SAM Blogger Sonal Goyal

At the end of June 2011, I returned from a three-week trip to Quetzaltenango, Guatemala, where I had traveled for the purpose of studying Spanish and observing healthcare in the area through a local language school. Through the school and my host family, I was introduced to many individuals during my stay, and quickly noticed the many teenage mothers throughout the city.  My first night there I met a beautiful baby boy whose mother was only 17 years old.  Having previously had another child at age 16, and with no husband and no stable source of income, she had tried to illegally terminate her second child multiple times, and wound up being hospitalized for several weeks before the baby was born.  A few days later I had the opportunity to meet another 17 year old and her daughter. She was more fortunate than the first girl in that the father of her child was very supportive, and they had married soon after she discovered she was pregnant.

Approximately 33% of births are unintended in Guatemala, where abortion is illegal unless the mother’s life is at risk.  Despite this, in 2006,  complications from abortion was the third largest cause of maternal mortality in Guatemala, contributing to one of the highest maternal mortality rates in Latin America.  Many abortions are conducted under unsafe conditions,  resulting in infections and other complications that place the mother at risk.  Approximately 8 out of every 1,000 women in Guatemala were hospitalized for induced abortions in 2003.  More recent studies of Guatemala have found that in 2006, there were 92 births per every 1,000 girls aged 15-19 years old, and in 2009, the average number of births per woman was

four, the highest fertility rate in Latin America. According to WHO in 2009, there were 110 female deaths per 100,000 live births compared to 66 per 100,000 regionally.

Until recently, pre-marital abstinence was the preferred method of birth control in this heavily Catholic society.  Sex education in public schools was disfavored and contraceptives were rarely discussed because their use was associated with promiscuous women.  According to the most recent statistics available from the World Health Organization, only 43% of the Guatemalan population use some sort of contraception, compared to 75% in Central America overall.  The lack of sex education and access to birth control has led to an increase in unwanted teen pregnancies.  Because abortion is illegal, some teens opt for induced labor outside of hospitals, further increasing the already high rate of maternal complications and death in childbirth.  Stopping through drug stores in Xela, I seldom saw condoms, and feminine products other than maxi pads were virtually non-existent.  Even if the use of birth control was encouraged, restricted access and high costs can create throw up more obstacles to its use.

Guatemala is a poor country. The gross national income per capita in international dollars is $4,570 compared to the regional average of $23,823.  The average woman has more than four children and in rural areas populated by indigenous Guatemalans that number is often closer to eight.  Having multiple children increases the financial burden on individual households and can lead to malnutrition and lower literacy among children.  At the national level the complications of unsafe abortions are costly to the country’s public health system and contribute to higher rates of infant and maternal mortality. A  2000 study of a facility in Coatepeque, Guatemala, estimated that 10% of hospital’s total budget, 30% its  maternity budget, was spent on complications related to abortion.  Medical expenses in turn add to existing financial strains on families and lead to higher taxes to address public healthcare costs.

In 2005, escalating costs finally forced the Guatemalan government to propose laws allowing sex education in schools. Despite the attempted intervention of multiple Catholic and conservative cultural institutions, a bill requiring sex education in grammar and high schools schools finally passed in 2009 and began being implemented in 2010.  While this new family planning law will help future adolescents and adults, measures are still needed to address men and women in rural and poor communities who either do not attend school or are past high school age.

Many organizations within Guatemala now provide sex education and increased access to birth control.  With greater support for sex education, we will hopefully start to see a decrease in the number of unintended pregnancies and unsafe abortions,which may in turn allow Guatemala to focus on the pressing issues of  malnutrition, access to healthcare, and education.

For more information, check out:

1. Singh S, Prada E and Kestler E. Induced Abortion and Unintended Pregnancy in Guatemala. Int Fam Plan Perspect. 2006 Sep; 32(3):136-45. http://www.guttmacher.org/pubs/journals/3213606.html

2. World Health Organization. (2011). Guatemala Country Statistics. http://apps.who.int/ghodata/?vid=9600&theme=country

3. Guatemala County Program. Planned Parenthood. http://www.plannedparenthood.org/about-us/international-program/guatemala-country-program-19006.htm

4. World Health Organization. (2011). Guatemala: health profile. http://www.who.int/gho/countries/gtm.pdf

5. Rivera, E. Sex Ed Classes for Kids Begin in Guatemala. AllVoices. http://www.allvoices.com/contributed-news/5064070-sex-ed-classes-for-kids-begin-in-guatemala

6. Valladares, Danilo. Sex Education, Family Planning Finally Available. IPS Inter Press Service News Agency.  http://ipsnews.net/news.asp?idnews=49436

Photo licensed via Creative Commons /archer10 (Dennis)

The study found that, while the decline in abortion rates found in earlier studies has halted, the number of unsafe abortions has increased from 44% in 1995 to 49% in 2008. Overall abortion rates did not correlate with restrictive abortion laws, and in fact, abortion rates were lower in regions with more liberal abortion laws.

Unsafe abortions — that is, abortions taking place outside hospitals and without qualified medical supervision —  are a major cause of maternal death, especially in the developing world where women are more vulnerable to infection and less likely to find sufficient care for excessive bleeding. The WHO study suggests that measures to restrict abortion do not decrease abortion rates, but rather put women at a greater risk of receiving abortions that are detrimental to their health or even fatal.

For the study, visit http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961786-8/fulltext.

A report released last year by the International Federation of Gynecology and Obstetrics has called for a sustained effort to reduce maternal mortality rates in Ghana.  The government has displayed valiant dedication in reducing maternal and infant deaths, but independent United Nations expert Anand Grover encouraged the country to redouble its commitment to these goals:

In order to ensure that current gains related to the right to health are sustained, the government must develop a strategy to address possible deficits in future funding.

The maternal mortality rate in Ghana remains high even among developing nations, making these issues particularly urgent. The article goes on to report that UN Secretary General Ban Ki-Moon found global rates of maternal mortality “unacceptable.”

Click here to read “Ghana ‘must develop strategy to sustain progress on maternal mortality’”

Click here to read the latest call to action from Ghana’s First Lady

Photo via flickr / adam_jones

The committee briefing was held to evaluate South Africa’s progress toward their Millennium Development Goals (MDGs). These eight goals were adopted by the 191 members of the United Nations, including South Africa, in 2000. The MDGs, which have a target date of  2015, address issues such as hunger, poverty, environmental sustainability, disease, and child and maternal health.

