A Rohingya woman and her child at a refugee camp in Bangladesh. Credit: Kamrul Hasan/IPS

By Sohara Mehroze Shachi
COX'S BAZAR, Bangladesh, Dec 8 2017 (IPS)

Under pouring rain, hundreds of young and expectant mothers stand in line. With her bare feet and the bottom of her dress covered in mud, Rashida is one of them, clutching her emaciated infant. She lost her husband on the treacherous trek from Myanmar to Bangladesh, and with nowhere to go and her resources exhausted, rain-drenched and standing in this long, muddy line for food and medicine for her child is her only hope.

Rohingya women line up for aid. Credit: Sohara Mehroze Shachi/IPS

Following the recent brutal campaign unleashed against the Rohingyas by the Myanmar military, over half a million refugees came to Bangladesh since August 2017, and more are arriving every day. The United Nations Population Fund (UNFPA) estimates that there are nearly 150,000 newly arrived women of reproductive age (15-49 years), and according to the Inter Sector Coordination Group’s September 2017 Situation Report on the crisis, there are over 50,000 pregnant and breastfeeding mothers among the new arrivals in Bangladesh who require targeted food and medical assistance.

“We collaborate with some groups and help refugees living in the camp areas where there is a shortage of medical supplies,” said Andrew Day, who has been advocating for refugees for the past two years in Bangladesh. “They don’t have the means to see a doctor.”

While small scale interventions are being taken by development organizations to supplement hospitals, such the placement of 35 midwives trained by UNFPA in two camps, hospitals are underfunded, overcrowded and struggling to provide care to the burgeoning pregnant refugee population and thousands of newborns.

Newborn children in the Rohingya refugee camps. Credit: Umer Aiman Khan/IPS

Early marriage and high birth rates are prevalent among the Rohingya community. According to a flash report on mixed movements in South Asia by the Office of the UN High Commissioner for Human Rights (OHCHR), a majority of the refugees were married young (at 16 or 17) and gave birth at an average age of 18.

In a Rapid Gender Analysis assessment conducted by Care in Balukhali Makeshift Camp at Cox’s Bazar, it was found that many female respondents between the ages of 13 and 20 years had children and others are currently pregnant.
The assessment uncovered that knowledge and practice of birth control was nonexistent or very limited among the Rohingya refugees, and religious sentiment was a strong factor contributing to the emphasis placed on pregnancy and the aversion to contraceptives.

“It (pregnancy) is God’s wish” said Jainul whose wife was expecting their sixth child. “God will help me feed the children,” he added. His wife echoed this belief.

According to locals, many Bangladeshis are donating money to the refugee camps as they believe helping fellow Muslims will earn them God’s blessings, and the resources are being used to set up Madrasahs – religious education schools. The imams of these madrasahs advise against contraception, so while the government and relief agencies such as the International Organization for Migration (IOM) are trying to provide birth control options and information on family planning, Rohingya women refuse to comply.

Girls taking religious education lessons at a Madrasah in the camps. Credit: Kamrul Hasan/IPS

Dr. Lailufar Yasmin, a lecturer in International Relations at the University of Dhaka, who is conducting research in the refugee camps, said at first when she went into the camps, she saw a lot of elderly and middle-aged females, but there were very few young women.

“But when I asked them about their age, I found out they were in their twenties,” she said. Repeated childbirth coupled with the trauma they experienced in Myanmar had taken such a toll on them that they all looked decades older than their true age, she explained.

“Many Rohingyas married their daughters off very young so that the military won’t come and rape them because their bodies become less attractive after childbirth,” she said.

“It is a community decision, not the girl’s decision, but the girls have internalized it that they need to have a lot of children because they need to save their race which is being persecuted,” Dr. Yasmin explained, adding that this philosophy contributed to the Rohingyas having very large families.

With thousands of Rohingya children soon to be born in Bangladesh, the need for ramped up medical care is acute. However, an IRC/RI assessment in October 2017 found that nearly 50 percent of all pregnant women have not received medical care and 41 percent of families with pregnant women do not know where to go for medical care for pregnant women. The report concludes, “These results point to a need for health messaging and services, as well as antenatal care and emergency obstetric care across the makeshift settlements.”

The series of reports from the border areas of Myanmar and Bangladesh is supported by UNESCO’s International Programme for the Development of Communication (IPDC)

Excerpt:

Women wait to immunize their children at the Kisugu Health Centre in Kampala, Uganda, where free vaccinations take place. The nurse in the foreground is Betty Makakeeto. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Jun 29 2016 (IPS)

Patience*, a Ugandan maid, planned on taking her three-year-old son for polio immunization during the country’s mass campaigns a year ago, until her landlord’s wife told her a shocking myth.

“The medicine they are injecting them with means the boy when he’s an adult won’t be able to reproduce,” Patience, 32, recalled to IPS what she’d been informed. “She said: ‘Don’t even think about immunization’.”

Patience said that in her neighborhood, the Kyebando slum in Kampala, many families “lied to medical personnel” because they were “terrified” about what this woman had told them.

