnatal period: an adequate midwifery workforce could prevent as many as 3.6 million maternal, fetal, and newborn deaths each year.

The panel, moderated by Dr. Richard Horton, Editor-in-Chief of The Lancet, brought together Ann Starrs, President, Family Care International;  Dr. Willibrord Shasha, AIDSTAR project, Jhpiego; Dr. Julie Gerberding, President, Merck Vaccines, Merck;  Mugara Joseph Mahungururo, Nurse-Midwife, Muhimbili National Hospital, Tanzania; Donald Steinberg, Deputy Administrator, USAID; and Christy Turlington Burns, Founder, Every Mother Counts to discuss the role of civil society, government and the private sector in promoting and supporting the health workforce.

Ann Starrs opened the event by noting that, despite increasing global visibility and focus on maternal health, and newly released data showing continued reductions in maternal and child mortality, MDG 5 is still far off track. “There are enormous disparities in access to health workers with midwifery skills, and the countries with the highest burden of maternal death have the lowest concentrations of these essential personnel,” Ms. Starrs said. She also noted that the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, launched a year ago, would be announcing a range of new commitments that afternoon at an event called Every Woman Every Child, including significant commitments to train more midwives in a number of countries. Ms. Starrs also announced that The Partnership for Maternal, Newborn and Child Health has produced two groundbreaking reports, one analyzing the commitments made to women’s and children’s health within the framework of the Global Strategy, and a second report, to be made available shortly, examining the aid architecture for reproductive, maternal, newborn and child health.

Dr. Shasha highlighted the importance of integrating maternal, newborn and child health care with HIV/AIDS, tuberculosis and malaria services. He noted that while it is possible in most African countries to get a haircut, have a cup of tea and buy a phone card in one place, it is difficult or impossible for women to get family planning services, immunization, and antenatal care in one health facility at one time. Health workers trained and equipped to provide integrated services could significantly improve access to maternal, newborn and child health services, and reduce the total cost of providing essential interventions.

Dr. Gerberding announced the launch of Merck for Mothers, a long-term effort to create a world where no woman has to die from complications of pregnancy and childbirth. The initiative will start with a 10-year, $500 million commitment to helping the United Nations tackle Millennium Development Goal 5 and improve maternal health worldwide as part of the United Nation’s Every Woman Every Child campaign.

Mugara Joseph Mahungururo, who became a nurse-midwife herself after a midwife saved her life when she had complications delivering her twins, shared her experience working in the main national hospital of Dar es Salaam, Tanzania. She described the maternity ward as having only three graduate-level trained nurses, even though they have already delivered more than 6,000 babies in 2011. Mugara called on stakeholders to support additional training for midwives, some of whom have not had the opportunity to upgrade their skills in over 10 years, and highlighted that, in addition to training, midwives need access to basic supplies, equipment, infrastructure, and fair pay for their work.  In order to provide lifesaving care, they also need and deserve a policy and social environment where they are supported, recognized, and valued.

Deputy Administrator Steinberg discussed the importance of women’s political, social, and economic empowerment for improving maternal health. He highlighted USAID’s support for new technologies (including through the Saving Lives at Birth Initiative) and expanding access to lifesaving maternal and child health services, including essential medicines and supplies, and to family planning.

Christy Turlington Burns explained that she experienced postpartum hemorrhage after the birth of her first child. If she had been in rural Africa or Latin America, without the care of a midwife and a skilled obstetric team, she would have died. That realization led her to begin advocating to raise awareness about maternal health, to make a film on the experiences of women in Tanzania, Bangladesh, Guatemala, and the US, and eventually to found an advocacy and outreach initiative called Every Mother Counts. Every Mother Counts launched its newest Public Service Announcement entitled Choices, which emphasizes the importance of health workers in improving maternal and child health.  Click here to watch the PSA.

The discussion highlighted the links between maternal health and non-communicable diseases (the focus of this week’s UN High Level Meeting), retention and training of health workers, strengthening aid architecture in order to better support expansion of the health workforce, and the importance of partnerships with a range of stakeholders – donors, UN agencies, governments, NGOs, health care professional associations, and academic and training institutions – all of whom have a role to play in addressing health workforce challenges. Dr. Horton closed the panel with a call echoing the outcome of 29th Triennial Congress of the International Confederation of Midwives in Durban, South Africa. He called for a world in which all health workers come out of the shadows, and where midwives are no longer invisible, so that all women will have access to lifesaving care for themselves and their children. FCI looks forward to working with all of the attendees of the event to make this a reality.

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