Foundations working on issues of Maternal health

1. An intergenerational network of Vermont women with the
common goal of supporting sustainable change in the lives
of women and children around the world. We are pooling
our resources to leverage the power of our donations, to
fund existing non-profits whose programs and services
address the issues of human rights, safety, health and
education for those in need.

2. Maternal Health
The Difficult facts:
 536,000 maternal deaths, 3 million stillbirths, and
23.7 million newborn deaths each year. Of these, it
is expected that 358,000 women and 3.6 million
newborn babies die due to largely preventable
complications during pregnancy, childbirth and the
postnatal period. This does not include the over 3
million babies who are stillborn.
 98% of these deaths occur in the developing
world.

3. Maternal Health
The Difficult facts:
 Worldwide, nearly 1,500 women and more than
10,000 newborns die every day from complications
of pregnancy or childbirth that could have been
treated or prevented with adequate care . These
needless maternal deaths—almost 350,000 per year—
have left millions of orphaned children behind.
And for every maternal death, another 20 women are
injured or disabled as a result of pregnancy or
childbirth—at least 10 million women every year.

4. Maternal Health
The Difficult facts:
 Maternal mortality is a sensitive indicator of
inequality, and current statistics show that the poorest
and least educated women have the highest risk of
death during pregnancy or childbirth

5. Maternal Health
The Difficult facts:
 In developing countries such as Rwanda or
Malawi, one woman out of every 35 dies as a result of
pregnancy or childbirth. In contrast, in Japan, only one
of 12,200 women will die in pregnancy or childbirth .

6. Some possible solutions:
 Ensuring free comprehensive health services
 Providing logistical assistance for women to reach health
facilities
 Training and staffing a strong network of community health
workers
 Strengthening the quality and quantity of services, provided
through public clinics and district hospitals family
planning, comprehensive neonatal care, adequate nutrition, and
professional medical attention for childbirth and emergency
complications of pregnancy.
 The vision is a world in which skilled care at every birth is
ensured for all women and their babies, regardless of their
social, cultural, ethnic or religious backgrounds.

7. Some possible solutions:
Four focus areas
 It is critical to understand the deep-rooted cultural beliefs in families
and communities that have a huge impact on a women’s decision to as
to whether or not she seeks skilled care during pregnancy and
childbirth.

 1 Skilled obstetric care for pregnancy and childbirth
 Throughout the developing world, 52 million births occur without help
from a skilled attendant, and 35 percent of pregnant women have no
contact at all with health personnel before delivery.
 Yet potentially fatal complications occur in 15 percent of all births.
 An estimated 700,000 midwives are needed world wide to ensure
universal coverage with maternity care, but there is currently a 50%
shortfall. In addition, 47,000 doctors with obstetric skills are required.

8. Some possible solutions:
Four focus areas
 2 Family planning
 Family planning is among the most effective tools for
reducing maternal mortality. Nevertheless, 50 percent
of all pregnancies worldwide are unplanned or
unwanted, accounting for nearly 300,000 new
pregnancies every day.
 These programs we’re talking about tonight mobilize
and train health workers trained in sex education and
reproductive health counseling, sexually transmitted
diseases (inc. HIV) contraceptive methods..

9. Some possible solutions:
Four focus areas
 3 Preventing mother-to-child transmission of HIV
 Ninety percent of the 2.5 million children living with HIV
became infected during childbirth . So did the vast
majority of more than 300,000 children who die of AIDS
each year before reaching the age of 5.
 Yet a simple and highly effective treatment for prevention
of mother-to-child transmission of HIV (PMTCT) has been
available in developed countries since 1994.
 This starts in pregnancy with HIV testing, providing
antiretroviral therapy, counseling on infant feeding and
advising on safer sex practices. In addition, it includes
appropriate obstetric practices, to prevent mother-to-child
transmission of the virus during childbirth.

10. Some possible solutions:
Four focus areas
 4 Postnatal care for mothers and babies
 This includes helping mothers and babies in
breastfeeding, managing complications such as severe
postpartum bleeding, infection, and depression. As
well as counseling on postnatal contraception.