Earlier this year, the country’s president signed the Immunization Act 2016, prescribing fines, a jail term of six months or both, for parents who don’t vaccinate their children in the age bracket of five days to one year old.“They said the vaccines are made out of pigs, wild animals, (that) our children will behave like wild animals.” -- MP Huda Oleru

The Act also requires the production of an immunization card before admission to day care centres, pre-primary or primary education. It also aims to provide for compulsory immunization of women of reproductive age and other target groups against immunisable diseases.

According to the legislation, passed by Parliament last year, diseases for which immunization is compulsory include tuberculosis, whooping cough, tetanus, hepatitis B, polio and measles.

One in five African children still do not receive all of the most basic vaccines they need, including ones for three critical diseases—measles, rubella and neonatal tetanus – a report issued by WHO at the first ministerial on Immunization in Africa, held in Addis Ababa, Ethiopia, in February.

Uganda was ranked lowest in east Africa for immunization coverage, with one example being the country’s 2014 diphtheria-tetanus-pertussis (DTP3) coverage which was at 78 percent compared to DRC (80 percent) Kenya (81 percent), Tanzania (97 percent) and Rwanda (99 percent).

According to outgoing female MP Huda Oleru, who tabled the private member’s bill in 2011, the biggest obstacle to vaccination in Uganda was the 666 cult made up of more 500 members but “growing” across the country, who refuse to immunize their children.

“They said the vaccines are made out of pigs, wild animals, (that) our children will behave like wild animals,” Oleru told IPS.

Oleru is continuing talks with the groups in eastern Uganda, and said she hoped “in the long-term” they would come around.

But for now the law was the “easiest way” of getting them to immunize their children.

“When I entered Parliament (ten years ago), I realised that we didn’t have an immunisation law, and a law is guidance or directive and it guides us in areas of impunity,” said Oleru.

At least ten members of a Christian group were detained over refusing to vaccinate their children against polio, the Daily Monitor reported last month.

Dr. Henry Luzze, the deputy program manager of the Uganda National Expanded Programme on Immunization, told IPS the government was currently vaccinating against ten diseases. It had submitted an application to GAVI ((the Vaccine Alliance) and received approval to introduce the rotavirus vaccine for diarrhea in children, a “big problem”. They were also looking at introducing a rubella vaccine by 2018 and a second measles vaccination to be given at 18 months.

Measles were still a huge threat, after outbreaks last year in western Uganda, he said.

“We still have some districts and communities that are still below what we want in terms of coverage in the eastern part of the country, areas where there are very high hills and no transport,” said Dr Luze.

Children were also not being vaccinated due to shortages in a number of facilities at a district level, but through recent support from GAVI, Uganda was able to procure solar powered fridges to keep the vaccines in areas prone to power cuts.

The influx of refugees from Burundi, DRC and South Sudan, where immunization rates are low, pose another challenge to Uganda. Late last month at least three cases of yellow fever were confirmed here, with scores of cases suspected.

According to the new Act, “the government shall provide free vaccines and other related services to every Ugandan required to receive vaccination”.

Dr Luzze said the law was good as it was balanced and compels the government to “make sure all the vaccination services are in place”.

“After that, then you commit the parents or the caretakers to make sure all their children are vaccinated,” said Dr Luzze, claiming the legislation “empowers CSOs to challenge the government”, who could be taken to court over shortages.

But there has already been some criticism from Ugandans that the law is too harsh, and during a recent mass polio campaign, held in March, there were reports that about 2,000 children below the age of five missed out on immunizations in Karamoja, northeastern Uganda, according to the country’s Daily Monitor newspaper.

The Act also creates the establishment of an Immunization Fund, house by the ministry of health, to “purchase vaccines and related supplies, cold chains, and funding of immunization outreach activities”.

Sources will be made of up monies appropriate by Parliament for the fund and donations.

“GAVI has been supporting this country so much and they’re still giving, but the challenge is GAVI has its criteria,” said Oleru. “Soon we might become a middle-income country, then we shall not be eligible (for support) under GAVI.”

Luzze said he believed the law would be easy to enforce because “the president, the ministers, the parliamentarians, religious leaders” all supported it.

President Yoweri Museveni was “aggressive” about promoting immunization because he believes it saves “families from spending too much money and time caring for sick members”, among other reasons, said his spokesperson Lindah Nabusayi.

Dr Moses Byaruhanga, the director of medical and health services for Uganda’s police, told IPS the authorities would go on radio talk shows to talk about the law, but would be strict on it.

“Police will be able to find out if (parents) did not take their kids for immunization,” he said, adding health workers, local leaders and schools would be the eyes and ears of the community.

International immunization experts such as Mike McQuestion, director of sustainable immunization financing at Sabin Vaccine Institute in the US, have praised the new legislation as a “textbook example of good governance”.

“The way the Ugandans created this law was itself impressive,” he told IPS. “Several public institutions had to work together to write it, vet it and push it through.”

In late March, about two weeks after it emerged the law had passed, Patience had her son immunized against polio, during a door-to-door mass campaign.

“It was very easy, they just put a drop in the mouth, then a mark on the finger,” she said, adding it took only three minutes.

