This Chicago Tribune story is a great reminder of how little things -- rather than giant, expensive interventions -- can make such a huge difference in the safety of birth.
Small steps cut maternal deaths
Birth control, iron supplements, safe abortion help reduce mortality in Nepal
By Laurie Goering
Tribune foreign correspondent
December 2, 2007
In the mountains of tradition-bound Nepal, women give birth the way they always have: in the cow shed.
When labor begins, they are sent out of the house, because bleeding associated with childbirth is seen as polluting. Most give birth on dirty rags or simply on the shed's cow-dung floor, sometimes with a local midwife helping. After the birth, the midwife routinely pummels or steps on the new mother's abdomen "to get the bad blood out."
Those traditional practices -- combined with an often four-hour walk to the nearest health facility, an average marriage age of 16 and a tradition of unsafe abortions of unwanted female fetuses -- are key reasons the country's maternal mortality rate has long been among the highest in the world, health experts say.
But over the past decade, as pregnancy-related deaths have fallen worldwide at a frustratingly slow rate of 1 percent a year, according to the World Health Organization, Nepal has managed to cut its losses by almost 50 percent.
It has done so without adding expensive emergency surgical delivery teams, once seen as the only effective way to cut the rural death rate. Instead, it has focused on more routine interventions -- teaching about birth control, giving iron supplements to cut anemia, encouraging later motherhood and providing safe abortions, among others.
"A lot of progress has been made here," said Birthe Locatelli-Rossi, chief of the health section for UNICEF in Nepal. "There's an international belief you can't fix this problem except with emergency obstetric units. No doubt those are really needed, but there are other things to do too."
In Nepal, "we're good at doing what we can with what we have," she said.
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