For Module III we will have three required discussion posts:

| October 21, 2015

a) From the facts on Maternal Health discussed in the Module III notes, identify ONE and write a short paragraph about it giving a specific country/ies example to illustrate the fact. I am not looking for terms like ‘globally’, rather I want you to say in Zimbabwe …….whereas in Australia ……… .. Much will depend on the ‘fact’ you choose to work on, so pick wisely. 250-300 words limit.

b) From chapter 4 (text and PPTs), identify one issue on maternal health and share your experience with that issue. Here I am looking for personal experiences. We are a diverse group, some are from urban settings others from rural, some are rich yet others are not so rich, some are from developed countries while others are from LICs – so please share those rich stories whether from your work as a nurse, your experience as a mother, father, brother or from growing up in a rural setting. No word limit.

c) Finally comment/respond to one posting. You are welcome to respond to as many as you find interesting! No word limit.

Attachments: Module III
Maternal Health _______________________________________________


In the Module we will explore maternal health paying particular attention to global disparities in the support and care mothers around the world get, the factors that promote such disparities, causes of maternal mortality and morbidity, the impact of reproductive patterns on the health of children, and mechanisms to reduce maternal morbidity and mortality, particularly in low-and –middle income countries.

At the end of this Module you should be able to articulate the following:

Critical Skills

1. Explain the global trends in maternal health.

2. Identify the key players and they play in promoting maternal health.

3. Be able to identify the causes of maternal mortality and morbidity in the U.S and other countries, particularly developing nations.

4. Explain mechanisms used to reduce maternal morbidity and mortality.

5. Be familiar with at least two development organizations/NGOsand their work around maternal health.

Maternal Health at a Glance

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While most women look forward to motherhood (and their spouses to fatherhood), for too many women, motherhood is a torturous experience associated with suffering, ill-health and even death. It is estimated that about 800 women die from pregnancy- or childbirth-related complications around the world every day. Consider the following few facts about maternal health (WHO):

• Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth – about 287 000 women in 2010 alone.Most of them died due to preventable cause like not being able to access skilled routine and emergency care.

• The FOUR main maternal mortality causes are: severe bleeding, infections, unsafe abortion, and hypertensive disorders (pre-eclampsia and eclampsia). After delivery bleeding is very serious condition, if unattended, it can kill even a healthy woman within two hours.

• Of the more than 136 million women who give birth a year, about 20 million of them experience pregnancy-related illness after childbirth.

• About 16 million girls aged between 15 and 19 give birth each year, accounting for more than 10% of all births.Complications from pregnancy and childbirth are the leading cause of death among girls 15-19 in developing nations.

• The state of maternal health mirrors the gap between the rich and the poor. Less than 1% of maternal deaths occur in high-income countries. The lifetime risk of dying from complications in childbirth or pregnancy for a woman in the developing world is an average of one in 150 compared to one in 3800 in developed countries. Of the 800 women who die every day,440 live in sub-Saharan Africa, 230 in Southern Asia and five in high-income countries.

• Most maternal deaths can be prevented through skilled care at childbirth and access to emergency obstetric care. In sub-Saharan Africa, where maternal mortality ratios are the highest, less than 50% of women are attended by a trained midwife, nurse or doctor during childbirth.

• In developing countries, the percentage of women who have at least four antenatal care visits during pregnancy ranges from 56% for rural women to 72% for urban women. Women who do not receive the necessary check-ups miss the opportunity to detect problems and receive appropriate care and treatment. This also includes immunization and prevention of mother-to-child-transmission of HIV/AIDS.

