+ Health and Societies 010 Recitation 207 Wednesday, April 21, 2011 MENA Maternal Health The Midwife Solution

+ Adama Turay’s Story When: Dec. 3, 2008 Where: Sierra Leone What: Adama went to give birth with a traditional birth attendant even thought she had been told to go to the hospital for a C-section. At 5 am the next morning, she had a baby girl and then immediately began to vomit and had the chills. She began to bleed and her family brought her to the hospital but it took several hours to pay for money for a taxi. At 8 a.m. after a 40-minute taxi ride, Adama died in the hospital parking lot.

+ “About half of the 10 million women who give birth every year in the Middle East and North Africa (MENA) experience some kind of complication”

+ Sudan: urban versus rural discrepancies Above: the blah blah hospital in XX Right: examples of rural medical services in XX

+ Deliveries taking place in health facilities Clear discrepancy between rural and urban deliveries taking place in health facilities Strong association between maternal deaths and the absence of good medical care Low rates of prenatal care in MENA due to lack of public awareness of importance of medical care during pregnancy

+ Maternal mortality ratio versus Income per person Lowest maternal mortality in MENA in countries with highest levels of health expenditure per capita 3/5 maternal deaths in the MENA from Egypt, Iraq, Morocco, and Yemen Yemen and Iraq have some of highest maternal mortality in world

+ Our Vision Our initiative aims to add one skilled midwife in each rural community throughout the MENA region, therefore reducing the complications associated with a lack of medical professionals and transportation.

+ What will the initiative do? Train midwives in normal childbirth, pre- and post- natal care, and in recognition of birthing complications Will start in Egypt, Morocco, and Yemen and gradually expand to the rest of the MENA region The program will begin in 10 larger, rural communities per country

+ Midwives criteria: At least a 9 th grade education and literate In good standing with their communities Between the ages of Training process: Ten midwife trainers will travel to ten communities For 3 months, midwives will live with their trainee Will be taught through lectures and hands-on experience Followed by two-week supervisory period After 1 year of unsupervised work, the midwives will become trainers for other midwives

+ Payment and cost of living Midwives will be employed by their national governments Will be paid a higher salary than they would otherwise make Is costly in a sense, but the low training costs will offset this Midwives are initially trained for free, in exchange for the fact that after a year of training they become trainers themselves

+ Expecting success because this is based off a program in Mexico Made pre- and post-natal visits mandatory They saw an 11% drop in maternal mortality Midwives will provide women with pre- and post-natal checkups Aim to improve maternal health by teaching future mothers importance of nutrition and healthy behaviors Detect signs of complications early Will distribute pre-natal vitamins and dietary supplements specifically, nutrients including folic acid and calcium both are crucial to an infant’s health Will directly reduce maternal mortality and set a strong foundation for healthy infants Post-natal visits with an emphasis on breastfeeding

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