A doctor from Tanzania and members of an American grassroots political action organization recently paid a visit to Birmingham to drum up support for legislation aimed at reducing the numbers of mothers and children who die before or during childbirth.
Pediatrician Dr. Namala Mkopi and members of RESULTS — which describes itself as “a movement of passionate, committed everyday people” committed to “influence political decisions that will bring an end to poverty” — say that a piece of bipartisan legislation called the Reach Every Mother and Child Act is one of the keys to significantly reducing maternal and infant mortality, which is particularly acute in poor countries.
According to the World Health Organization, nearly 830 women die from preventable causes related to pregnancy and childbirth every day, meaning that by the end of 2015, 303,000 women will have died from such causes. 99 percent of those maternal deaths occur in developing countries. The numbers of women dying from issues arising during pregnancy and childbirth is higher in rural areas and poor communities.
Despite these advances, every year 6.6 million children die before five years of age (44 percent as newborns) and [on average] 289,000 maternal deaths occur, most from preventable causes.
During the period of 1990 to 2015, the numbers of mothers dying during pregnancy or childbirth has dropped 44 percent, WHO reports. But the numbers, advocates say, remain unacceptably high. That is especially true in Sub-Saharan Africa and Asia where more than four-fifths of all maternal and child deaths occur.
That includes Tanzania, where Dr. Mkopi regularly sees the dire circumstances of mothers and their children. And it includes South Africa, where the story of a child named Kiki brings the point home, especially for a UAB School of Public Health student who is working with RESULTS, Aarin Palomares.
Palomares, who is working on her bachelor’s and master’s degrees at the same time, is a Real Change Fellow with the Birmingham contingent of the Washington, D.C.-based organization RESULTS. “Real Change is a youth program. It’s a fellowship for one year,” she said. Her fellowship started in May.
“Last summer I actually did a scholar program in South Africa and I stayed with a host family while I was there,” Palomares said. “And we had this little girl, her name was Kiki. She was 5 years old. And every day when I came back from the work that I was doing, Kiki would always wait for me by the door with this beach ball and she was always ready to play. We would always play in the front yard until her mom called us in for dinner. Kiki was my favorite part of that experience….
“One day her mom told me that Kiki wasn’t always this active little girl,” Palomares recalled. “She was very sick when she was first born and the closest hospital was an hour away. They had no way to get her there. There was no sort of transportation that they could have accessed, so really, the only reason Kiki got out of that bad situation and she was able to be diagnosed and treated was because … her uncle was one of the two villagers in that rural village to actually go on to university. He was actually a nurse in Cape Town, which was four hours away. And he came back and he stayed and now he practices community health in the village to make sure they have basic health care.
“But if Kiki’s uncle hadn’t come back, she could have easily died from something that was completely preventable. So really the legislation works to increase access to people like Kiki and people in these rural villages where they don’t even have access to basic needs.”
For Palomares, that experience makes the need to improve health care in poor and rural areas particularly understandable. Still, the issues of poverty and infant mortality are hardly unheard of in Alabama.
“Poverty is not just an issue around the world, it’s an issue here as well, especially in Alabama,” said Laura Turner, a local RESULTS volunteer. “And with that poverty comes decreased access to just primary healthcare.”
There were 58,162 children born in Alabama in 2013, according to the Alabama Department of Public Health. Of those, 13, 697 were born to mothers who had less than adequate care — meaning that the mother had less than half the number of prenatal health care visits or did not start getting prenatal care until after the fourth month of pregnancy, according to ADPH.
Between 2011 and 2013, Alabama’s infant mortality rate was 8.5 percent. During that two-year period 1,500 infants died statewide. In Jefferson County, 300 infants died during that period, giving the county a higher rate of infant mortality at 11.3 percent.
As sobering as those numbers might be, the situation on a global basis is worse. “Millions of people die every year from preventable diseases,” Turner said. “We’ve worked over 35 years … on decreasing this and we’ve had great impact. However there’s a lot more work to be done.”
Mkopi is the Secretary General of the Pediatric Association of Tanzania, and an attending pediatrician at Muhimbili National Hospital. A leading advocate for child health in his home country, Mkopi’s expertise is in clinical pediatric medicine, research, and community-based child health issues.
Still he said, he would never have fully understood the issue of maternal and child health had he never married and become a father. “I’ve learned quite a lot but it all made sense when I became a father,” Mkopi said. “I can’t take it — seeing if my son would have died because of these preventable diseases or my wife would have died while giving birth to my son because of these diseases. I am lucky and my family is lucky that we are together. But there are so many other women and children who are dying in my country because of these very preventable causes of death.”
Like many other parts of the world, Tanzania has seen decreases in mortality of mothers and infants, but it’s not enough, Mkopi said. “As a country we have actually made a lot of progress but we can’t still bear the numbers we have now,” he said.
In the 1990s more than 800 women died for every 100,000 live births. Today, that number has been cut nearly in half — 410 women dying out of every 100,000. “So still you would say we have [won] half the battle but still, 410 women dying for every 100,000 births, that is a lot,” Mkopi said, “and most of these deaths can actually be prevented. That is the worst part.”
Since the year 2000, he said, vaccinations have reduced the number of children dying by two-thirds, from 170 deaths per 1000 live births to 51. “It’s a good success, but it doesn’t mean we can’t do more,” he said.
