The survey estimates that 29 percent of Nepalese children under the age of five are malnourished and that the burden is not distributed equally between genders. Boys and men, for example,  traditionally eat meals first and consume the most nutrient-rich foods, while women and girls eat what is left over.

Indra Raj Panta, program officer for UNICEF’s Decentralized Action for Children and Women in Nepal explains, “Girls are neglected because they are thought not to need strength.” This sentiment does not reflect the labor responsibilities demanded of Nepalese women and girls, who continue to labor throughout their pregnancies. The result is a cycle of women delivering underweight babies who are then subject to stunting and wasting. IRIN notes, “Girls who are not fed well turn into women who are more likely to give birth to low weight babies, and so the cycle perpetuates.”

Read the full IRIN article.

Read the Nepal Demographic Health Survey Preliminary Report.

Photo by I, Seeteufel [GFDL (www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (www.creativecommons.org/licenses/by-sa/3.0/) or CC-BY-SA-2.5-2.0-1.0 (www.creativecommons.org/licenses/by-sa/2.5-2.0-1.0)], via Wikimedia Commons

Women face particular danger of sexual assault and violence when searching for firewood in the bush outside of the camps. With many refugees in competition for wood, tensions are high. Boisson quotes  Sinead Murray of the International Rescue Committee as saying, “There’s a fear of going to the bush because they think they are going to encounter violence. Many women say that there are men in the bush and these men have guns and they’re going to attack.”

Even the numbers of reported attacks in Dadaab are misleading; the stigma associated with sexual assault, coupled with lack of confidence that perpetrators will be penalized, leads to an underreporting of gender-based violence. While aid groups work to offer counseling to victims and provide female refugees with whistles and flashlights, the pervasive threat of violence against women in the camps reveals the complete lack of protection and security of the displaced Somalis.

Voice of America also reports on sexual violence against Somali women.

Photo by Oxfam East Africa [CC-BY-2.0 (www.creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

Dr. Mabeya stresses that the solution is to lower the cost of cesarean section delivery, particularly in rural areas of the country. Pre-natal care and delivery within a health facility by a trained birth attendant can prevent obstetric fistula for the women of Kenya, but only if they can afford and access such treatment. The impact of user fees or copayments on health is an urgent human rights issue.

The information needs of frontline health care professionals are vast, ranging from the latest WHO protocols and country-level policies to knowledge of the newest life-saving technologies. Promising new technologies — including mobile health facilities; lightweight, portable diagnostic tools; solar-powered devices; and simple ways to save neonates — are emerging at a more rapid pace, but these developments are not centrally tracked. Such innovations are often reported in medical journals, but subscription requirements mean that this information is out of reach for many. In addition, most innovations are only written up once they are through testing and/or trials and not at the very early stages of their development. Thus, even after life-saving technologies are developed, a major barrier to use of these technologies still exists — knowledge of their existence. One solution: websites like Maternova.

Maternova is a new online knowledge-sharing platform (or “innovation portal”) that brings together social entrepreneurs who are developing or have developed life-saving technologies. The website allows all of their ideas and innovations to be documented in a single place. A number of these innovators are well known globally, but many of the innovations have only been uncovered after months of research. Now, innovators are starting to come to us through word of mouth.

As our name suggests, Maternova purposefully focuses on much-needed global access to information on maternal and newborn technologies. We also provide information on a variety of more general innovations — to us, anything that augments or expedites safe childbirth (for mother and infant) in the field is an innovation, including improvements in lighting, power, infrastructure, communication technologies, and, of course, health technologies. These are all part of a health system that can save mothers’ lives.

Three very basic questions guide our work. First, what are the effective, low-cost tools (both those in development and those on the market) that can save lives? Second, given the tools that exist, what are the priorities for new ideas? And third, where are the facilities located that can provide skilled care to women?