As of 2007, South Africa has sustained a child mortality rate of 104 per 100,000 live births and  a maternal mortality rate of 625 per 100,000 live births. These figures are alarming since given South Africa’s  pledge to reduce the child mortality rate to only 38 per 100,000 live births and the maternal mortality rate by 75% by 2015.

Motsoaledi stressed the gravity of these figures and noted that vast improvement in South Africa’s health systems would be crucial to meeting these goals.  He suggested restructuring the healthcare system by addressing cost and sustainability with an emphasis on prevention. A preventive focus could help cut costs, he said, whereas  the current focus on curative care would prove more expensive in the long-run:

“More should be done to strengthen our country’s primary health care, which operates at community level and where more people’s problems can be solved. This level aims at prevention of certain diseases.”

Click here to read “Child, maternal mortality rates reach crisis levels.”

Click here to read “Millenium Development Goals (MDGs).”

Photo via Creative Commons / La Chiquita

SAM Blogger: Sara Gorman

Most public health crises facing India need no introduction: communicable diseases, lack of healthy drinking water, HIV/AIDS, poor hygiene practices, and poor quality healthcare and healthcare facilities top the list of problems studied by professionals and covered in the international press. But what about health-seeking behavior among Indian populations?  Are people aware of existing healthcare options and how best to access them? Can those living in impoverished and rural areas identify symptoms requiring immediate medical attention? What are some of the social reasons that diseases, especially among women and children, go untreated? Can increasing health literacy really make a difference?

A 2007 Pew poll surveyed global populations on what they perceived to be the greatest problems facing their countries. The priorities listed for Asia as a whole were, in order of decreasing urgency: crime, corrupt political leaders, pollution, illegal drugs, spread of HIV/other diseases, and terrorism. The spread of diseases, which was not even listed in the same category as “healthcare,” ranked relatively low in comparison to concerns about crime and corruption, and in comparison to where these same problems ranked in other parts of the world, notably Africa, where health concerns consistently topped the list. If, however, healthcare ranked lower on the scale of national concerns for populations in Asia, health on a family or individual basis consistently emerged as a primary concern across all regions, continents and socioeconomic groups. When asked to name the issues of highest personal concern, health ranked second only to financial concerns among people polled in 33 countries around the globe.

This disjunction between personal and national concerns suggests a fundamental disconnect between individual versus national healthcare priorities.  It also raises questions about whether people understand how the health challenges they face as individuals can affect their country’s overall healthcare profile. According to the Pew study, in Asia as a whole, the list of the most pressing healthcare priorities was, in order of descending urgency: HIV/AIDS; building and improving better healthcare facilities and better prenatal care; clean water; hunger and malnutrition; chronic diseases and immunizations; access to care; tuberculosis, malaria and other infectious diseases. In areas with the highest rates of low birth weights and unattended births, including Bangladesh, Mali and India, prenatal care consistently ranked among the top three health concerns. Yet concern over immunization and infectious diseases was staggeringly low in Asia, where epidemics are a constant threat. Similarly, access to care ranked eighth in a list of nine healthcare issues, surprisingly low given the actual existence of serious barriers to care in places like India. What accounts these mismatches between perception and reality, and how do these misperceptions affect the attainment of quality care?

A brief look at the way India handles maternal mortality can help shed light on why perceptions of health issues are sometimes divorced from reality.  A recent report by Human Rights Watch reveals a disturbing mismatch between the number of reported and actual maternal deaths in the developing world.  The high number of maternal deaths is caused by a lack of tools and personnel needed in an obstetric emergency. This issue falls squarely under the category of building and improving healthcare facilities identified by the Pew poll as the second-ranking concern among healthcare issues in Asia as a whole. However, several of the other major barriers to prenatal care are not issues listed as of prime importance to those surveyed in the Pew poll. A lack of awareness among healthcare workers of what constitutes a maternal death contributes to the mismatch between actual and reported numbers of maternal deaths in places like Uttar Pradesh. For example, if a woman develops a fever and dies 72 hours after giving birth, her death is not recorded as a maternal death, even though it is well-known in the medical community that women can develop complications from childbirth 72 hours after giving birth and that fever is often the first sign of such complications. Without accurate statistics on maternal mortality women in these nations cannot appreciate the true scope of the problem.

Other barriers to access may have such deep roots in societal custom that they failed to be perceived as barriers.  Gender discrimination in neonatal care has been acknowledged in India for years, but quantitative data to confirm this accepted assumption have emerged only very recently. A 2009 study of the Uttar Pradesh region published in the Journal of Health Population and Nutrition found that the average expenditure for neonatal care in houses with newborn males was nearly four times higher than the expenditure in houses with newborn females.  Furthermore, in 55% of households, decisions to seek healthcare from a provider were made by family members other than the mother, usually by the husband (31%) or the mother-in-law (18%).

These data confirm gender-specific patterns of health-seeking behaviors recorded in a 2006 study of Uttar Pradesh published in the Indian Journal of Community Medicine. Through interviews and focus groups researchers discovered that most women did not seek care because their husbands refused to accompany them to the doctor. The women were generally not permitted to seek treatment for themselves or for their children without being accompanied a male member of their household.  Most men refused to discuss their own health problems with their wives, especially if they were suffering from reproductive health problems or sexually transmitted diseases.  In many cases, men approached doctors in nearby villages in secret or discussed health problems with their mothers. Aside from confirming the fact that women are most often neglected in family healthcare decision-making, this suggests that women’s exposure to sexually transmitted diseases could be reduced in part if their husbands discussed their health problems with them more openly.

Can health literacy, increased awareness and general education help healthcare access in these cases? Several recent studies suggest that the answer to this question is “yes.” One study on knowledge of hygiene and its health consequences in Eastern India found that basic socio-economic factors, especially education, “play a pivotal role in conditioning the perception and practice of hygiene.” More than 90% of people with some kind of formal education indicated knowledge of proper hygiene practices, and women with better knowledge of good hygiene reported less disease in their households. This finding is important because some of the most potentially serious infectious diseases in India are associated with poor hygiene, including typhoid fever, cholera, hepatitis, malaria, dengue and worms. The 2006 Uttar Pradesh study reported that literacy status and perceived quality of healthcare services play essential roles in the selection of a healthcare provider. Not only are general education and health literacy pivotal in increasing access to care, but perception of the state of local healthcare services also determines the process of seeking proper aid. Educating people in India about the major health crises facing entire communities and making them aware of healthcare options may go a long way to increasing individual access to care.