Patience admitted she had been “partly” worried about going to jail under the new law, and that was the reason she’d chosen to vaccinate her son. But she said the nurse had told her “you shouldn’t not vaccinate him because you’ll be arrested, but because he can get sick”.

“I think now he is free from becoming sick,” said Patience.

*Patience’s name was changed for personal reasons.

Photo Credit: @islamicrelief

By Siddharth Chatterjee
Mandera County, Kenya, Oct 19 2015 (IPS)

For many women in Mandera County – a hard to reach, insecure and arid part of North Eastern Kenya – the story of life from childhood to adulthood is one about sheer pain and struggle for survival.

As little girls, they undergo female genital mutilation (FGM), a painful carving out of the external genitalia that leaves them with lifelong physical and psychological scars.

Most girls will be married off when barely into their teens, forcing them to drop out of school, their immature bodies thrust into the world of childbearing.

As a result, Mandera – just a two-hour flight from the dynamic, modern East African hub of Nairobi – has maternal mortality ratio of 3,795 deaths per 100,000 live births, a rate that surpasses that of wartime Sierra Leone (2000 deaths per 100,000 live births) and far above Kenya’s national average (448 deaths per 100,000 live births).

Mandera is an example of a marginalized community rife with internecine conflicts, pockets of extremism, poor human development and cross border terrorism, where residents are trapped in poverty, misery and desperation. Cultural norms like status of the women, FGM and child marriage makes it worse. Among the poor, inequities hurt women and girls most.

However, things are looking up. Kenya’s decision to devolve government, putting much more power in the hands of local authorities, is having an impact on the ground. Indicators such as number of health facilities offering basic maternal and child health, and the number of women giving birth in a health facility, are improving.

Just as critical to these improvements is the recently established private sector’s coalition to transform the health landscape of this county, long considered a lost frontier. The goal of this coalition is to develop new products and service delivery models, like community life centers (CLCs) to improve maternal and new-born health among most vulnerable populations in Kenya.

An inter-agency team consisting of the Office of the President of Kenya, Ministry of Health, Kenya Red Cross, UNOCHA, Save the Children, technology company Philips, Amref, Safaricom, GlaxoSmithKlein and UNFPA, visited Mandera on 13 October 2015 with the ambassadors of Turkey and Sweden to Kenya, to launch a Ministry of Health-UNFPA–Philips innovation partnership.

The UNFPA and Philips CLC project is expected to bring quality primary healthcare within reach of about 25,000 people through small improvements that enhance the functionality of health facilities like 24-hour lighting that will allow facility deliveries to take place and sick children attended after dark. If successful, this initiative could be scaled-up and transform maternal and child health in Mandera county.

Mandera has long remained out of bounds for most international UN staff and diplomats due to insecurity. Hopefully the visit by the Turkish and Swedish ambassadors , who are ardent advocates of the rights of women and children, will pave the way for more visits to all the country’s North Eastern counties which face similar challenges.

The ambassadors spoke of their countries’ commitment to work with the county to change the narrative, especially to advance the rights and wellbeing of all women and girls.

The broader partnership, which also includes Huawei, Kenya Health Care Federation and MSD, together with the United Nations’s H4+ partners, will focus on the six counties with a high burden of maternal mortality: Wajir, Marsaibit, Lamu, Isiolo, Migori and Mandera.

The main activities in these six counties will include strengthening supply chain management for health commodities, increasing availability and demand for youth-friendly health services, capacity building for health professionals, youth empowerment and research. These activities be complemented by the results-based financing supported through the Health Results Innovation Trust Fund managed by the World Bank.

It is also in line with the full-scale Kenyan government commitment to reduce maternal deaths and the new polices of free maternity care and user fee removal.

Kenya’s First Lady Margaret Kenyatta once remarked that “I am deeply saddened by the fact that women and children in our country die from causes that can be avoided. It doesn’t have to be this way. This is why I am launching the ‘Beyond Zero Campaign’ which will bring prenatal and postnatal medical treatment to women and children in our country.”

The dividend from healthier women will be a more educated and healthy society, with more economic opportunities and reduced exclusion which will engender peace and hopefully reduce the drivers of violent extremism.

It will be a major score for Mandera towards fulfilling the vision of UN Security Council Resolution 1325, which is about empowerment and participation of women, ending discrimination and the scourge of harmful traditional practices like FGM and child marriage.

(End)

Excerpt:

According to an African proverb, “every woman who gives birth has one foot on her grave.” It is time to make this proverb a historical fact and not a present reality. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Jun 27 2014 (IPS)

An African proverb says that every woman who gives birth has one foot on her grave.

Sadly, this is still true today, especially within the context of the AIDS epidemic.

In spite of the huge advances in the prevention of mother to child transmission of HIV (PMTCT) in Africa, experts are concerned that these have not matched other pillars needed to eliminate maternal mortality caused by HIV and AIDS.

Preventing unintended pregnancies among women living HIV, as well as providing contraceptives for women who need them are some of the missing pillars. Another is making motherhood safer for all women.

Pregnant women with HIV die at much higher rates than women without HIV, Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS.

