Why do so many women still die in pregnancy and childbirth? According to the World Health Organisation (WHO), unavailable, inaccessible, unaffordable or poor quality healthcare is fundamentally responsible for the majority of maternal deaths. 99% of all maternal deaths occur in developing countries. In the vast majority of cases, the complications suffered in pregnancy or childbirth are fatal simply because the woman did not have access to the healthcare she needed to survive.
The solution is thus overwhelmingly simple: better and more accessible healthcare. This includes sufficient resources, trained doctors, nurses and midwives, and a programme which covers the full spectrum of needs faced by women and their children during pregnancy, childbirth and the post-natal period.
Motherkind: Putting Mothers and Children at the Centre of Healthcare
Motherkind is a Muslim Hands project which aims to deliver such a standard of care in Somalia and Afghanistan, both of which have some of the worst maternal and infant mortality statistics in the world. Below is a comprehensive outline of the issues affecting maternal health in Somalia and Afghanistan and how our Motherkind clinics are helping to solve these problems.
Undernutrition in pregnant women, mothers and their children:
Undernutrition is a priority issue in both Somalia and Afghanistan, due to poverty and conflict. However, in Somalia, the issue is critical as drought and famine have led to food insecurity and a lack of safe water and sanitation. 1.7 million people face acute food insecurity in Somalia (IRC, July 2017).
The Motherkind clinics are helping to solve nutritional problems in three main ways:
- We carry out nutrition screenings for all the children who attend our clinic in Somalia. Severely malnourished patients are referred to other health centres for nutrition rehabilitation.
- In both countries, to prevent and treat micronutrient deficiency disorders, we provide micronutrient supplements such as Vitamin A, iron and foliates to pregnant and lactating women and children.
- Regular discussion sessions are held for local women to raise awareness about good dietary practices, including explaining what a balanced diet is, why it is important, and what local ingredients they can use to ensure they and their children are receiving the nutrients they need.
What are the effects of the above? Firstly, healthier pregnancies, leading to healthier infants; secondly, healthier lactating women, ensuring healthy early development in children; and thirdly, improving the health of children under five, thus reducing illnesses and preventable deaths. Furthermore, the awareness sessions have been highly effective, and the information is also shareable with others in the local and wider community, ensuring a lasting impact.
Preventable illnesses among children, often leading to death:
1 out of every 7 Somali children dies before seeing their fifth birthday. The leading causes are preventable illnesses such as measles: almost a quarter die from pneumonia and almost a fifth from neonatal disorders. Undernutrition is an underlying factor in over a third of the deaths.
Meanwhile, in Afghanistan, although conditions are improving, around 80,000 children under five still die each year, 12 per cent of whom are dying from diarrhoea.
Protecting young children from preventable illnesses is a priority in both countries. Regardless of their income background, children deserve both immunisation and medical treatment in these critical first years, and it is essential for us to educate mothers on how to protect their children.
The Motherkind clinics are helping to improve children's health in a variety of ways, including:
- We run a comprehensive vaccination programme, including tuberculosis, measles, polio, tetanus, PCV, rotavirus and pentavalent vaccines.
- We raise awareness about effective breastfeeding practices to ensure misconceptions don't endanger the infants' health. For example, in Somalia, many mothers believe that breastmilk isn't enough, and provide formula milk or sugar water to their children as well. The child is then too full to drink breastmilk, so isn't receiving the major health benefits of exclusive breastfeeding.
- We provide discussion sessions to educate mothers about the immunisation programme and its importance, so we can reach as many children as possible with lifesaving vaccines.
- We also run discussion sessions on how to prevent and manage diarrhoea. 26 children a day are dying of diarrhoea in Afghanistan, and it accounts for almost a fifth of under-5 deaths in Somalia. These awareness-raising sessions are essential to significantly reducing this number.
- We promote basic hygiene practices such as handwashing and waste disposal, as well as educating women about food, water and home hygiene.