Addressing the issue of water is a crucial step for the development of this country. Without access to safe water development becomes impossible.

Tangalle main road

“Water-borne diseases are one of the most serious threats

to child health in developing countries and affect mainly the poorest people.”

Along with reducing the incidence of water-borne illnesses like hepatitis and diarrhea, this new project will give women and children more hours in the day. This will allow for women, especially, to use that time to bring in income rather than travel long distances to retrieve water.

Click here to read “New water supply in Sri Lanka brings health and hope to thousands.”

Photo via Creative Commons / Krankman

Click here to watch the entire episode and here for more information on the show.

Recalling the glamor of years past, the third annual Save A Mother charity gala, held on September 16, 2011, successfully brought 220 of Chicago’s philanthropically minded gliteratti to the historic Drake Hotel for a night of fine dining and casino-inspired activities. This year’s event married the theme of Monte Carlo with the mystique of a masquerade ball and proved to be the premier charity gala of the summer.

Save A Mother also honored Mr. Niranjan Shah and Mrs. Pratima Shah for their lifelong commitment and outstanding contributions to humanitarian work.

The event raised over $60,000 to provide health solutions for underprivileged women and children in India.

For more details about the event, please visit
http://www.masquerademasti.org

Save a Mother's 2011 Chicago Masquerade Masti was held at the Drake Hotel.

Masqueraders enjoying the 2011 Chicago Masquerade Masti.

Houston Masquerade Masti 2011

The Houston Chapter of Save a Mother held its second annual fundraiser earlier this year, complete with hand-painted masks and resplendent crimson and yellow decor.  The event took placed on May 13, 2011, at the Chateau Crystale.  The evening’s program was emceed by Girija Bhargava Patel, Shayam Parikh, and the Board of the Houston Chapter, and included presentations on SAM’s mission and methods in the field. Guest speaker Dr. Harvinder Singh Bedi shared data comparing infant and maternal mortality rates in the US and other countries to illustrate how India lags behind on each of these indices. Entertainment was provided by local talent with songs by Keka and Satyajit Kar, Hardik Jani, Raghavendra Prabahakar, Neha Srivasta and the ICC Idol winners.

The event raised over $50,000 to provide health solutions for underprivileged women and children in India.

Revelers enjoying the 2011 Houston Masquerade Masti.

The Houston chapter of Save a Mother hosted its 2nd annual Masquerade Masti at the Chateau Crystale.

Click here to read “Global Activists Seek Improved Nutrition for Pregnant Women, Infants.”

Photo via Creative Commons / Ragesoss

Maternal mortality in Senegal is estimated at 1,200 per 100,000 births. The high rate is partly attributed to illiteracy and lack of adequate health information, particularly in the rural areas.

Every playing card shows a cultural image and typical cultural notions and proverbs are written underneath.

In Khombole, there are hardly any job opportunities or social activities for the residents to engage themselves in. And because most women in the village can’t read or write, they have little idea of the progress of pregnancy.

But with the W3 game Plan International is enlightening these women through the colours they are familiar with and the signs and images that relate to wellbeing.

In rural Senegal women can’t openly discuss pregnancy and motherhood issues. So what the W3 game does, is to give an informal platform to the women to discuss and learn about their health through symbols and images rather than words.

 

Click here to check out “Senegal’s Life Saving Board Game”

Woman and her Child in Nigeria

Reproductive health experts in Nigeria report that rates of maternal mortality are still high and require urgent attention.  Though maternal deaths have dropped by almost fifty percent in recent years, Nigeria is second only to India, a country nearly ten times its size, in total annual maternal deaths.  Most experts point to malaria as the leading cause of both maternal and child deaths.  The disease — which by some estimates afflicts 50 percent of the adult population each year — has caused suffering and slowed development throughout Nigeria and Sub-Saharan Africa.

Read the full article here: Maternal Deaths Still High in Nigeria

Photo via Flickr / Mike Blyth.

Over the past year, IBM’s consultants have been engaged by the Cross River State government to help roll out the state projects “Hope” and “Comfort” in a bid to address issues of infant and maternal mortality and increase levels of literacy amongst the poor. To date, IBM has helped in registering over 135,000 for the programs.

The work benefits from advanced technologies such as biometric identification and solar energy to make the programs more efficient, reliable and accurate.

“We launched project Hope to provide free healthcare for pregnant women and children under five, so as to mitigate both infant and maternal mortality rates which were unacceptably high.  Running alongside is project Comfort – a social benefit program designed to provide financial assistance to people living in poverty and support in educating family members,” said Senator Liyel Imoke, Governor of Cross River State.

Click here for the article

Childbirth is the number-one killer of young to middle-aged women in developing countries, and one of the worst-affected countries is Rwanda, where maternal mortality rates have been dire.

But a new rural hospital is transforming the local health system and offering a model of how to turn around the situation in the country.

The Butaro Hospital has been built to provide quality healthcare in one of Rwanda’s most remote districts. Just a few years ago Burera district only had one doctor for its 350,000 population.

Dr. Agnes Binagwaho, the Rwandan Permanent Secretary of Health, welcomed the new facility. “There are too many deaths that we could prevent by increasing access to care in a geographic way and also increasing the expertise of health professionals that deliver services,” she said.

The first baby to be born at Butaro Hospital had difficulty breathing, but he survived. Health professionals say this may not have been the case if the delivery had taken place at home or in a rural health center.

Click here for the article

The discovery of the New Delhi superbug has brought into focus the urgent need for a national policy on antibiotic prescriptions.  It all started with a report in Lancet in August 2010 of a new microbe discovered in India, nicknamed New Delhi metallo-b-lactamase-1, or NDM-1.  The enzyme NDM-1 makes bacteria resistant to almost all antibiotics, including carbapenems, antibiotics of last resort.

Antimicrobial resistance is generally the result of misusing medication.  In the absence of guidelines from the government and easy over the counter availability, antibiotics are used indiscriminately in India.  While doctors may prescribe antibiotics without assessing needs, people also self medicate without attention to course of treatment.   Not finishing a prescribed course of treatment, low-quality medicines and wrong prescriptions all contribute to drug resistance, making infections caused by drug resistant microorganisms difficult to treat.

Although viewed as a problem exacerbated by the developing world, developed nations are also recognizing the urgency of antibiotic resistance.  The US has begun to support measures to address the issue of antimicrobial resistance: Policy Statement 9908 advocates educational programs for providers and patients on appropriate antibiotic usage as well as recommendations for increased and improved oversight.  Amongst developing nations, Chile has banned over-the-counter sale of antibiotics and a prescription is now mandatory for access to antibiotics.  China will also launch a nationwide campaign this year to regulate the antibiotic use.