The risk of pregnancy-related death is six to eight times higher for HIV positive women than their HIV negative counterparts.

Studies have shown that HIV increases maternal mortality directly from the progression of the HIV disease itself, and indirectly through higher rates of sepsis, anaemia and other pregnancy-related conditions.

This is bad news at a big scale. In South Africa alone, up to 310,000 HIV positive women gave birth in 2012, and 110,000 in Mozambique, says the Joint United Nations Programme on HIV/AIDS (UNAIDS).

While all HIV positive women, whether on antiretroviral therapy (ART) or not, are more vulnerable to sepsis and anaemia because of their compromised immune system, Kieffer says that ART does boost the immune system that protects women from infections.

Another problem is that women become infected with HIV during pregnancy at higher rates compared to women who are not pregnant, alerts Kieffer.

Experts attribute this to biological changes in the woman’s reproductive tract, including the increased blood volume and hormonal changes.

In southern African countries, “as many as five percent of pregnant women who tested HIV negative during their second trimester of pregnancy become infected with HIV later in pregnancy or during breastfeeding,” Kieffer told IPS.

Rethinking PMTCT

While ART for prevention of mother to child transmission of HIV is key to reducing maternal mortality, “fighting HIV is about more than pushing ARVs into health systems,” says Kieffer.

In South Africa, where nearly two out of 10 persons aged 15-49 are HIV positive, in spite of universal PMTCT coverage, HIV still accounted for six out of 10 maternal deaths in 2012, according to UNAIDS.

In Lesotho, with an HIV infection rate of 23 percent, four out of 10 maternal deaths are attributed to HIV related complications. In Malawi it is three maternal deaths out of ten, with an HIV infection rate of 11 percent.

Naseem Awl, an HIV specialist with UNICEF in Lesotho, told IPS that “much work remains to be done besides the provision of medicines, and one is ensuring women deliver in a health facility.”

UNICEF statistics show that in Eastern and Southern Africa only four out of 10 pregnant women deliver their babies with the assistance of a skilled health professional.

In Lesotho, while nine out of 10 pregnant women attend at least one antenatal visit, more than half do not deliver in the care of a skilled birth attendant. Mozambique has a similar pattern – and up to 110,000 HIV positive women gave birth here in 2012.

Kieffer believes there is a need to rethink PMTCT, “not just as a way to keep the infant from acquiring HIV but as an essential part of maternal and child health care for all women.”

Sheurges an improvement of health services delivery and health staff attitudes.

“A good number of health workers believe that HIV positive women have no right to get pregnant,” she says. The consequence is that many women show up late for antenatal care or deliver at home.

Protecting young women

Addressing unwanted pregnancies among young women aged 15-24 years is yet another pillar, because they are two to four times more likely to be infected with HIV than men of the same age.

The highest incidence for HIV lies in the 19-24 age group, “when people are sexually active and may not have a single partner. It is also when most women become pregnant for the first time,” says Kieffer.

The two major causes of death for young women are complications of childbirth and HIV, according to the United Nations Population Fund. Because their bodies are not fully mature, they experience more problems with a pregnancy and are at higher risk of HIV infection.

“Young women lack experience with the health system, they may discover their pregnancy late and be afraid to go to the clinic,” Kieffer explains. “They are less emotionally mature and less likely to have a partner that they can rely on for emotional support, either for the pregnancy or the HIV.”

She adds that health workers may not treat young women with care or lack the time to give the extra attention, information and support they need.

Meanwhile, staggering needs for contraceptives present other challenges. In Lesotho, the unmet need for family planning is 23 percent. In Mozambique, 29 percent, says UNAIDS.

Even where contraceptives are available, “ART clinics are overcrowded and overwhelmed, and have resisted putting emphasis on family planning because they did not have the capacity,” says Kieffer.

Dr Chewe Luo, senior adviser on HIV at UNICEF, told IPS that the new ART involving only one pill per day for pregnant women living with HIV will “have a serious impact on AIDS-related maternal and child deaths.”

In addition, the integration of maternal and child health services will result in more women and children reached sooner, and more mothers’ lives saved, she told IPS.

By strengthening all the pillars needed to improve maternal health, the African proverb about mothers having a foot on their graves will become history instead of a grim reality.

Excerpt:

Delegates to this week’s annual meeting of the World Health Assembly (WHA) in Geneva should agree on an ambitious agenda to sharply cut the rate of newborn deaths and stillbirths over the next two decades, according to maternal and infant health experts.

Reducing the rates of newborn deaths and stillbirths has lagged significantly behind the remarkable progress achieved in cutting mortality among children between the ages of one month and five years, according to a new study in the “Every Newborn” Series published by the British medical publication, ‘The Lancet”.

Thanks in major part to the U.N.’s Millennium Development Goals (MDGs), reductions in mortality for children 1-59 months and maternal mortality have averaged 3.4 percent and 2.6 percent annually, respectively, in recent years. By contrast, the neo-natal mortality and stillbirth rates fell by only two percent and around one percent per year, respectively.