An example of a simple, low-cost, life-saving tool is a calibrated bag that is used to measure postpartum hemorrhaging, which is the leading cause of maternal death in low-resource settings. In these settings, there is often no way to measure how much blood a woman is losing during delivery — often midwives will simply look at how many cloths are soaked through with blood. A group in India developed a calibrated drape — a bag that simply collects the blood and measures volume of blood lost. This simple plastic bag can (with proper training of the birth attendant) help signal when a woman needs to be urgently referred to a higher level of care.

Mahmoud Fatallah eloquently stated a connection between maternal survival and human rights, saying “When women are risking death to give life, they are entitled to have their own right to life and health protected.” The rights to skilled care at birth, to measurement of what is going wrong in labor and delivery, to other life saving tools are all extremely concrete dimensions of the human right to health.

Our approach is extremely practical, and we rely upon reports from the field about new, simple technologies and about which techniques that are working. For example, through the Maternova site, we learned that a group in California has imported the drape concept from India and is now using it throughout the state.

We believe that by connecting the various groups already linking nurses, midwives, and physicians (including GHDonline’s Global Health Nursing and Midwifery Group) and exchanging concrete solutions, we can accelerate and amplify the kinds of exchanges described in the calibrated postpartum hemorrhage bag example. And looking forward, we would like to assist these groups in bringing their own priorities for innovation to the forefront of global health policy dialogue.

For more information, please visit http://maternova.net. To go directly to the tools for maternal health, please see http://maternova.net/tools/to-save-mothers, and for the tools for newborn health, please see http://maternova.net/tools/to-save-infants. For Structures and Systems, please see http://maternova.net/tools/structures-and-systems. And if you have a specific idea for an innovation to be featured in the Index, please send word through the comment section on the Maternova site.

Meg Wirth is the founder of Maternova and a S.E.VEN fellow. She has worked on women’s health and inequalities in health throughout her career in Appalachia, for John Snow International’s Mothercare project in Jakarta and South Kalimantan, Indonesia, and for the Rockefeller Foundation. She is also a co-author of the UN Millennium Project’s final report on child and maternal health titled Who’s Got the Power? She has a BA from Harvard University and an MPA in international development from Princeton University’s Woodrow Wilson School.

At a recent conference, health delegates from 42 countries agreed to implement a new strategy that trains NPCs in emergency obstetric surgery to address the lack of health care workers. Along with other developing areas, most African countries are suffering from a significant lack of medical professionals. This shortage is particularly implicated in the high rates of maternal and infant deaths during childbirth. The WHO has estimated that in sub-Saharan Africa alone, there is a shortage of nearly 1.5 million health care workers; women there face a 1-in-13 risk of dying in childbirth. Most women are unable or unwilling to access medical facilities or workers, even during emergencies; for example, in Ethiopia, only 6% of all births occurred in a health facility.

By expanding the number of NPCs and training them in surgical childbirth procedures, it is hoped that more births will be attended by trained health care workers who can assist women during emergencies. A program in Mozambique that trains midwives in surgical techniques has already achieved significant results. The country is on the way toward meeting several of the UN’s Millennium Development Goals, particularly those surrounding maternal and newborn health.

In a similar low-tech program, USAID’s maternal health group ACCESS (Access to Clinical and Community Maternal, Neonatal, and Women’s Health Services) focuses on developing and extending home and community based interventions. A new report from ACCESS is a guide for carrying out “community mobilizations” to improve maternal and newborn health. The program focuses on identifying the specific obstacles of the community, and working with the population to implement realistic changes. For example, essential interventions like the use of misoprostol (which induces labor) can generally be provided safely by trained health care workers at the household and community level, and prevent almost 70% of infant deaths. Additionally, simple preparations, such as providing folic acid to the mother during pregnancy and preparing a clean space for the birth, can be done by community health workers trained in pregnancy and childbirth.

More information:

Video: Birth of a Surgeon (documentary of Mozambique’s midwife training program)

In War and Isolation, a Fighter for Afghan Women

Bold Solutions to Africa’s Health Worker Shortage

Malawi: Role of traditional birth attendants to change

Global Low-cost Health Initiatives