In response to the global outcry over NDM-1, the Health Ministry in India formed a 13-member expert panel in September 2010 to create a proposal for an antibiotic policy.  The proposal was submitted to the Union Health Minister Ghulam Nabi Azad earlier this year and is currently being finalized.

To start with, the new national antibiotic policy is likely to be piloted in three government hospitals in Delhi: Lady Hardinge Medical College, Safdarjung Hospital and Ram Manohar Lohia Hospital. It will also be mandatory for antibiotic drugs to be sold against prescriptions.  In addition, doctors will have to write prescriptions for antibiotics in duplicate with pharmacists having to retain a copy for a year from the date of sale in order to facilitate verification and audit.  Implementation of such rigorous regulation and government policy is likely to be effective as proven by example in other countries.

I have been volunteering with Save a Mother since August 2010 when I started the Save A Mother Club at my high school.  Our primary goal is to spread awareness of the lives of poor women in India.  Using the tools that can be found on the Save a Mother website, our club has taught many students at our high school of the troubles these women must endure and how they can help the cause.  Doing so has not only brought a sense of awareness at our school, but has also encouraged students to take an active role in helping the cause.  We plan to start a fundraising program through selling custom Save a Mother shirts, auctioning items from India, and a car wash.  Regardless of what we choose to do, the important part is that all of the proceeds will benefit the cause and help change the lives of several women and children in India.  That is the real push factor behind our club; knowing at the end of the day that we are not only positively changing the life of a mother, but also that of a child who has limitless potential.

In the future, I hope to see a world that isn’t so crowded with hate and mistrust. As idealistic as it is, I hope that one day a society can be born that would raise a generation filled with empathy and benevolence. A generation that would be able to look beyond the background of an individual, and instead, see them for who they are, one just like themselves.

New Delhi: Another International Women’s Day, another occasion for a national assessment of the status of women in a country where the glass ceiling is within reach but not broken, where health statistics are still determined by

Save a Mother participated in 9 CLA (village organization) meetings and 5 BLA (block level) meetings.
Periodic field visits to program areas

Save a Mother’s Founder and Chief Volunteer, Dr. Shiban Ganju, co-authored a paper entitled, “Financing Healthcare for all: challenges and opportunities” in the January issue of The Lancet.¹ This paper addresses shortcomings in health care coverage and finance and makes recommendations for policy responses required to make healthcare affordable for all in India.

Here’s a summary:

Key Challenges:

Opportunities:

Key Recommendations:

Financing health care for all: challenges and opportunities. Kumar AS, Chen LC, Choudhury M, Ganju S, Mahajan V, Sinha A, Sen A. Lancet. Jan 10, 2011.

By Megha Patel

The ‘Curricular Reform Committee for Undergraduate Medical Education’ has made recommendations to India’s Health Ministry to shorten the medical school curricula to three years to allow for larger numbers of doctors to meet healthcare needs in rural areas. This is proposed to be accomplished by shortening clinical training and possibly creating separate medical courses for rural students if the central government approves.

The current doctor to population ratio in India is 1:1700 compared to the world average of 1.5:1000. Though India has the highest number of medical colleges in the world as of the past two decades, there remains a fundamental challenge of bridging the gap between need and availability of doctors. With the population projected to increase with an annual growth rate of 1.4% over the next three decades, the Medical Council of India (MCI) felt that the existing medical colleges are unable to meet this need and are therefore seeking to double the current intake of medical colleges to achieve their target.

While their short term solutions include increasing intake of medical colleges, their long term solutions include creating new medical colleges and hospitals in under-served and rural areas. The MCI aims to improve the ratio of India’s doctors to 1:1000 by 2031 if their recommendations are taken into consideration.

However, apart from these proposed changes to the curriculum of India’s medical schools, a national-level committee of medical experts has proposed an even more radical curriculum change to the government that seeks to create doctors in three years flat for students from rural areas after the class of 2010. Since the ratio of doctors to the population is even more exacerbated in rural areas, this proposal would create doctors exclusively for rural areas since it is apparent that city-based doctors are unwilling to work in these areas.

This three year course of education would be called the “Bachelor of Rural Health Care” (BRHC) and though it is still under consideration by the government, this is viewed as the only practical solution to improve access to healthcare in rural areas according to many supporters. The way this degree would work is that students intending to work in rural areas would either sign a 10 year bond or make a lifetime commitment to solely work in rural under-served communities. In addition to establishing the three year MMBS programs, the committee also proposes increased medical colleges in under-served areas till 2015, similar to the proposal of the MCI.

Though this seems like a positive move to quickly address the increased gap between rural healthcare needs and access to doctors, it is not a foolproof plan and comes with many potential problems and concerns. Being a controversial change, doctors argue that this could deteriorate standards of medical education in India. As the government decides whether to follow the proposal or not, they will need to address issues such as how they plan to monitor rural healthcare graduates to ensure they are not practicing in urban areas as well as if the level of education given in rural schools are comparable to urban ones and if only rural students are able to apply to such programs. If these schools are only aimed at rural students, possible future problems could include increased inequality between urban and rural doctors and the quality of training they receive.

Regardless of the possible problems that could arise, there is an apparent and increased need for rural doctors and an ambitious proposal like this has long been overdue. If this proves successful, it could drastically improve healthcare access in India and possibly be a model for other developing countries that are also dealing with shortage of access in rural areas.

References:

1. Thakor, Prashant. “If govt gives nod, rural students can become doctor after class 10”, Ahmedabad, India. DNA 2/10/11

2. Medical Council of India. Proposal. Undergraduate Medical Education Working Group 2010.a

Photo used under Creative Commons from ernstl

By Katie Malizia

This year in India 68,000 women will die from complications of pregnancy, childbirth, and abortion. Roughly 1.8 million Indian children – more than the entire population of Manhattan – will either lose the struggle to be born or succumb to infections, prematurity, or malnutrition before the age of five. Despite steady declines in maternal and child mortality, social inequities, changing demographics, and the uneven distribution of healthcare continue to slow progress toward adequate, nationwide coverage for women and their children. But these problems are not without solutions. A report published earlier this year in the medical journal The Lancet¹ urges that comprehensive maternal and child healthcare can be achieved through the expansion of public health facilities, increased focus on early childcare, and, perhaps most crucially, community engagement and education through the deployment of skilled healthcare activists.