Breast milk is vital for a premature newborn weighing barely 500 grams.
Credit: Manipadma Jena/IPS

That lag has been caused above all by “disappointing levels of investment in newborn health,” according to the study, which drew on the work of more than 55 experts from 29 institutions in 18 countries.

“So far, investment targeted to newborn health has been miniscule,” noted Joy Lawn of the London School of Hygiene & Tropical Medicine, who led the research on which the study is based along with Zulfiqar Bhutta from the Hospital for Sick Children in Canada and the Aga Khan University in Pakistan.

“Nearly half (44 percent) of all deaths in children under five are in the first month of life, yet only four percent of donor funding to child health even mentions the word newborn,” Lawn told IPS.

Indeed, every year, some 2.9 million infants die within 28 days of their birth, and another 2.6 million die in the last three months of pregnancy or during childbirth, according to U.N. estimates. Nearly half of these deaths occur during labour.

Many of those stillbirths have remained invisible, however, on the global health agenda, because nearly all of them go unreported to health authorities, and data collection on both stillbirths and neo-natal deaths is in any case inadequate. This is particularly true in the most-affected countries which include India, Pakistan, Afghanistan and Bangladesh, as well as Nigeria and a number of other sub-Saharan countries, according to the study. More than 75 percent of newborn deaths occur in South Asia and sub-Saharan Africa.

This week’s meeting of the WHA, the governing body of the World Health Organisation (WHO), will take up the “Every Newborn Action Plan” (ENAP) aimed at encouraging donors and beneficiary countries to accelerate action aimed at addressing the problem.

“The plan is based on a series of measures that are already proving effective in keeping women and children healthy – from preconception and pregnancy through to childhood and adolescence,” according to Dr. Elizabeth Mason, irector of WHO’s Department for Maternal, Newborn, Child and Adolescent Health. “Our goal is to end preventable newborn deaths within a generation.”

Specifically, the plan envisages reducing national neo-natal mortality to fewer than ten deaths per 1,000 live births and stillbirth rates to fewer than ten per 1,000 by 2035, resulting in global averages of seven and eight, respectively, according to the report.

If successful, that would cut current rates of neo-natal mortality and stillbirths by more than half and by as much as 85 percent in the worst-affected nations.

The study identifies proven interventions, including the promotion of breastfeeding; neo-natal resuscitation; so-called kangaroo mother care, which involves holding pre-term infants close to the mother’s skin for warmth and regulating their heartbeat; and providing corticosteroids that prevent infection resulting from cutting the umbilical cord.

The implementation of these interventions by themselves “could get newborn deaths down substantially in the first couple of years,” Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, the world’s largest private source of funding for global health initiatives, told the ‘Wall Street Journal’ in an interview published Monday.

She is scheduled to address the WHA in support of ENAP Tuesday. Along with the U.N. Children’s Fund (UNICEF), WHO, and various bilateral agencies, the Gates Foundation is expected to be a major source of funding for the plan.

Lawn stressed the importance of having trained personnel available during and immediately after birth. “A critical issue is the need for more midwives and nurses with skills to look after women in labour and small and sick newborns,” she told IPS in an email. Each year, one million babies die on the day of their birth, according to the report.

Indeed, the most common barriers to improving survival rates were related to the dearth of trained health workers, according to studies of eight of the worst-affected countries – Afghanistan, Bangladesh, Democratic Republic of Congo, India, Kenya, Nigeria, Pakistan, and Uganda.

The study found that those countries that have achieved the most rapid reductions in maternal and newborn mortality – such as Malawi, Nepal, and Peru – have done so in major part by expanding their health workforce, improving care for small and sick newborns, and implementing new programmes designed to reach the poorest families.

Along with trained personnel, the availability of healthcare facilities is also critical.

“The increasing number of women who are giving birth at healthcare facilities presents the most immediate opportunity for action,” according to Bhutta.

“Our analysis shows that by increasing facility births and closing the quality gap at healthcare facilities by 2020, we could prevent an estimated 113,000 maternal deaths, 531,000 stillbirths, and 1,325 million newborn deaths each year. This should clearly be an immediate priority,” she added.

Lily Kak, the senior advisor for Global Partnerships and Newborn Health at the U.S. Agency for International Development (USAID), praised ENAP, calling its introduction a “historic moment and opportunity” and noting that it is “the first plan to unite the global community around progress toward newborn health outcomes.”

“Although we have seen incredible success in bringing down under-5 deaths, neo-natal mortality rates have declined at a slower pace,” she told IPS in an email. “This is in part because newborn health was not a global priority, investments were minimal, and simple and cost-effective ways of tackling the leading causes of newborn mortality—prematurity, asphyxia and sepsis— are better understood now.”

Lindiwe Dlamini nurses her six-week-old baby boy. Credit: Mantoe Phakathi/IPS

By Mantoe Phakathi
MBABANE, Jan 7 2014 (IPS)

Smiling as she breastfeeds her six-week-old baby boy, Lindiwe Dlamini, 38, is optimistic about his future.

Dlamini, who is HIV-positive, is determined that her baby will not be infected. The mother of three – who conceived her first two children when she was HIV-negative – was on antiretroviral therapy (ART) when she delivered a healthy boy in November.

