Strong professional links to academic institutions are necessary to address global maternal and neonatal mortality, says a new Michigan Medicine paper.
Around the world, women and newborns still die every day from childbirth.
And one group plays a central role in reducing maternal and neonatal deaths: academic institutions, according to a new Michigan Medicine-led article in the American College of Surgeons Bulletin.
Lead author Frank Anderson, M.D., MPH, professor in the Department of Obstetrics and Gynecology at University of Michigan's Von Voigtlander Women's Hospital, is working to bolster this support.
Anderson leads the 1,000+ OBGYN initiative, which aims to train more than 1,000 new OB-GYNs in the next 10 years to help prevent maternal and neonatal mortality in sub-Saharan Africa.
He answers questions about how institutional partnerships may address global health inequities.
How prevalent is maternal and neonatal mortality in developing countries?
Anderson: We don't have an accurate way to truly measure the problem because so many deaths go unreported, especially in rural areas where women die in their homes and never get to a hospital. But we know it's a crisis.
Globally, reproductive health issues are a leading cause of poor health and death of women of childbearing age, and women in developing countries suffer disproportionately from reproductive health issues. Women's health continues to be a particularly urgent health issue in sub-Saharan Africa and South Asia, which account for nearly 90 percent of maternal deaths worldwide. Maternal mortality is highest among sub-Saharan Africans, with 546 maternal deaths per 100,000 live births, or roughly 200,000 maternal deaths a year — compared to 13 deaths per 100,000 live births in the U.S. and eight per 100,000 in the U.K.
Why are so many women still dying from childbirth?
Anderson: The most common causes are issues we see and treat all of the time in the U.S., including preeclampsia [a condition related to high blood pressure during pregnancy] and postpartum hemorrhage [heavy bleeding after birth]. Midwives and health workers are trained to provide the first line of defense. But some people need advanced care like blood transfusions or surgery — something only an obstetrician can do and that requires anesthesia, which is scarce in developing countries. We have to complete the maternal team. The obstetrician piece is sadly missing in so many parts of the world.
Many of the pregnancy complications that could be detected, followed and managed require action at the right time go unaddressed. Here at Michigan, for example, we see life-threatening pregnancy complications every day — but we are ready to handle them. We identify at-risk pregnancies and babies at risk of health complications and act quickly to treat them before and after birth. That complex management requires a modern obstetrics approach. Many women around the world do not have access to these approaches that we take for granted here.
What's unacceptable is that most of these maternal and neonatal deaths are preventable. We know how to reduce maternal and early neonatal mortality in the U.S. and we need to share that knowledge and experience to help global partners protect women and newborns everywhere.
Maternal mortality is the health indicator of the greatest disparity between developing and developed countries. To leave it unaddressed leads to unnecessary suffering for women, children and families.Frank Anderson, M.D., MPH
What role do academic institutions play?
Anderson: We know that international academic partnerships have the potential to make monumental breakthroughs in the health of poorer countries. University-based programs can be integral to global health development.
Countries are lacking professionals that can actually create the programs on the ground to create a sustainable system for quality care. In order to achieve the United Nations sustainable development goals, universities need to be involved in creating a cadre of faculty and practitioners in each country to fill in the gaps. What we keep learning over and over again is that the future of global health depends on engaging these partnerships where universities can train faculty, researchers and health professionals to help create a health context and academic curriculum in line with modern obstetric. Some programs have already been established but we have more work to do to integrate care.
What are some successful examples of these partnerships?
Anderson: For more than two decades, U-M's collaboration with Ghana has helped train and retain more than 240 obstetricians in the country via in-country training programs that pool resources and knowledge. This is an incredibly strong model that we hope to expand and adapt to other global programs. We have a similar effort in Ethiopia, with a U-M center working with local medical schools to train health professionals in critical, lifesaving reproductive health services not generally accessible to many women in low-income countries.
What are the ideal next steps?
Anderson: You have to start from the beginning. Many African countries don't have enough well-trained professionals to develop a country's modern obstetric plans to prevent maternal and early neonatal mortality. People in the U.S. see doctors who have been trained and certified by a specialist board. These types of training programs and boards don't exist in many African countries. Women don't have equal access around the world to modern obstetric care and the institutional support for sustainability.
Addressing global health inequities requires a comprehensive response from the world's professional societies and surgical, anesthesia, and obstetrics and gynecology communities. The dream would be to establish an international consortium to prevent maternal neonatal mortality, to expand and connect academic partnerships to start OB-GYN training programs to measure the effect of training and add as many new highly trained OB-GYNs as possible.
We need to build a strong foundation, starting at the education level. These health care professionals need to share evidence-based knowledge and experience and collaborate to develop training programs and initiatives that ensure sustained, functioning health care systems. If you only have a couple of OB-GYNs in the country in the first place, how are they going to train the rest of country?
The goal would be to create a network to build a core based on our experience in Ghana, Ethiopia and other colleagues who have had experience with this so they can teach other universities how to do it as well. We would build equal partnerships with other countries, with our own students benefiting from learning opportunities in developing countries.
Why is this an important health issue to solve on a global level?
Too many women are dying strictly because they have poor access to the high-quality care they need. No woman should have to suffer poor health outcomes because of where she lives. It's unacceptable that women and babies are dying in poor countries, and it's completely preventable.
How we treat women in the world is extremely important. It is a moral responsibility. Maternal mortality is the health indicator of the greatest disparity between developing and developed countries. To leave it unaddressed leads to unnecessary suffering for women, children and families. When a mother dies, her children are more likely to die as well. A mother's health affects her family, community and society. We aim to work toward erasing these inequities and preventing unnecessary death and suffering
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