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Invisible epidemic kills millions of mothers and children

DPA, NEW DELHI
Thursday, Apr 07, 2005, Page 9

ILLUSTRATION: MOUNTAIN PEOPLE

A barefoot battalion of shishu rakshaks or child protectors fans out across remote villages in the backward eastern Indian state of Orissa, ensuring the survival of newborn babies.

Life after birth cannot be taken for granted in India, and several countries in Asia and Africa, where millions of babies die in the first month of life. Most of these neonatal deaths are totally preventable.

Newborns are not the only ones at risk. Every minute, somewhere in the world, a woman dies from complications related to pregnancy and childbirth. The World Health Organization (WHO) calls it the "invisible epidemic". An estimated 99 percent of these deaths take place in developing countries.

Each year close to 11 million children do not celebrate a fifth birthday. An overwhelming 40 percent do not live beyond a month. The Southeast Asia region alone accounts for 170,000 mother and 3 million child deaths annually.

The WHO's World Health Day today will focus on maternal, newborn and child health, urging governments to give a high priority to the health of women and children.

At least 4 million babies worldwide die in the first month and a similar number are stillborn every year, according to a report last month in The Lancet journal. While three-quarters of neonatal deaths take place in the first week, the highest risk of death is on the first day of life.

The causes vary from infections such as pneumonia, septicemia, meningitis and diarrhea, to asphyxia and pre-term births.

"Almost all [99 percent] neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1 percent of deaths in rich countries," the Lancet said.

Countries reporting the highest neonatal deaths include India, China, Pakistan, Bangladesh, Afghanistan, Indonesia, Tanzania, Nigeria, Ethiopia and the Democratic Republic of Congo. Most have made little progress in reducing mortality in the past 10 to 15 years.

In India, two newborns die every minute, according to a study last month by the National Neonatal Forum, the PTI news agency said.

"The glaring fact is that a vast majority of infant deaths can be averted through affordable interventions such as breast-feeding, clean delivery, maintaining warm temperature for the baby and antibiotics," said Vinod Paul of the All India Institute of Medical Sciences' pediatrics department.

Orissa's shishu rakshaks equip themselves with three disarmingly simple life-saving devices -- a thermometer to monitor the baby's body temperature, a color-coded weighing scale to check if it is underweight and a watch to record its pulse.

Each shishu rakshakss is responsible for a population of 1,000. They visit pregnant women at least three times before delivery and check the baby 10 times in the first month. Initially viewed suspiciously because of their meticulously-maintained medical charts, they have gained acceptance among poor and illiterate villagers who have limited or no access to health care.

In South Asia, a woman's health is inextricably linked to her social status. The cycle of discrimination starts at birth because of a preference for sons and the perception of girls as an unwanted financial burden. Parents are reluctant to invest in girls' health and education because they will get married young.

Studies have shown that female babies in South Asia are breastfed less frequently than male babies, and are often not treated for illnesses. In most households women eat last and the least, their growth stunted by nutritional deficits.

They marry early, do not use contraceptives and become under-weight, anemic mothers, health experts said, adding that they are further weakened by frequent childbearing. Malnourished mothers have low-weight babies, who have few chances for survival.

The main causes of maternal deaths are hemorrhage, infections, obstructed labor and unsafe abortions, WHO said. The problem persists because health care is either unavailable or inaccessible.

But many women have no role in decision making even when it comes to their own health. A 1999 UNFPA survey in Nepal found that the decision for a pregnant woman to seek medical care was made by her husband, or in some cases her mother-in-law.

In India, where the rural healthcare system is almost non-existent and people have to walk several hours, even days, to the nearest doctor, pregnant women are forced to rely on unskilled attendants.

According to WHO, life-threatening complications occur in 15 percent of all births. A trained attendant makes the difference between life and death for the mother and child. In south-central Asia only 37.5 percent of births are in the presence of a skilled attendant, as compared to the global average of 61 percent.

In India, open-air caesarean operations are still performed, or babies are delivered at home in unsanitary conditions without proper medical care. There are shocking cases of traditional healers who put their bare hands inside a pregnant woman's uterus to straighten the baby and then kick the womb to induce labor.

Today the international community will have an opportunity to review the pledge made by leaders from 189 countries at the Millennium Summit in New York last September. They promised to reduce child mortality by two-thirds and maternal mortality by three-fourths between 1990 and 2015.

"The real tragedy is that millions of women and children are dying needlessly, and we are failing to act," said WHO Director General Lee Jong-wook.

"Mothers and children are the foundation of families, communities and societies. When a mother or child dies, that foundation crumbles," Lee said.

"If we want to improve the health of future generations, we must start with the health of mothers and children today, he said.
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