Ambitious project aims to 'Save the Mothers'

In this story: Lack of care Multiple problems Addressing 'invisible' risk RELATED STORIES, SITES

By Michele Dula Baum
CNN

(CNN) -- Looking at a modern hospital birthing suite with homey furniture and state-of-the-art equipment hidden tastefully behind rich cherry wood accents, it's hard to imagine that in some parts of the world, expectant mothers often still face death -- miles from any doctor -- in the very act of giving life.

Sometimes pregnancy complications are insurmountable, but more often, lives could be saved with the timely intervention of a trained professional, explained San Francisco, California obstetrician Anne Foster-Rosales, United States technical advisor for the Save the Mothers project in Central America.

Save the Mothers, a project of the International Federation of Gynecology and Obstetrics, fosters partnerships between physicians in the U.S., Sweden, Canada, Italy and the United Kingdom and practitioners in Central America, Ethiopia, Uganda, Pakistan and Mozambique to decrease maternal and infant mortality in the developing nations.

"The last thing we want to do is impose our world view," said Foster-Rosales, who has visited various Central American locations on training missions more than half a dozen times since 1984. "But we help them to think through new, creative ways to overcome geographic or bureaucratic barriers to care."

Such intervention can have real results.

Antonia Chapeta Querma of Guatemala delivered her sixth child -- a healthy baby -- last year at the age of 32. But after the birth, she began to bleed uncontrollably.

Because Dr. Juan Gonzalez at the rural health center in Solola had received training just a few months previously in recognizing and treating postpartum bleeding, he was able to save Querma's life.

Lack of care

"In Latin America, there tend to be enough rural health centers and enough hospitals, but there aren't enough rural health centers providing basic emergency care," said Foster-Rosales, who has lived in Nicaragua, Mexico and El Salvador. "It's a problem of distribution."

A recent report compiled by the Washington-based independent policy group Positive Action International shows that the risk of dying during pregnancy and birth is 33 times higher in poor nations than in rich countries.

The PAI report ranks 133 countries in sexual and reproductive health care availability and pegs 98 percent of maternal deaths in poor countries squarely on the substandard availability of such care.

Women in Ethiopia have the highest risk of dying from complications during pregnancy -- a one-in-seven chance, according to the report. Other high-risk countries identified were Chad, Afghanistan and the Central African Republic. By comparison, a woman in Italy faces a one in 6,261 chance of dying from pregnancy complications. In the United States, the figure is one in 3,750.

"Around the world, one woman dies each minute from complications of pregnancy and childbirth," said Dr. Giuseppe Benagiano, director of the Italian National Institute of Health and Save the Mothers chairman. "The majority of these deaths are preventable with access to emergency obstetric care."

All it takes is proper funding and resources, Foster-Rosales noted.

"Sri Lanka reduced mortality levels equal to the developed world," she said. "If you reorganize and prioritize the care to women who are pregnant or have recently delivered, the problems are solvable with relatively few resources."

What it takes, she said, is "political will."

Multiple problems

"There are several levels of problems," continued Foster-Rosales. "The status of women is a big issue. The long-term solution is education for women that I can't provide -- that's a 100-year plan."

More concrete solutions, such as improving access to quality health care, are far more achievable, she said.

Guatemalan physicians have partners among members of the American College of Obstetricians and Gynecologists, explained Dr. Edgar Kestler, Central American coordinator for Save the Mothers.

"Monday, Tuesday and Wednesday we did training in Solola," he said recently. "This week, we finished training in emergency obstetric care."

Similar training sessions remain to be scheduled for rural clinic practitioners in Sonsonate, El Salvador; Copan, Honduras; and Matagalpa, Nicaragua.

Training sessions were scheduled in Managua, Nicaragua, for March.

"While it is still early in the program, we have been very pleased that the health care providers have found ways to improve emergency obstetric care in ways that will benefit women for years to come," Benagiano noted of the three-year pilot project begun in 1997. "We hope to expand upon these results going forward."

Addressing 'invisible' risk

Funding provided by ACOG is making sure the project goes forward in Central America, said Kestler. "The issue here is that we continue the work," he added. "We never stopped."

Beginning in 1997, the mission of Save the Mothers was to assess needs among the project's partners in the developing world. The diagnosis, Kestler said, was that "none of these countries are prepared to offer emergency obstetric care."

In rural areas, many hospitals and clinics are staffed by general practitioners rather than obstetrical specialists, the physician continued. "What we are doing is training the generalists. They need to have skills in midwifery."

Save the Mothers also is working closely with the Guatemalan health ministry, he said.

"In Guatemala, there is a large indigent community," said Foster-Rosales, estimating that as many as 80 percent of women deliver their babies at home in that country. "That's why you see higher death rates."

Issues are basic.

"They are afraid to walk four hours on a footpath to a clinic and maybe find nobody there, or they will try to get to a regional hospital and, because of the distance, there will be a critical delay in care," said Foster-Rosales. "They prefer home delivery. The risk of dying is very invisible."

Maybe one woman will die in a typical village, and then it will be years before another one dies in the same community. But, in reality, more than 1,000 women died in El Salvador, Guatemala, Honduras and Nicaragua from pregnancy complications in just one year, 1998.

Health care conditions in Latin America resemble those of the United States 100 years ago, she added. "If we can convince high-risk individuals to come in to a rural health center and deliver with a trained provider, it can have a tremendous impact."

According to Foster-Rosales, 15 percent of women will develop labor complications such as fever, infection and postpartum bleeding. If they are not handled promptly, they can become life threatening.

"If you added up all the women who die every day from childbirth, they would fill four jumbo jets," she said. "It's the greatest unsolved public health problem in the undeveloped world."

U.N. report: Women's unequal treatment hurts economies
September 20, 2000
Pregnant teens: Numbers are down but risks are up
May 19, 2000
Brooklyn baby deaths double the national average
April 1, 2000
More women die from abortions in poor countries
January 22, 1999
Poor health care endangers pregnant Mexican women
July 25, 1996

Save the Mothers Fund
International Federation of Gynecolocy and Obstetrics
Save the Children: State of the World's Mothers 2000
World Health Organization
ACOG -- American College of Obstetricians and Gynecologists

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