In 2005, the Indian government launched the National Rural Health Mission (NRHM), an extraordinary effort to reform the country’s ailing rural health system. NRHM set ambitious goals to improve maternal health, including the use of cash incentives to encourage poor women to give birth in health centers or government hospitals. This program, known as Janani Suraksha Yojana, has been one of NRHM’s great success stories. Janani Suraksha Yojana offers women who give birth in a health facility INR 1400 (approximately US $35). Health workers who accompany pregnant women to a facility receive INR 600 (approximately US $15) for transportation expenses and as compensation. In just five years, the number of women who have benefited from the program’s incentives has increased 13-fold, from 750,000 in 2005-2006 to nearly 10 million in 2009-2010. Health activists have been the lynchpin of this achievement. Over 750,000 have been trained and deployed to villages since 2005, and their efforts have been the driving force behind the implementation of the Janani Suraksha Yojana program.

But while the success of Janani Suraksha Yojana has helped reduce maternal mortality and improve newborn care, it has done little to curb infant mortality or address the needs of post-partum mothers. Increased demand for care in public health facilities has not been met with a comparable expansion of healthcare services. Doctors, nurses, and midwives are in short supply, and as a result, women are often discharged from facilities just hours after giving birth. Only 51% receive any kind of postnatal care, and most never receive counseling in newborn care or the importance of breastfeeding. Education in family planning and sexual health is likewise lacking.

Accredited health activists can help bridge this gap in reproductive and child health. Home visits within the first week of delivery can ensure that complications from delivery and other danger signs do not go undetected. Granting health workers the right to dispense oral antibiotics to treat pneumonia and infections in children could also dramatically reduce early child mortality. The behavior-changing strategies so effective in implementing Janani Suraksha Yojana could likewise be used to encourage women to breastfeed and vaccinate their infants, and to educate young people about good reproductive and sexual health practices. The need for contraception in rural communities is substantial, and an activist armed with supplies and counseling skills could do much to improve women’s control over their own reproductive future.

Systemic problems require system-wide solutions, and in a country of over 1 billion people, instituting reforms at even the state and district level can be challenging. Currently, district training centers for health activists are underfunded and understaffed, with ad-hoc efforts by professional organizations and a few select national centers supplying most training efforts. Greater attention and resources must be committed to bringing health activists to India’s most burdened and underserved communities. Once in place, activists must be monitored and provided with continued incentives and necessary supplies to promote maternal health and early child care. All this can sound overwhelming. But the evidence has shown that just one accredited health activist per 1000 people can make a substantial difference in healthcare for mothers and newborns. NRHM and similar programs have provided a viable and effective model for change in rural communities. The challenge now is to expand and improve on that model until adequate healthcare is a reality for women and children in every corner of India.

1 Reproductive health, and child health and nutrition in India: meeting the challenge. Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Sankar MJ, Bhandari N, Sreenivas V, Sundararaman T, Govil D, Osrin D, Kirkwood B. The Lancet. 22 January 2011 ( Vol. 377, Issue 9762, Pages 332-349)

Photo taken by Save A Mother staff at a training session in Tiloi.

These three women and their plight have exposed the huge gaps in India’s tottering public health system that offers little or no emergency obstetric care, and continued care in the post-partum period for underprivileged women. But stories such as these have initiated a new era in read more

Infant mortality rates (IMR) and maternal mortality rates (MMR) continue to be “areas of concern” in India, it has been claimed.

Union health minister Ghulam Nabi Azad said: “In spite of the achievements made so far there are still areas of concern. The pace of decline in various key health indicators like IMR, MMR, Total Fertility Rate and death and morbidity due to read more

The city is witnessing an increase in maternal mortality rate as the Brihanmumbai Municipal Corporation (BMC) registered 206 maternal mortality cases in 2010, compared to 149 the year before. According to the figures available with the civic body, of the 206 deaths, 125 were of read more

In 2010, President Barack Obama signed his long debated health care bill into law, but it still remains an issue of controversy among concerned Americans.

While the United States deals with its own share of health care issues, there is another world of health concerns on the other side of the world and some inquisitive University of Chicago students in a new student group have taken notice.

The Global Affairs Leadership Society (GALS) became a Registered Student Organization (RSO) in the fifth week of the first quarter. The basic premise behind the group is to provide a place where students can discuss issues of conflict within women’s rights in the Western and in the developing world. Not only do they seek to talk about these important issues, they also want to take an active role in combatting them.

“So many people spend their time talking about important issues, but spend no time doing anything about it,” says Molly Cunningham, a GALS board member and 2nd year in the College, “GALS is ‘doing’ rather than just talking.”

One of the first issues the group has sets its eyes on is the high maternal mortality rate in India. According to saveamother.org, over 160 women in India die each day due to problems from pregnancy and complications in childbirth, over 50 times higher than the rate in the United States. Statistics and concerns such as these spurred the members of GALS to become involved with Save A Mother, which is a local organization that is working to reduce the maternal mortality rate in India by educating villagers regarding better ways to maintain good health while in pregnancy. Eventually, these educated villagers become health activists in each of their villages.

Hoping to learn more about this organization, GALS held a special event at the Center for Gender Studies on January 10th. Dr. Shiban Ganju, founder and chief volunteer of Save A Mother, visited the university in order to talk further about the organization’s work and to inspire the group to further the organization’s cause.

Dr. Ganju: Just do it

Throughout the upcoming quarter, GALS is going to work on strengthening its relationship with Save A Mother and continue furthering the organization’s cause.

“Ignorance kills even the best of ideas,” says Cunningham. “We are hoping to raise awareness about important issues and even if the students we talk to don’t get involved, it is still a better world because we opened their eyes a little more.”

Read the original article here

Hyderabad, Jan 12 (PTI) Despite the achievements madeunder National Rural Health Mission (NRHM), key healthindicators like maternal mortality ratio (MMR) and infantmortality ratio (IMR) are still “areas of concern”, unionhealth minister Ghulam Nabi Azad said here today.

“In spite of the achievements made so far there are stillareas of concern. The pace of decline in various key healthindicators like read more

According to the document, tabled by Finance Minister Pravin Gordhan in Parliament on Wednesday, South Africa’s read more

Save A Mother: January 1^st, 2008 through June 30^th, 2010

We expanded to two new districts with the help of local NGOs, who wanted to add a health care component to their existing activities. 49 women attended the 3-day induction training in Chikballapur district of Karnataka and 31 women attended the induction training in Mijwan in Azamgarh district of Uttar Pradesh. We are closely monitoring the progress in the new districts to validate the applicability of our program.