11.  Http://www.vimeo.com/8704278
 http://www.vimeo.com/8704278

12. Partners in Health
Family planning
 Family planning is an integral part of the model of comprehensive
women’s health care that was developed in their clinic in Haiti.
 Each of Haiti’s’s clinical sites has a full-time nurse trained in sex
education and reproductive health counseling.
 They have been offering free condoms and other contraceptive
methods for over 15 years.
 In 2003, they began training and mobilizing community health workers
who specifically promote family planning and women’s health. These
ajans fanm (women's health agents) travel throughout the
countryside, teaching women and men about sexually transmitted
infections (including HIV) and contraceptive methods, distributing
condoms and oral contraceptives, and referring pregnant women and
others to the clinics. This successful model is being replicated at PIH
sites in Rwanda, Malawi and Lesotho.

13. New Maternity
Clinic in Rwanda

14. Partners in Health
Skilled obstetric care for pregnancy and childbirth training
specialized community health workers
 In Haiti each Clinic site has a fully-functioning women’s health clinic staffed by a professional
midwife and six full-time obstetrician/gynecologists cover all of PIH’s clinical sites. PIH also
works with matrons, traditional birth attendants, to refer women to prenatal services and
hospitals for delivery.
 in Rwanda, rapid scale-up of obstetric and comprehensive women’s health care has been facilitated
by the support of clinicians with years of experience in rural Haiti. The nursing staff at the women’s
health clinic at Rwinkwavu Hospital includes specialists trained in prenatal counseling and delivery
as well as family planning. The number of women receiving prenatal care continues to grow.
 In Lesotho in June 2009, PIH began training specialized community health workers to educate
and accompany pregnant women to the health center and ensure that they receive care from skilled
health professionals.
 As of January 2011, 203 women had been trained to serve as Maternal Mortality Reduction
Program Assistants (MMRPAs), many of whom are former traditional birth attendants.
 Establishing “mothers’ waiting houses” for 1-2 weeks before due dates so that all deliveries occur at
the clinic; giving new baby care packages that include blankets, clothing and hygiene items to women
who attend all ANC appointments, are tested for HIV, and deliver at the health center; and providing
ART or PMTCT prophylaxis to HIV-positive pregnant women.
 The MMRP has dramatically increased women’s access to health care. In 2010, 70% of reported
deliveries in Bobete Health Center in Losotho catchment area occurred at the Health
Center, constituting a 350% increase in facility-based deliveries. Furthermore, the number of
pregnant women seeking prenatal care, HIV testing and other health services through the Bobete
Health Center continues to rise.

15. Partners in Health
Preventing mother-to-child transmission of HIV
 90% of the 2.5 million children living with HIV became infected during
childbirth.
 So did the vast majority of more than 300,000 children who die of AIDS each year before
reaching the age of 5.
 PIH programs continue to demonstrate that even in low-resource settings, virtual
elimination of mother-to-child transmission of HIV is both necessary and possible.
 In 1995, the clinic in Haiti began providing antiretroviral treatment for PMTCT to HIV-
positive pregnant women in rural Haiti. ZL continues to offer free HIV counseling and
testing to every pregnant woman seen, and recorded nearly 90,000 visits with pregnant
women in the past year alone. Since the PMTCT program was introduced, the HIV
infection rate of newborns has fallen to levels rivaling those in developed
countries.
 The model for preventing mother-to-child transmission developed in rural Haiti has
become an essential and standard component of PIH's model of HIV prevention and care
wherever we work. In Rwanda, Malawi and Lesotho, PMTCT programs are integrated
into comprehensive care for both mother and child. After giving birth, mothers living
with HIV receive counseling and a small monthly stipend to cover basic nutritional needs
and monthly travel costs to the clinic. They are also paired with an accompagnateur,
a community health worker who will deliver and observe antiretroviral therapy
twice daily.

16. Summary of Partners in health
 Enhancing the rights, power, and opportunities for women
is critical to addressing the underlying causes of maternal
mortality.
 PIH seeks to increase women’s right to healthcare by:
ensuring free comprehensive health services, providing
cash transfers and logistical assistance for women to reach
health facilities, training and staffing a strong network of
community health workers, strengthening the quality and
quantity of services provided through public clinics and
district hospitals, and pursuing scholarship and advocacy
for global policy change.


17. Partners in Health
What our donation can buy
 $5000 Provides 10 specialty beds for safe labor and
delivery
 $1000 Hire and train a maternal health worker for
one year
 $500 Purchase a fetal monitor
 $250 Provide a surgical kit for cesarean section
 $100 Stock birthing kits for five deliveries
 $50 Supply blood pressure cuffs for every prenatal
visit

18. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
 COMMUNITY-BASED INITIATIVES
Are serving 50 villages and 29,000 people, and include:
COMMUNITY HEALTH WORKER TRAINING:
These are volunteer village members who are charged with
the responsibility of overseeing the health of their fellow
community members. Lectures are provided on topics
including pregnancy, normal labor, and emergency
recognition and complication readiness. Upon
completion, over 200 Community Health Workers in fifty
villages will have been trained.

19. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
Dr. Lisa Nathan conducting community health worker
training at Nyamasheke Health Center

20. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
COMMUNITY LEVEL MATERNITY CENTER:
Health Posts provide the foundation of the health care
service delivery in Rwanda. Health Posts can be found
at the village level, and provide basic ambulatory
services to vast numbers of people.
The services of the Health Post in Gako have effectively
been expanded by starting birthing services at the
site. A new building with running water and solar-
powered electricity provides an accessible destination
for rural mothers in labor to have uncomplicated
vaginal deliveries.

21. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
TRANSPORTATION ASSOCIATIONS:
Transportation is one of the major obstacles to
accessible birthing services for women in rural
Rwanda. A hilly terrain without developed
infrastructure makes traveling even short distances
difficult and dangerous for pregnant women.
Volunteer associations have been mobilized in each
village and supplied with a traditional ambulance to
help transport women in labor to the nearest birthing
facility.

22. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
MOBILE REPRODUCTIVE HEALTH CARE
DELIVERY:
Prenatal care, family planning, birth planning, and
prevention of mother-to-child transmission of HIV are
provided as a mobile service to the 14 villages within
the Nyamasheke District.
These services are provided by a nurse who visits one
village per day, meeting with patients in a central
location to each village population.

23. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
Project Coordinator conducting community
sensitization in Shara cellule for the mobile
reproductive health services

24. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
HOSPITAL-BASED INITIATIVES at the Kibogora District
Hospital, one of two District Hospitals in Nyamasheke District, that
serve approximately 588 Villages, include:
PATIENT SAFETY MEASURES: Various measures have been initiated
on the maternity ward to decrease error and improve overall patient
safety. Protocols and checklists have been developed and implemented
with the local staff. Hemorrhage kits have been made readily available
in the delivery room and operating theater.
Leadership capacity building activities have been initiated, including
identification of a Chief and Assistant Chief of Maternity among the
generalist physicians working at the hospital. These two doctors now
work solely on the maternity ward, and work closely with the head
maternity nurse to provide continuity of care for all patients on the
maternity ward.

25. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine

26. The Rwanda Women’s Health Initiatives of the
Albert Einstein College of Medicine
PHYSICIAN AND NURSE EDUCATION:
Recognizing the lack of specialty training among the physicians
working at Kibogora, a curriculum that includes hands-on training, has
been developed to cover basic labor management, obstetric
emergencies, and basic gynecology. Lectures and hands-on training in
labor management is also being provided to the maternity ward nurses
and midwives at the hospital as well as at the Nyamasheke Health
Center (a main referral site.)
To further enhance skills and education, physicians are provided an
opportunity to participate in an intensive five-week training at The
Albert Einstein College of Medicine. The Bronx, NY labor floor
provides an ideal learning environment. The physicians participate in
an observership on the labor floor combined with an intensive
obstetric emergency simulation-based training program.

27. The Rwanda Women’s Health Initiatives of
the Albert Einstein College of Medicine
What our donation can buy
$20 Pays for an entire box of Magnesium Sulfate
(to prevent Eclampsia, one of the leading causes of maternal mortality)
$20 Pays for 100 tablets of Cytotec/Misoprostol
(for postpartum hemorrhage, the leading cause of maternal mortality in Africa.
Approximately five tablets are used to treat a case of postpartum hemorrhage)
$400 Purchases a Labor and Delivery Bed
$300 Purchases a Postpartum Bed
$100 Provides a Delivery Kit (Contains essential materials used to deliver a baby)
$233 Funds a nurse’s salary for a month
$700 Funds a nurse for an entire quarter
$300 Pays for the mobile services program for one month
$900 Pays for the mobile program for an entire quarter
$615 Funds all maternity center operation costs for a month
$1,850 Funds for the maternity center for an entire quarter

28. Future Meeting Dates
The first Wednesdays of each month

 August 3, 2011
 September 7, 2011
 October 5, 2011
 November 2, 2011
 December 7, 2011
 January 4, 2012
 February 1, 2012
 March 7, 2012
 April 4, 2012
 May 2, 2012
 June 6, 2012