- Of course, we also provide full medical care to women and children, including running tests, providing antibiotics, giving comprehensive advice and referring cases to other hospitals if needed. As mentioned before, simply having access to high quality healthcare reduces maternal and infant mortality rates significantly.
Lack of health infrastructure:
In both countries, decades of conflict have taken their toll on health infrastructure, with the poorest families suffering the most. In Kabul, for example, there are only two maternal hospitals. Lack of infrastructure means: not enough trained health professionals, insufficient resources and lack of medical facilities. It has also led to a serious lack of health information in Somalia and Afghanistan, and trust in the medical community has been eroded. The entire local community is vulnerable to this effect, not just mothers and children.
Although the Motherkind clinics put mothers and children at the centre of healthcare provision, they are community clinics, where patients from all backgrounds can access consultations and treatment or be referred to other clinics and hospitals. Our clinic in Kabul has been awarded the title of 'Best Clinic in the Area' by the Afghan Department of Public Health for the life-saving healthcare we've been delivering since 2011. The work we do doesn't just improve patients' health - it affects all aspects of their lives, from improving their focus at school to giving them the ability to establish a livelihood.
Culture norms vs. accessing medical care:
Lack of health infrastructure has fed into the problem of cultural norms preventing women from accessing healthcare. In Afghanistan, for example, women from traditional families often don't leave their homes for medical treatment, which makes home visits a fundamental part of ante-natal and post-natal care. Yet only 43% of all births in Afghanistan are attended by trained professionals. A health project such as Motherkind needs to take their unique situation into account.
Our community outreach programme is a fundamental part of the Motherkind clinic. The community health workers carry out regular home visits throughout the patient's pregnancy, provide support during childbirth and monitor the mother and infant's progress in the post-natal period. This not only prevents needless illnesses and death, it builds trust in the community. Our health workers establish their reputations as trustworthy experts, allowing Motherkind to build links with local families and deliver healthcare to as many people as possible.
A study conducted by the UN in 2018 into global maternity care made the following related recommendations to health clinics worldwide:
- Respectful maternity care, which maintains dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth
- Effective communication between maternity care providers and women in labour, using simple and culturally acceptable methods, is recommended.
With your support, our Motherkind clinics can continue to provide such a standard of care. The women in the local Somali and Afghan communities know they can trust us to maintain their privacy and dignity, and our outreach programme has been a massive help in establishing our reputation as trusted experts. We aim to continue to help women and their families make informed choices about their health and receive the care they need.
Looking to the future:
Undoubtedly, vast improvements have been made in maternal health over the last three decades. Between 1990 and 2015, maternal mortality worldwide dropped by about 44%, and the global humanitarian effort continues to make huge strides in maternal health. Clearly, the current approach of providing nutritional care, vaccinations, attended deliveries and community outreach is working.
However, Afghanistan and Somalia still have some of the highest maternal mortality rates in the world. Afghanistan has an MMR of 396 (deaths per 100,000 births), while Somalia has an MMR of 732.
The work Motherkind is doing has had a significant impact upon local communities, and we will continue to deliver high quality healthcare to mothers and children with the support of our donors. However, we also aim to go beyond what we've already established - with sufficient funding, we can do so much more!
Our goals for the future include:
- Establishing Motherkind clinics in other high-risk countries, to reduce the maternal and infant mortality rate in countries suffering from conflict and impoverishment
- Training more women within local Somali and Afghan communities to be community health workers, thus expanding the reach of the clinics we've already established
- Providing more mental health care to women and children in Somalia and Afghanistan, including educating communities and providing counselling and treatment
- Expanding our early child development programme (between 0-6 years old) to ensure more children receive quality healthcare in these vital years
The World Health Organisation aims to reduce the global maternal mortality ratio to less than 70 per 100,000 births by 2030. Motherkind is part of this global effort, but we can't do it without your support.
830 women a day are still dying from preventable causes related to pregnancy and childbirth. Our work is saving lives. Donate now to help us protect at-risk mothers and their children.