Reducing maternal and newborn mortality to advance Rwanda's future

Sometimes the technical words we use to describe a problem mask its true nature. Such is the case for the approximately 1,300 women who die during pregnancy or delivery each year in Rwanda. For them, the official cause of death may be recorded as postpartum hemorrhage or uterine rupture. Similarly, for the alarming number of newborns who perish, their mothers may be informed the cause was asphyxia or birth trauma. Yet in each of these cases, the underlying cause of death is actually something far more fundamental: lack of access to basic health care. The vast majority of the mothers and newborns who die in Rwanda are lost to preventable health problems. They would have survived had they lived in a wealthier community with more doctors, hospitals and resources. Unfortunately, this picture is representative of a much larger crisis in maternal and newborn health. According to UNICEF and the World Health Organization, 800 women worldwide die each day of preventable complications related to pregnancy and delivery. And every day, 7,400newborns die, most also from avoidable causes. It is a gross injustice whenever the joyous occasion of birth instead is a preventable death. But there is reason for optimism. Over the past generation, global efforts have significantly reduced maternal mortality, and newborn deaths have declined as well. New data released this week confirm that Rwanda is making progress battling maternal and newborn mortality. Since 1990, Rwanda has reduced both under-five mortality and maternal mortality by approximately three-quarters. Further, last year, approximately 95 per cent of Rwandan HIV-positive mothers received services to prevent mother-to-child transmission of HIV – a significant increase from less than 1 per cent in 2005. Progress comes at an important time. Last month, world leaders gathered at the United Nations headquarters in New York to adopt an ambitious set of Sustainable Development Goals for eliminating extreme poverty and building a prosperous, healthy planet. These goals, which call specifically for further reductions in maternal and newborn deaths, have the potential to accelerate progress even further if we stay focused on what works to save lives. Simple interventions go a long way. These include exclusive breast-feeding, keeping a newborn’s umbilical cord wound clean and dry to prevent infection, and promoting skin-to-skin contact between newborns and their mothers to regulate the baby’s body temperature and breathing. Meeting women’s health needs is just as important, and a newborn’s well-being is closely tied to her mother’s. Providing women with greater access to family planning and other essential services, as well as nutritious food, can help to ensure that women and their children stay healthy and strong enough to contribute to the development of their families and communities. We also need to help countries strengthen their primary health care systems so that more women and newborns have access to quality services and vital medicines before, during and after delivery. Countries and international donors can do this by increasing funding levels for primary health care, collecting better data on where gaps in services are greatest and by training more front-line health workers to deliver basic education and care to people and places that have little or none. If we take these steps, I believe that we can end most preventable maternal and newborn deaths — as well as eliminate the health disparities within and among countries so that every child has the chance to prosper — within a single generation. This is the message I took with me to Mexico City this week, as experts from around the world came together to discuss how to align their efforts at the Global Maternal Newborn Health Conference. While in Mexico, I thought about young women like Sarah Briton, who I met recently in Malawi after she gave birth to her first child, a healthy baby boy. Late in her third trimester, Sarah made the five-hour journey to Malawi’s capital city, Lilongwe, where she could stay in a home near a women’s clinic to ensure that she and her baby had access to lifesaving care when she went into labor. Sarah wasn’t willing to accept the idea that her and her baby’s lives could be cut short simply because they were born in extreme poverty. She knows that progress is possible, and she’s ready for it to begin with her and her family. Many women across Rwanda undoubtedly share Sarah’s story. If we’re willing to match their commitment with our own, we can help guarantee a healthier, brighter future for women and children everywhere. Melinda Gates is co-chair of the Bill & Melinda Gates Foundation.

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Reducing maternal and newborn mortality to advance Rwanda's future