As of the end of February 2010, our activists are working in more than 700 villages in five districts of Uttar Pradesh and Karnataka. We plan to expand our work to more villages of these districts and consolidate our work for the rest of 2010.

• Ten one-day refresher trainings were conducted in eight blocks of Uttar Pradesh during December ’09. A total of 83 Swasthya Sakhis (Health Activists) received the refresher trainings.
• We conducted a three-day induction training of Swasthya Sakhis in Rahi block. 21 Swasthya Sakhis were trained and 15 other local women attended the training.
• We trained nine volunteer Master Trainers from Karnataka. We will officially be starting our work in Karnataka on 26th January, 2010 by introducing our program in Chikballapur district.
• Dr Satish Khera, professor of maxillofacial surgery in the U.S., attended our training sessions in Uttar Pradesh. We hope to start an oral health program in the region with his support very soon

Photo taken by Save A Mother staff at Lal Ganji.

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Solutions from Tsunami-hit Tamil Nadu. Click on the link below to find a heartwarming article about the transformation that has taken place in parts of Tamil Nadu that were hit hard by the tsunami. It shows how donation, global aid, and local government efforts can come together and not only successfully reconstruct devastated regions but also create long-term social transformation. Read on… Contributed by Hemant Kashyap

An Invisible Revolution in Rural India. Self Help Groups (SHGs) are a transformational phenomenon that has swept rural India over the last decade and a half. In a country where almost two-thirds of the population have no access to formal financial services, SHGs are a unique route to financial inclusion, increasing incomes, and building productive assets among the poor. Click on the link below to learn more about SHGs and the turning point of the SHG movement in early 1990 when the National Bank for Agricultural and Rural Development (NABARD) in India pilot tested the SHG-Bank Linkage Program. Today more than 400 women join a SHG every hour in India! Contributed by Ravi Grover

We crossed our target of training 400 new health activists in 2009 by November. December trainees will be an added bonus. Over 1,000 women have attended training sessions in 2009 and 412 have been designated as health activists. We have loftier targets for 2010.

We have expanded to a new district. Our team of trainers went to Babina, Jhansi and trained over 20 women. We are attempting to replicate our program there. We will also launch our program in Azamgarh on 6th January, 2010. Starting this month we are for the first time expanding our work to another state, Karnataka. Our trainers will conduct their first training in Chikbalapur, Karnataka. Our training books are currently being translated into Kannada. Mr Kamalkar Hallambi, Ex-Director of the Rural Literacy Mission of Karnataka will lead this program.

We are evolving into a health literacy organization with maternal mortality as our entry point into a community. Recognizing our potential to promote health literacy, our program is getting noticed. The Ministry of Health has asked us to participate in a national health literacy program through a national health portal.  The Ministry of Health will own and manage the portal with private-public partnership. We have already started on this project and in the next few months we will see the launch of the national program to spread health literacy.

According to our plan for 2009, we had planned to pilot test our program in a new district to see if we can replicate our work and methods outside Sultanpur district of Uttar Pradesh. The plan is on schedule. We are expanding to a new district: Jhansi. Our staff will travel to Babina, Jhansi to train new health activists from 26th to 29th November. We have also received requests from other states to start our program there. We may do this in 2010 depending on our resources and experience in Babina, Jhansi. We are currently drawing up our plans for 2010, which we will publish in our January 2010 newsletter.

This fall’s major Save A Mother fundraising event was a Masquerade Ball held on Saturday, October 24th, at the InterContinental Hotel on Chicago’s Magnificent Mile. The first of its kind for Save A Mother’s Chicago chapter in size and scale, the event exceeded its fundraising targets and attracted a noteworthy guest list. The evening featured a silent auction and a fashion show arranged by local fashion designer Poonam Kamdar, with proceeds from the sale of showcased creations going toward the charity. Vocalist Suchismita Das performed a colorful variety of Indian musical pieces, and the evening closed with the tunes of local DJ Sunny Singh.

The event helped further increase awareness on the issue of maternal mortality in high-risk areas in India, while raising sufficient funds to sponsor the training of hundreds of more health activists in Uttar Pradesh. The funds raised will help Save A Mother extend its work to new districts in Uttar Pradesh. The organization extends thanks to the evening’s generous corporate sponsors, including National Republic Bank, Acreete, RedBull, and Quality Inn and Banquets of Burr Ridge. We extend special thanks also to Dr. Abbasi, Ajay Goel, Patricia Dominguez, Tara-Shamo Swaminathan, Sudesh Khosla, Reena and David Reynolds, Desh and Mini Thakkar, Drs. Prema and Brij Malani, Sudesh Vohra, Anita Singh, Miguel Bautista, and Dr. Surander and Vijay Singhal for their generous donations to sponsor health activists in the field.

Save-A-Mother plans to continue the tradition of an annual fundraiser during the Diwali season, with the goal of using proceeds to not only intensify the fight against maternal mortality, but also to begin growing other organizational causes such as tuberculosis eradication.

Incredible Solutions From Around the World: Meet the outstanding winners of The New York Times’ Half the Sky contest. Read on to learn how it is truly possible for one individual to bring about desperately needed change and impact the lives and futures of so many.

• In September, we conducted four, three-day long trainings for new health activists. We trained 79 new activists in all
• We conducted eight refresher training courses for those already in the field
• We are now working in 459 villages and will reach our target of 600 villages by the end of December 2009

REPLICATION

• Our project manager visited Phoolpur in Azamgarh district in Uttar Pradesh to conduct a preliminary survey. The district does not have a larger NGO for us to piggy back on, as we are doing in Sultanpur district. But the district does have a well run girls school, so we will launch our Save A Mother program (health education, trainings, activism) in that school and see how far we can progress. This is a new district for us with a new twist
• Jhansi district in Uttar Pradesh has a micro-credit NGO of moderate size. We will enter this new district by launching our program using that NGO’s support base

LINKAGE WITH ASHA

• Our project manager attended a master training program for training ASHA (Accredited Social Health Activist) workers (they are part of the Government of India’s National Rural Health Mission). The program was conducted by Shabhagi Kendra and PATH in Lucknow. This gives us a better understanding of the ASHA methodology and stronger links with ASHA workers in our area.