During his career he has seen significant drops in the mortality numbers due to malaria, HIV and diarrheal diseases. Malnutrition remains a significant challenge, Mkopi said.
“If a child, a young child, is having malnutrition for a prolonged period of time — that is, having chronic malnutrition — they develop what we call ‘stunting’,” he explained. “It actually impairs their growth and development. And most importantly, it affects their cognitive ability, which means even their learning capacity in school will be impaired and therefore they won’t be good productive citizens when they grow up.”
Malnutrition in childhood also affects a woman’s ability later in life to bear healthy children, he noted.
“They usually have complications because of malnutrition they had during childhood. This malnutrition actually endangers their life as well as the child they are going to bear. So it’s not only a problem that is affecting [the] immediate generation, but it affects even the second generation of this particular family.”
What countries like Tanzania need, he said, is for people to look beyond borders for a solution to endemic issues of poverty and mortality. “We want to make people understand that we need a global initiative — a global village — people to act together to make sure that by 2035 we actually prevent all these deaths that are coming about by these preventable diseases,” Mkopi said. “Wherever you live in this world, whether you are in America, whether you are in Africa, every other child has the same right. And that right is [the] right to live life, a healthy life, and grow up to become an adult and realize their potential.”
Call for action
Mkopi has been in the U.S. talking to RESULTS volunteers, and to the U.S. Congress to promote efforts to reduce maternal and infant mortality through the Reach Every Mother and Child Act.
According to the Library of Congress summary of the legislation, the purpose of the Reach Every Mother and Child bill is to direct “the President to establish: (1) an inter-agency working group, led by the Child and Maternal Survival Coordinator at the U.S. Agency for International Development (USAID); and (2) a 10-year strategy to achieve with partner countries and donors the goal of ending preventable maternal, newborn, and child deaths by 2035…. The U.S. government, through USAID and other relevant executive branch agencies, shall develop a financing framework to leverage public and private capital to expand delivery of high-impact, evidence-based interventions for maternal, newborn, and child health.”
RESULTS and its partners who are pushing the bill contend that it is not only possible to stop the needless deaths of mothers and infants, but that it is critical for the Congress to act now.
“For the first time in history, experts and scientists agree that it’s possible to stop these avoidable deaths once and for all,” the organization said in a position statement released to the media. “Unlike many of the world’s problems, this is one that we have the power to solve. And we’ve made some incredible progress. With the support of [USAID] and its global partners, the number of children under the age of 5 dying annually has fallen at an astonishing rate, from 12.6 million in 1990 to 5.9 million in 2015.
“But with 16,000 children still dying each day, mostly from treatable causes like diarrhea and pneumonia — much work remains.”
USAID numbers show that its maternal and child survival strategies “have resulted in nearly two-and-a-half million more children surviving and 200,000 maternal deaths averted since 2008” in the 24 countries prioritized by the agency. In the August report detailing its success rate, USAID also discussed how to “reach 38 million of the most vulnerable women around the world with increased access to health care during delivery by 2020.”
RESULTS, however, cites a 2014 finding that USAID is “not on track to meet its ambitious goal of ending preventable child and maternal deaths by 2035,” the organization said, contending that the Reach Every Mother and Child Act would “make sure USAID gets back on track.”
Specifically, the Reach Act is supposed to “hold USAID accountable for sticking to its promises,” RESULTS said. The act would, without additional funding, develop a government strategy to end preventable mother and child deaths with “ambitious, clear and measureable goals;” increase accountability and transparency; focus on the poorest and most vulnerable populations while recognizing “the unique needs within different countries and communities;” markedly increase the use of methods that have been proven “to work and save the most lives;” create a position of “Child and Maternal Survival Coordinator” who would have oversight over resources; create “new innovative funding sources” to add to American investment; and stretch “every dollar further to save the most lives.”
As of July 30, the Reach bill has been read twice and referred to the Committee on Foreign Relations. “It’s really exciting about the Reach Every Mother and Child Act, how many groups and organizations have really come out in support of this bill,” said Cricket Nicovich, senior policy associate with RESULTS.
“RESULTS isn’t working alone. We have partners including the American Academy of Pediatrics, Save the Children, CARE, WorldVision, United Methodist Church. A lot of organizations have come out and really have put a full force behind this bill because everyone wants to see moms and kids survive and thrive.”
Despite that and the fact that versions of the bill have been introduced into both houses of Congress, Govtrack.us. gives the bill only a 5 percent chance of being enacted. But that’s not stopping advocates like RESULTS or Mkopi.
“We really need our Alabama congressmen and senators to sign on to this legislation,” said Aarin Palomares, who shares her RESULTS colleagues’ faith that the legislation will pass and make a life changing difference for women and children around the world.
“Maternal and child health is something that I’ve always been passionate about. But how do we fix that?” she said. “Advocacy is a huge part of that…With this legislation, with decreasing child mortality, it’s something that I can personally say that I’ve been a part of. When 2035 comes around and maternal and child health is no longer an issue, I can say, this legislation helped to do that.”
Mkopi said he could not believe that “anybody living in a different continent would be happy knowing that there are a lot of mothers dying. There are a lot of children dying before their time… We are tired of seeing these children dying for the conditions that can be prevented. These efforts not only end up reducing mortality but again it improves the economy of our countries because mothers who are having children who are not sick actually become more productive and raise the economy of these countries. So at the end of the day it’s a win-win situation.”