• About 21 million unsafe abortions are carried out, mostly in developing countries every year, resulting in 47 000 maternal deaths. Many of these deaths could be prevented if information on family planning and contraceptives were available and put into practice.
Who is at risk?
The major factors that prevent women from receiving or seeking care during pregnancy and childbirth include:poverty, distancelack of information, inadequate services, and cultural practices.
The Poor and Rural
With the understanding you got from Module II, it is not hard to see why 99% of all maternal deaths are in developing nations – uneven distribution of resources. With maternal mortality ratio in developing countries of 240 per 100 000 births as compared to 16 per 100 000 in developed countries, the inequities in access to health services, and quality of care between rich and poor countries cannot be more evident. In high-income countries, virtually all women have at least four antenatal care visits, are attended by a skilled health worker during childbirth and receive postpartum care. Of course, there are other factors that contribute to poor help in developing countries: cultural practices and politics for example. Although there are external wealth disparities among rich and poor nations, internal income and geographic disparities play an equally important role in determining the health of mothers within nations – the poor have less access to quality care, so does those living in rural areas, far from big cities where the infrastructure is. In these countries, just over a third of all pregnant women have the recommended four antenatal care visits. The irony is that it is those people without the means to access quality care who tend to have more pregnancies (again for different reasons ranging from cultural, economic to personal).
The Young
The risk of maternal mortality is highest for adolescent girls under 15 years old who are mostly in developing nations. The practice of child marriage is the main source for this. Child marriage is defined as marriage before the age of 18 and applies to both boys and girls, but the practice is far more common among young girls.Though a global issue, in both proportions and numbers, most child marriages take place in rural sub-Saharan Africa and South Asia. According to WHO, the 10 countries with the highest rates of child marriage are: Niger, 75%; Chad and Central African Republic, 68%; Bangladesh, 66%; Guinea, 63%; Mozambique, 56%; Mali, 55%; Burkina Faso and South Sudan, 52%; and Malawi, 50%.
According to WHO and United Nations Population Fund (UNFPA) if current levels of child marriages hold, 14.2 million girls annually or 39 000 daily will marry too young.
The unborn child/thepregnancy
When a pregnant women is in poor health, this affects the pregnancy as well. A baby in poor health is likely to be a low-weight birth, at time with other complications. Many die during or soon after delivery, while thousand also die before age 1.

What is being done?
WHO response
Improving maternal health is one of WHO’s key priorities. WHO is working to reduce maternal mortality by providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States. In addition, WHO advocates for more affordable and effective treatments, designs training materials and guidelines for health workers, and supports countries to implement policies and programs and monitor progress.
One target of the Millennium Development Goals (MDGs) is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. So far, progress has been slow. Since 1990 the global maternal mortality ratio has declined by only 3.1 % annually instead of the 5.5% needed to achieve MDG 5, aimed at improving maternal health.The Global strategy for women’s and children’s healthlaunched in 2010 by the UN MDG summit isaimed at saving the lives of more than 16 million women and children over the next four years. WHO is working with partners towards this goal.
Please read the short story:
As you have seen/read, most maternal deaths are avoidable. Access, access, access – all women, irrespective of where they are, whether poor or rich, need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. To live is a world where 99% of all maternal deaths are in a few parts of the world, and where 14.2 million girls marry too young and 21 million unsafe abortions are carried out annually, is a moral failing. We must act NOW! And save lives!
Schedule and Assignments for Module III

Assignments Due Date (by mid-night)
1. Study all required reading materials.
Chapter reflection.
Post your Bb discussion.
Respond to posts Sunday Oct 11

Friday Oct 2
Ongoing but preferably by Oct 2
2. Take Module III Quiz.
Sunday Oct 11: Test questions cover material mostly from Jacobsen assigned readings and PPT notes.
3. Group 2 Tegrity Presentation Oct. 2
4. Watch Group II Case presentation and post questions and thoughts Sunday Oct 11.

a) Chapter 5 and 6. Jacobsen (2014)
b) Cases: 6- Saving Mothers’ Lives in Sri Lanka
4 – Reducing Child Mortality Through Vitamin A in Nepal
13 – Reducing Fertility in Bangladesh
c) Module III PPTs
d) Optional reading: Chapter 4. Merson et al (2012)

Recommended resourceson Maternal Health:
Centers for Disease Control & Prevention

World Health Organization

For those of you interested in this topic, please visit more articles from around the globe.

Sources Used
Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 2004. 192:342–349.
Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet, 2009, 374:881–892.
Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tunçalp O, Balsara ZP, Gupta S, Say L, Lawn JE. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet, 2011, Apr 16;377(9774):1319-30.

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Principles of Epidemiology 15EW1 Just answer all the questions.

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