Reducing child and maternal mortality?

What do you know about the Millennium Development Goals?

To my shame I knew next to nothing until a few weeks ago, despite them being one of the most important agreements in the world.

Basically all countries have signed up to 8 targets to be achieved by 2015. These range from an end to poverty and hunger, and promotion of universal education and gender equality, through to HIV/AIDS prevention, environmental sustainability, and global partnership.

Noble aims – but quite a challenge!

My work in Cambodia is linked with two particular goals – number 4, to reduce the mortality rate for children under five, and number 5, to improve maternal health.

In July, all the VSO health workers in Cambodia and our volunteer assistants gathered in Phnom Penh to share our learning and refocus on why we are here. This year we looked specifically at these goals - reducing child and maternal mortality and morbidity in Cambodia – and what difference we can make as volunteers.

Where we are going seems to be well defined – starting from 1990, the aim is to reduce child mortality by two thirds and maternal mortality by three quarters by 2015. Only five years left then!

So where are we now? Agreeing on figures was surprisingly difficult. For example, according to the Central Asia Health Review, from 1990 the maternal mortality rate (the number of mothers who die as a result of childbirth, per 100,000 live births) fell from 900, to 590 in 1995 and 450 in 2000. But then the rate not only stopped falling, but had actually risen to 540 by 2005.
Does this mean that things are getting worse?

Not necessarily! In discussion it seemed that the increased rate may have more to do with better reporting than worse outcomes. Either way, it will be really difficult to meet the three-quarters reduction, which would be a rate of 225 in just five years time.

It’s worth pausing to take in what these numbers actually mean. Right now, for every 100,000 live births in Cambodia, 500 women die due to childbirth every year. If this doesn’t shock you, note that in neighbouring Vietnam the figure is less than a third of this, at 150 a year.

And in rich nations such as the Netherlands the rate is only 6.

This is because most maternal mortality is entirely preventable, a result of severe bleeding or haemorrhage and bacterial infections, pregnancy-induced hypertension (pre-eclampsia) and obstructed labour, along with unsafe abortions. These are often associated with other issues such as malaria, HIV/AIDS, complicated pregnancy and cardiovascular disease - and by the distance and cost of travelling to the nearest clinic.

This is truly a global scandal – women are still dying of completely preventable conditions in poor countries like Cambodia.

So what are we doing about it?

Encouragingly, we heard many examples of work VSO colleagues are doing to help prevent women dying unnecessarily.

Our guest speakers came from a small project called M’day Reak Reay, Kone Reak Reay (‘happy mother, happy baby’) who promote cooperation between midwives and traditional birth attendants. They gave us fascinating insights into how to work through the social hierarchy, getting permissions from every conceivable level, and how traditional birth attendants can actually play a useful role in identifying early complications and encourage women to go to hospital – which could literally save their lives.

We also had a great session on ‘behaviour change’ – if we are to make any lasting contribution then we need to work with women, families, communities and healthcare colleagues to change some of the factors which lead to maternal death. We reflected on what might influence us to change what we do (say washing our hands or wearing a moto helmet), and soon recognised that our own belief in a benefit or the support of those we trust can be far more powerful than lectures or threats from well meaning outsiders or ‘the authorities’.

Even our lunch break was a chance to learn: VSO recruits a number of nutrition advisors, who cooked us a traditional lunch whilst helping us to understand the importance of good nutrition in reducing mortality and morbidity. They demonstrated simple techniques such as putting tofu into soup and carrots or green leaves into the traditional bor-bor (rice porridge) - it was actually very tasty!

Our final session, bringing together all this background, challenged us to come up with practical ways in which we can make a difference to these goals as VSO volunteers. These included practical suggestions such as sharing our information, resources and skills, learning to work within the cultural hierarchies, role-modelling good practice, and getting the best from our volunteer assistants – and remembering that many improvements don’t need money. We also identified that we can be most effective when we ourselves are healthy and motivated – so I vowed to go off to nibble carrots and learn the 33 Khmer consonants.

To round things off, the Phnom Penh 5 O’Clock Blues Band (formed just a few hours earlier) brought some light relief to the evening, showing what the accompanying partners are up to whilst we are saving the world. My highlight was undoubtedly ‘The Development Blues’: “I godda big white four by four… Yeah I godda big white four by four… Need a four by four… to he-elp the poor”. Cutting!

A fascinating, , exhausting and inspiring 2 days – hopefully it will help us to make a difference.