Maternal and Infant Mortality

Prevention Program

Every minute of every day a woman dies from complications related to pregnancy or childbirth. Each year 530,000 women die from pregnancy related causes. Most of these women live in the developing world with limited access to medical services due to transportation and infrastructure barriers. It is estimated that sixty million women in the developing world give birth each year without a skilled birth attendant present.

When a mother dies, children lose their primary caregiver, communities are denied her paid and unpaid labor, and countries forego her contributions to economic and social development. A woman's death is more than a personal tragedy--it represents an enormous cost to her nation, her community, and her family. Any social and economic investment that has been made in her life is lost. Her family loses her love, her nurturing, and her productivity inside and outside the home.

Safe motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth.

Each year, approximately 4 million newborn infants die during the first month of life, and an additional 4 million are stillborn- most of these deaths are due to infection, asphyxia and birth injuries, and complications of premature birth. Low birth weight contributes to newborn death in about 40-80% of cases. Nearly all of these newborn deaths occur in developing countries, and most of these deaths can be prevented if good quality care is available.

Newborn health and survival are closely linked to the health of the mother before and during pregnancy, as well as during labor, childbirth, and the postpartum period.

In Cameroon, maternal mortality is 1000 maternal deaths per 100,000 live births with a risk of maternal death of 1 in 16. Compare this to the US where maternal mortality is 7 per 100,000 live births. The infant mortality rate, under 1 year, is 87 per 1000 live births and the neonatal mortality rate, the first month of life, is 30 per 1000 live births.   These numbers are greater in rural areas such as Lomie District where most women deliver at home with an unskilled birth attendant. GeoAid Cameroon has included in their strategic plan to improve maternal and newborn care in Lomie District. In November 2007, Geoaid Cameroon conducted an assessment of maternal and infant services in Lomie District.

Mary Carpenter, CNM, FNP, maternal and infant health advisor, and GeoAid Cameroon staff visited Lomie District Hospital, Messok and Nygola Sub-Hospitals and 11 private and public health centers. Facilities were assessed for their ability to handle maternal and newborn complications and their capacity to provide emergency obstetrical care. Doctors, nurses and pregnant women were interviewed to identify problems with accessing care.  Maternal and infant morbidity and mortality rates were reviewed.  Local village traditional birth attendants were also interviewed to determine their level of experience and birth practices.

The assessment determined that most women in Lomie District give birth at home with a traditional birth attendant. TBAs have little or no formal training and lack problem identification skills needed for early problem recognition and referral. Complications and maternal deaths that were reported at the health centers were predominately from obstructed labor and postpartum hemorrhage. Complications from unsafe abortions were also prevalent. Sepsis and prematurity were the most common reported complications in newborns. Actual rates for these problems were difficult to estimate without more accurate reporting of maternal and infant morbidity and mortality rates but are far greater than the national statistics on these indicators.

GeoAid Cameroon has included in their health plan for 2009 a program to address problems with maternal and infant mortality. In collaboration with the ministry of health, the American College of Nurse-Midwives (ACNM), Home Based Life Saving Skills (HBLSS) program will be implemented. HBLSS program is a community and competency based program that aims to reduce maternal and neonatal mortality by increasing access to basic life saving measures within the home and community and by decreasing delays in reaching referral facilities where life threatening problems can be managed. It is a program designed for countries where home birth is common and access to skilled health care providers is limited. HBLSS has been field tested in India and Ethiopia and has been implemented in Haiti, Liberia, Bangladesh and Afghanistan. HBLSS is a cascading training model with a multiplier effect that should institutionalize the programs in 18 months to 2 years. It is estimated that 15,000 people will be trained in safe delivery techniques and early problem recognition the first year. The program begins with families and then mobilizes communities in solving their problems with access to care.