USA CHAPTERS

• We are launching a Los Angeles chapter on 7th November, 2009. The chapter will have a small function in Niravana Restaurant
• Our New York Chapter will have a gathering at Sundaram Tagore Gallery on 11th November, 2009. Our Board Chairperson, Ms. Shabana Azmi will attend
• Our Chicago chapter will have a fundraising event – a Masquerade Ball – on 24th October, 2009
• We are exploring chapters in Toronto, San Francisco, and Philadelphia

OTHER UPDATES

• Our Chairperson, Ms Shabana Azmi spoke at FICCI (Federation of Indian Chambers of Commerce and Industry) in Delhi in September on health care and talked about Save A Mother’s work. A full transcript of her speech can be found here
• This is an amazing, inspirational story about what one person can do to bring about change to the lives of so many. And, that one person is only 16 years old!! Introducing Babar Ali…

Birth weight is affected by weight gain during pregnancy. Weight should be gained throughout pregnancy but is most critical in the second trimester. Even if overall weight gain is poor, birth weight is usually acceptable with appropriate second-trimester weight gain. Women who are underweight are advised to gain a total of 12.5-18 kg. This translates to 0.5 kg/wk in the second and third trimesters. Women of normal weight are advised to gain a total of 11.5-16 kg (25-35 lb), or 0.4 kg/wk, in the second and third trimesters. Women who are overweight or obese should limit their weight gain to 7-11.5 kg (15-25 lb), or 0.3 kg/wk, in the second and third trimesters. The demands of pregnancy necessitate additional dietary requirements. Obviously, additional caloric intake is required to support recommended weight gain. Because energy requirements in pregnancy are increased by 17% over the non-pregnant state, a woman of normal weight should consume an additional 300 calories a day of high nutrient density. Nutrient density reflects the amount of protein, vitamins, and minerals per 100 calories of food. Protein should comprise 20% of a normal pregnancy diet. Pregnant women should be aware that many animal sources of protein are very high in fat and might contribute to excessive weight gain; therefore, animal proteins should be taken sparingly. Fat should only comprise 30% of a normal pregnancy diet. Carbohydrates should comprise the remaining 50%. Total energy intake should vary by BMI, but the average recommendation is 2500 calories per day.

Several minerals and vitamins are of critical importance and dosages must be increased during pregnancy. These include Vitamin A, B-1, B-2, B-3, B-6, B12, C, D, E, K, folate, niacin, iron, phosphorous, calcium, and zinc. Folate is of particular importance. A well rounded diet should cover all dietary needs but a vitamin supplement is recommended.

In India, of particular interest is the vegetarian diet. Well-balanced vegetarian diets that include dairy products provide adequate energy and nutrient intake and do not require special supplementation. However, vegan diets may be deficient in vitamins D and B-12. It may also be extremely low in fat, making satisfaction of energy requirements a challenge. Pregnant women who follow vegan diets require supplemental vitamin D, and vitamin B-12. These women also have to pay careful attention to energy intake.

In lower socio-economic regions, there are several steps that are being taken and can be taken to combat poor maternal nutrition. Education is one of the most important components. Teaching women what foods need to be eaten as well as the proper quantity needed to be consumed. Also, providing food to women who do not have access to fresh food needs to be done. Also of critical importance is providing women with necessary supplements such as folate and iron.

Varun Renjen is a physician who has been in cancer research. He is now moving on to medical strategy. He is based in New York and is a Save A Mother volunteer.

Photo taken by Save A Mother staff.

Solution: From polio to HIV, cell phones are playing an important role in Zambia’s child health strategies. Check out this link to learn more.

 

One of our objectives in 2009 is to expand to another district. We conducted our first survey of Phoolpur in Uttar Pradesh to understand local need. Even though membership of the local NGO is not large, we will start a small pilot program. Our program manager Anoop Pant and I will visit the area to start the program at the end of November.

Anoop Pant will also attend a training program in Lucknow, conducted by PATH – an international NGO. Subsequently, he will become a master trainer for ASHA workers of the National Rural Health Mission. This will bring us even closer to the public health workers in our area, with whom we already have a working relationship. We will supplement the public health programs sponsored by the government.

Solution: Changing the lives of women and girls in the developing world can change everything. The empowerment of women could help solve many of the world’s problems, from poverty to child mortality to terrorism. Click on the link below to read how – contributed by Hemant Kashyap

Which got me to wonder why do we get involved? Usually, we can relate to the cause in some way, but, for me, as a lawyer, it’s because I can see the results. I believe that in tough times like this while each of us have a limited amount of capital to invest in the things that interest us, the organization or cause that shows tangible results will succeed more rapidly than the one based on good intentions or slick marketing.

I chose to get involved in the Save a Mother cause not just because of the passion of its founder and some members, but because of its budding use of social media. Before you snidely think “oh so because they are on Facebook/Twitter, you joined?,” let me clarify. To me, it represented several things that most well meaning organizations consistently fail to do.

Transparency: Anytime, anyone actively becomes part of a media that is built on communication, information, and community it is forward thinking and showing a willingness to be an actor in that world rather than just soliciting. Don’t get me wrong, creating a profile can be done by any 14 year old (case in point, my nieces), however participating, disseminating information, and laying it out for all to see shows great faith, trust, and confidence in what the organization stands for.

Viral Marketing: the greatest promise of social media is its ability to connect others with similar interests anywhere across the world. It is as, author Malcolm Gladwell stated, a great “flattener.” In a sense, social media marketing is about giving your fans a platform to talk about you in a positive way – something Facebook makes seamless. If a fan of your Facebook business page decides to comment on something you’ve posted, their friends will see that action in their news feed. If your fans mark a photo as something that they “like” then their friends will see that, likewise, if they sign up to attend an event by sending in their RSVP, it shows up for all of their friends to see. In this way, Facebook can make any content viral.

Participation: Any community is only as good as its communication. If you only talk about yourself, and do not interact with others, you are guaranteeing very few followers and worse, a push back into the closet mentality. Everyone can speak, but what’s important is what you are adding to the conversation. Using social media is an opportunity to grow, and that expansion can only happen if people like you, and want to hear from you. That occurs only when it’s a 2 way conversation. If that doesn’t appeal to you, then social media is not for you.

Examples: So you signed up, you are ready to make change happen in the world, but you are not exactly sure what to do. I have always believed that copying is the sincerest form of flattery, and my initial research took me to http://www.gauravonomics.com/ , a great resource on using social media to create social change in India.