Now she is feeding him on breast milk and nothing else for six months – advice she received during antenatal care. She knows mother’s milk is more nutritious and carries antibodies.

“Breastfeeding is the most affordable method for me because I’m unemployed, but I wasn’t so sure considering my status,” Dlamini told IPS.

Half of all new episodes of HIV transmission to children occur during breastfeeding if mothers are not on ART, says the Joint United Nations Programme on AIDS (UNAIDS).

Alarmingly, although Swaziland recorded a 38-percent decline in new HIV infections among children between 2009-2012, seven out of 10 mothers here do not receive antiretroviral medicines during breastfeeding to prevent infecting their babies, says the 2013 UNAIDS Progress Report.

Swaziland has one of the highest HIV infection rates in the world, at 26 percent of people aged 15 to 49.

A domestic worker who had to quit her job after falling pregnant, Dlamini relies on the income from her partner, a construction worker. Buying formula milk would strain the family budget. A 900-gramme tin costs 130 emangaleni (about 13 dollars) and lasts a month.

Dlamini breastfed her first two babies without any problem, but faced a dilemma with the third, or so she thought: “The worst thing that could happen to me is to infect my baby with HIV.”

Help came through a mentor mother, Jabu Mkhaliphi, who works for the NGO Mothers to Mothers. An HIV-positive mother who breastfed her three-year-old daughter, Mkhaliphi allays the fears of pregnant women.

“No mother wants to infect their baby,” Mkhaliphi told IPS. She takes them through her experience and, as a result, most of her clients, like Dlamini, embrace exclusive breastfeeding despite their initial fear.

Yet many women living with HIV are sceptical about breastfeeding in this impoverished southern African country. Only 17 percent of children aged four to five months are exclusively breastfed, says the most recent Demographic Health Survey.

And, with a median duration of mixed breastfeeding of 17 months, there are many chances for HIV infection.

Percy Chipepera, director of the Swaziland Infant Nutrition Action Network (SINAN), links this trend to the discovery, back in the 1990s, that breast milk carries the virus, when HIV positive mothers were discouraged from breastfeeding.

“During this period, a lot of children died of diarrhoea and malnutrition,” said Chipepera.

Some deaths could be attributed to poor hygiene when preparing the feeding bottles, leading to gastrointestinal infections, while many parents could not afford formula milk, which led to malnourishment, he explained.

A glimmer of hope was restored when ART was introduced around 2005. ART lowers the mother’s viral load significantly, making breastfeeding, if done properly and exclusively, quite safe.

Being at body temperature, breast milk will not damage the baby’s delicate mucosa lining up its digestive system. However, hot food can cause microscopic lesions through which the virus could enter.

The good news: if the mother’s viral load is low or undetectable thanks to ART, the chances of transmission are greatly reduced.

The art and science of breastfeeding

Exclusive breastfeeding – giving the baby nothing but breast milk – for six months is recommended by the United Nations Children’s Fund (UNICEF), by SINAN and by the Ministry of Health.

However, exclusive breastfeeding is not that simple for many mothers. Grandmothers and aunties may believe that babies are not satisfied by breast milk alone and must be given supplementary food or ritual herbal teas.

Dr. Florence Naluyinda-Kitabire, an HIV/AIDS specialist with UNICEF, attributes these practices to poor understanding of breastfeeding.

Among the things that mothers should learn, said Naluyinda-Kitabire, is that babies should not be removed from one breast until they have dried it out.

“There is a lot of art and science around breastfeeding,” she said. “We need to educate not only the mothers but their families.”

One common mistake is that mothers remove the infant from the one breast soon after they have finished the liquid milk, leaving the hind milk. Yet the hind milk fills up the baby because it has fat.

“While HIV/AIDS is responsible for the decline in breastfeeding, other issues need to be addressed,” said Naluyinda-Kitabire.

One is the misconception, not only in Swaziland, that exclusive breastfeeding is for HIV-positive mothers. Naluyinda-Kitabire stressed that all babies, irrespective of the mother’s HIV status, should be breastfed because it is good for their health.

On average, exclusive breastfeeding by Swazi mothers lasts only three months, reports the 2010 Swaziland Multi-Indicator Cluster Survey.

Part of the reason is that mothers must return to work after 12 weeks. The International Labour Organisation, through the Maternity Protection Convention, which Swaziland has not yet ratified, calls for a minimum maternity leave of 14 weeks and for workplace support for nursing mothers.

Another deterrent is the aggressive commercial marketing of formula as a good substitute for breast milk. The government is considering a Public Health Bill to limit false claims in formula marketing, and to force manufacturers to explain, on the tin, in the local language, SiSwati, that breast is best.

For the past five years, babies have been born in health centres managed by humanitarian organisations in North Kivu, DRC. Credit: Kristin Palitza/IPS

By Taylor Toeka Kakala
GOMA, DR Congo, Jun 2 2013 (IPS)

“Many hospitals and health centres” that are not run by NGOs “do not meet health standards,” according to Dominique Baabo, provincial medical inspector for North Kivu province in eastern Democratic Republic of Congo.