Perhaps the best example that’s stuck with me was this: On April 14, 2009 actor Hugh Jackman pledged to give AUS $100,000 to the charity that could best convince him, via Twitter, that it was deserving of the award. On Friday, Jackman announced that, unable to decide, he had chosen two winners to split the prize: Operation of Hope, a medical foundation that donates surgical procedures to children in developing countries born with facial deformities, and Charity: Water, a non-profit dedicated to providing safe drinking water in developing countries. One of the winning tweets came from Charity: Water president and founder Scott Harrison, who tweeted a link to a photo of a group of Ethiopian children holding up a hand-made sign with the simple message “Dear Mr. Hugh Jackman, thank you for helping us!” Harrison added: “dear @realhughjackman — just snapped this near Eritrean border at a school of 1400 w/o clean water.” (courtesy of PBS.org).

And that is the power of Social Media.

Sanjay Sabarwal is a Save A Mother volunteer. He is also the General Counsel as well as co-owner of Ziba Beauty, a chain of brow lounges in Southern California that specializes in The Art of Threading ® and The Art of Mehndi.

100% of the proceeds from the event went towards training village health activists to reduce maternal mortality and improve health in rural Uttar Pradesh, in India.

Solution: In Africa and South Asia pregnancy and childbirth complications are still the leading cause of death for women. 85 percent of maternal mortality occurs in sub-Saharan Africa and South Asia. Click on this link to learn more about the problems and solutions of maternal mortality in the developing world today – contributed by Shiban Ganju

The participants came from Sultanpur district and two other districts: Azamgarh and Jhansi. The syllabus included extensive interactive training pertinent to rural health. We hope that these participants will help in carrying out further training in their regions with minimal outside help. We will closely monitor the progress and take action to improve. They will also assist with our ongoing training program.

We also continue to train local women to be village health activists who educate and assist the villagers. In July 2009 we will conduct four training sessions at Bhadar, Gauriganj, Amava, and Singhpur Blocks in Uttar Pradesh. 15 to 20 participants will attend each training and the recently trained trainers will assist. 

We will continue to keep you informed of our progress through our newsletters.

Maternal mortality, as defined by the World Health Organization (WHO), is “death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” It is worth noting that 45 percent of these deaths occur within the first 24 hours of delivery. There is direct maternal death which is caused by complication of the pregnancy, delivery, or the management of the birth. Indirect maternal death is pregnancy related death caused by a pre-existing or new medical condition. Some of the major causes of maternal death are bacterial infections, gestational hypertension (pre-eclampsia and HELLP Syndrome), obstetrical hemorrhage, ectopic pregnancy, amniotic fluid embolism, and complications of unsafe abortions. In the developing world, 20 in 100,000 births lead to maternal mortality. It is 400 in 100,000 worldwide and 440 in 100,000 in the developing world. The Maternal Mortality Rate has decreased from 520 to 308 per 100,000 live births in India over the last 40 years. However, many regions of India still maintain a mortality rate of over 500/100,000 such as Sultanpur district in Uttar Pradesh, where Save-A-Mother works. This breaks down to 160 women in India a day dying giving birth. This is very high, even in relation to other developing countries, including nearby Sri Lanka that has a rate of 58/100,000. China has a rate of 46/100,000 births and a developed country such as the USA has a rate of 8.9/100,000 births.

While these are the main causes of maternal mortality; unavailable, inaccessible, unaffordable, and poor quality of care also are major causes of many preventable cases. This is generally from lack of nearby medical care and poor nutrition. These include malnutrition, anemia, infection, sepsis, lack of immunization, excessive bleeding, and difficult labor. Every pound less a child is born than the average doubles the risk of complications. This is precisely the case in Uttar Pradesh. This is where Save-A-Mother comes in. The project, in conjunction with local NGOs, is committed to the education of mothers about pregnancy, nutrition, immunization, delivery, and care of the child through trained health activists. Human care is a fundamental right and through education we believe that society will demand proper care. By starting off on a small scale, the plan is to educate and track maternal progress on an individual basis to ensure maternal safety. The health and safety of children will be followed as well. This data will be collected on a village by village basis to measure progress. This will start off with 190 trained health activists in 150 villages. By the end of 2009, the plan is to have more than 400 volunteers educating about sanitation, infectious disease, AIDS, adolescent health, and reproductive health. Ultimately, the hope is through this methodology as well as fresh innovative ideas that come through over time to expand the program through other villages and states in India to other parts of the world.

Ultimately, success will be measured by a few different avenues. Obviously, a decrease in maternal mortality is tantamount. However, we want a maximal number of mothers to register and be educated through us. As they have more success in child delivery; through word of mouth more mothers join the program and reap the benefits of education. Awareness, education, nutrition, and access to healthcare as well as to institutional delivery are fundamental to the project. Mothers will become accustomed to and demand the newer ways of maternal health as it becomes the norm. The measure of success will not take months but years. But through constant hard work, collaboration, and innovation we know it is possible. We are looking to achieve a 50 percent reduction of mother mortality in 5 years in our pilot project area. The plan is to then expand this to replicate this model in 2 more districts in 2 years and then to parts of India where maternal mortality is higher than average for India.

There are several ways one can help. We are a purely volunteer organization so there is no overhead. One can donate some time, effort, keep others informed, and educate others about maternal mortality. Donations are also welcome. Merely 7 dollars a month will help us develop a master training facility where we can educate health workers to go out to the villages and to pass on the knowledge to help prevent maternal mortality. All donations are tax deductible.

Every woman has a right to go through pregnancy and child birth without the danger of disability and death… Through some simple changes and education we know this is possible. We want to give every mother the safety and facilities to minimize suffering and death associated with the child bearing experience. In turn, we ensure that their children have a mother’s love in life. Many children die before the age of 2 when a case of maternal mortality strikes. No child deserves a life without a mother. Together we can help ensure more mothers survive and are able to have a rich life filled with mutual love with their children. It will take a change in attitudes, hard work, and a little luck to ensure success. With the undying human spirit, anything is possible. So much has already been done over the years of humanity to prevent maternal mortality and now we want to further that progress to every corner of the world. Welcome to Save-A-Mother.

Photo taken by Save-A-Mother staff.

Solution 1: Click on this link to read about the internationally renowned Ela Bhatt and her Self-Employed Women’s Association (SEWA), an empire for poor working women in Ahmedabad, India created using a Gandhian approach – contributed by Rima Shah

Solution 2: Read about a successful micro-planning initiative in Thane District of Maharashtra, implemented by Population First, an NGO working on population and health issues within the framework of women’s rights and social development – contributed by Ashvini Bommakanty