The health sector in the DRC faces serious medical challenges including having to deal with obsolete biomedical equipment, the lack of cold rooms for vaccine storage, and a shortage of qualified personnel, Baabo told IPS. He added that a lack of maternity wards in the country posed an obstacle to health care here.

But a lack of maternity facilities is not what the people of Matanda, a region in North Kivu province, have to worry about any longer. Theophile Kaboy, the Catholic bishop of Goma, opened a maternity ward in Matanda’s local health centre on May 15. The local diocesan medical office manages the health centre.

“I am not used to giving birth in a maternity ward since one had to travel between two and three days before giving birth in Kirotse (30 km away) or to Masisi (25 km away),” Jeannette Uwera, the first woman to give birth at the new maternity ward in Matanda’s local health centre, told IPS.

Mado Uwiteka, another Matanda resident, told IPS that in the past she had to be “carried to the maternity hospital in Kirotse on a stretcher by foot to deliver two of my children.”

“My three other children were delivered at home,” Uwiteka said. Two of her three children that were delivered at home died before their first birthday.

“But it was easy to get to the maternity hospital in Matanda because it’s close by,” she added.

However, in North Kivu, where a long-running conflict has raged, civil society representatives point out that humanitarian agencies have replaced the state – which has practically abdicated responsibility in every sector.

For the past five years, babies have been born in health centres managed by humanitarian organisations. Along every road, you can see new or rehabilitated structures fitted out by humanitarian agencies, “in line with the provincial health inspectorate’s programme,” Baabo noted.

The State of the World’s Mothers 2013 report released on May 7 by international NGO Save the Children ranked the DRC last out of 176 countries on its Mother’s Index. It assesses the well being of mothers according to a number of factors, including maternal health figures and under-five mortality.

The report states that one in 30 women in the DRC is at risk of dying from pregnancy-related complications. In Finland, ranked first on the index, only one out of 12,200 women is at risk.

Speaking to health sector representatives on May 10 in DRC’s capital, Kinshasa, Congolese Health Minister Felix Kabange reacted to the report with an admission that this central African nation will not be able to meet its United Nations Millennium Development Goals to reduce infant mortality by two thirds between 1990 and 2015, or to reduce maternal mortality by three quarters over the same period.

The eight MDGs, adopted by all U.N. member states in 2000, aim to curb poverty, disease and gender inequality.

Although maternal mortality has fallen from 1,800 deaths per live birth to 549 since 1990, “if we continue to deal with the situation in the same way, the country will not even meet these goals in 2065,” the minister said.

Kalume Mushaba, an obstetrics lecturer at the University of Goma, believes that the DRC’s problem is one of leadership. He said that health allocations in this country have never exceeded five percent of the national budget.

The DRC is a signatory to the 2001 Abuja Declaration, in which African countries pledged to allocate 15 percent of their national budgets to health.

Together with Afghanistan, Haiti and the Darfur region in western Sudan, the DRC is amongst the world’s most volatile regions, and receives the most development aid. “Despite this, we are ranked last on the human development index,” Mushaba told IPS.

According to a 2009 study by the U.N. Development Programme (UNDP), health care remains unaffordable for eight out of 10 women. North Kivu has one doctor per 23,328 inhabitants and one nurse for every 1,100 inhabitants. The World Health Organization recommends one doctor per 10,000 inhabitants.

These figures show an overall poor quality of healthcare in North Kivu, the UNDP study said.

In order to improve maternal and infant health, Mushaba appealed to authorities to address the “three delays” that prevent women from seeking or obtaining care. These are the reluctance to use maternity hospitals for financial or cultural reasons; lack of transport to, or knowledge of, existing services; and inadequate equipment or shortages of qualified personnel.

A month ago, the government signed over 12 million dollars to the U.N. Children’s Fund to purchase radiology and ultrasound equipment, generators, operating tables and solar-powered refrigerators, for the 70 general referral hospitals in the DRC. This marks a new start, said Kabange.

Included in the equipment, which was received on May 10, were 200 gynaecological tables, 5,000 hospital beds, 7,200 examination beds, and pharmaceutical products, the health minister said. “We want to save the lives of more mothers and children, and to protect newborns,” he added.

Paediatricians in Argentina are working to protect the environment in order to provide better child healthcare. Credit: Malena Bystrowicz/IPS

By Marcela Valente
BUENOS AIRES, Jan 4 2013 (IPS)

A group of Argentine paediatricians has been combining work on environmental protection and child health for more than 10 years. It appears a basic principle to apply, but the task is turning out to be increasingly challenging and complex.

“We can’t clean up a river, or give a family a new house, but we can teach people to put chlorine in the water,” Dr. Stella Maris Gil, the coordinator of the Environmental Paediatric Unit (UPA) at the Pedro de Elizalde Children’s Hospital in the Constitución neighbourhood of Buenos Aires, told IPS.

The UPA provides health care with a strong environmental component, educates the public using the hospital, trains doctors and carries out research, explained Gil and other paediatricians belonging to the unit.

“The idea arose in the 2001 crisis,” Gil said, referring to the economic and social collapse at the end of that year, when poverty and unemployment reached unprecedented levels in Argentina and also had an impact on health.

“We were seeing a lot of illness connected to poor living conditions: respiratory diseases, gastroenteritis, skin infections … So we decided to give courses on the impact of environmental pollution on health, and we devised a project aimed at protecting the environment in order to provide better health care for children,” she said.

The project, which gave rise to the UPA, had a healthcare component “with strong environmental awareness,” Gil said, “and also a component for educating the public, another for training our colleagues and ourselves, and one for researching environmental topics.”

The hospital authorities accepted the proposal, and in 2005 it was adopted by the government of the Autonomous City of Buenos Aires. The first UPA was created, and the model was later reproduced in other hospitals in different parts of the country.

At first, colleagues looked askance at members of the unit, but as information about climate change spread, they began to treat the unit members with growing respect and consult them for advice.

This type of unit exists in other countries, like the United States, Canada, Mexico and Spain. The World Health Organisation (WHO) recommends formation of the units to focus the attention of health professionals on the stage of life that is most vulnerable to the effects of pollution.

The paediatricians are motivated by the concept that children “are not just small adults.” Their organs are in the process of developing, and their physiological and metabolic systems are immature. This is even truer of foetuses in the womb, where damage can be irreversible or fatal, the experts warn.

As well as seeing patients and acting as consultants when doctors suspect disease or symptoms of exposure to pollution, the UPA paediatricians spend a lot of time working with families on preventive health care.

“Doctors are trained to work with illness, but the main thing is prevention,” said another of the doctors on the team, Graciela Masu. “In recent years there has been a change in attitudes; previously, medicine was regarded as identical to health,” she said.

The UPA holds workshops to train colleagues; gives talks to family members in the waiting room while they wait for their children to be seen; and promotes projects like replacing mercury thermometers or limiting prescriptions of examinations that involve exposing patients to radiation.

Mercury thermometers are extremely polluting if they break. The campaign led to their replacement, first in the hospital, and then in other clinics and hospitals. The city government no longer purchases them, Masu said. However, achieving change is not always a simple matter.

“In our role as doctors, we can advise mothers about the best living conditions for their children’s development, about the importance of hygiene, of not smoking, of clean water tanks, about consumption and waste disposal,” Masu said.

“We don’t concern ourselves with eradicating waste dumps because that is not something we are responsible for. What we try to do is to improve the interior environment,” she said.

Another important campaign they carried out was aimed at limiting the use of ionising radiation, which is used in X-rays, radioscopy and tomography. “Children are more vulnerable to this radiation, which can leave them more prone to developing leukaemia or thyroid cancer,” Gil said.

She said medicine cannot do without these diagnostic tools, but it is necessary to raise awareness about “the rational and justified use” of these tests in the fields of neonatology or paediatrics.

They are also campaigning about the effects of ultraviolet radiation, a key issue in a country that is affected by the thinning of the ozone layer, which allows harmful radiation from the sun to reach the earth’s surface, causing skin damage if proper protective measures are not taken, particularly in young children.

But the pollutant that causes most concern is tobacco smoke, which pollutes air inside homes and causes respiratory illnesses in children. “Cigarettes are the greatest scourge because they result in premature births, low birth weight and infant mortality,” said Gil.

Then there is the issue of managing waste, which in shantytowns piles up in the open and pollutes air, soil and groundwater; and pesticide use. “We see a lot of parasitic diseases, infections, and vector-borne illnesses like dengue or hantavirus,” one of the doctors says.

More serious diseases make up a smaller proportion. “It’s not always possible to relate a serious disease to pollution, although it often is possible to find traces of lead, benzene and other chemicals in blood, urine or hair. But in order to find them, we have to look for them,” she said.

Gil said that threshold levels of particular pollutants used to be tolerated, but nowadays the view in paediatrics is that any exposure may have short, medium or long term effects. At present the hospital has seven cases of gastroschisis, a congenital defect of the abdominal wall, which is being seen more frequently than a few years ago, she said, and may be related to maternal exposure to pollutants during pregnancy.

Gil said the UPA relies heavily on the work of the toxicology department, which advises on requesting complementary tests based on particular symptoms or suspicions.

Yet another problem linked to the environment and living conditions is alcohol and drug abuse among pregnant teenagers, which exposes both mother and child to risks in their future development.

By Ashfaq Yusufzai
PESHAWAR, Dec 28 2012 (IPS)

As the 2015 deadline for achieving the Millennium Development Goals (MDGs) approaches, Pakistan must reckon with its patchy progress on maternal and child health.

About 20,000 women die due to pregnancy-related complications in Pakistan every year, while 3.2 million children under five years of age die of diarrhoea and pneumonia every year, according to the United Nations Children’s Fund (UNICEF).

Six hundred Pakistani children per 100,000 live births die before reaching their fifth birthday. Diarrhoea and pneumonia account for 76 of those deaths per 100.000 live births, or 11 percent and 13 percent of childhood deaths in Pakistan, respectively.

What’s more, the polio virus continues to plague Pakistan — particularly the northern provinces, which face the added burden of the Taliban’s militancy.