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A matter of birth and death: unsafe conditions still killing new mothers and newborns

Saturday, 13 December 2014

New publication reports that a lack of safe water, sanitation and hygiene in birth settings is killing mothers and newborns in the developing world.

NurseLondon School of Hygiene & Tropical Medicine and WaterAid today join the World Health Organization, UNICEF, UNFPA, SHARE Research Consortium and other organisations in a call to protect the lives of new mothers and their babies, by improving access to safe water, basic sanitation and hygiene in healthcare facilities and homes.

A paper published in PLOS Medicine argues that despite improvements in health care, new mothers and newborns are still dying because a reliable supply of safe water, good hygiene practice and adequate toilets are often not present.

A companion paper in PLOS ONE illustrates the situation in Tanzania, where less than a third (30.5%) of births occur in places with safe water and basic sanitation. In 2013, one in 44 women in the country faced dying in childbirth in their lifetime.

Women face a similar level of risk in many developing countries. Globally, an estimated 289,000 women died from complications related to pregnancy or childbirth in 2013, a number which researchers say can be more rapidly reduced through better provision and monitoring of safe water, basic sanitation and hygiene to prevent infection and improve care.

Some 38% of healthcare facilities in 54 low-income countries are without an improved water source, according to a forthcoming survey [1], leaving doctors, nurses and midwives struggling to care for their patients.

Sixteen researchers representing the London School of Hygiene & Tropical Medicine, WaterAid, World Health Organization, UNICEF, the United Nations Population Fund, the University of Aberdeen and The SoapBox Collaboration, BRAC and BRAC University, and Evidence for Action authored the flagship paper, From joint thinking to joint action: A call to action on improving water, sanitation and hygiene for maternal and newborn health.’

The research was funded by the Sanitation and Hygiene Applied Research for Equity (SHARE) Consortium, a five-year initiative funded by the UK Department for International Development and based at the London School of Hygiene & Tropical Medicine.

Lenka Benova of the London School of Hygiene & Tropical Medicine, lead author of the companion paper on Tanzania, said: “Nearly 8,000 women in Tanzania die each year in or immediately after childbirth. Sepsis from infection causes at least 10% of these deaths. Nearly half of women, and disproportionately the country’s poorest, are giving birth at home, and almost none of these homes have clean water and basic sanitation. But women cannot be expected to go to a health facility to deliver if it is dirty.

“This situation is not limited to Tanzania. What is frustrating is we know infection-related deaths are preventable, with the addition of clean water, basic toilets and good hygiene practice. Our hope is these findings will guide future work on UN development goals and make the provision of these services a priority, when trying to improve the health of new mothers and their babies.”

Yael Velleman, senior policy analyst, sanitation and health, at WaterAid, said: “We have known since Victorian times about the importance of clean water and good hygiene in birth. Yet today tens of thousands of mothers will be giving birth in places where doctors and midwives, if present, do not have access to clean water. The process of giving life should not mean unduly risking death.

“Health agencies and governments have encouraged women to give birth in hospitals and clinics to give them a better chance of surviving complications. But if those environments are dirty, without safe water, basic toilets and a way to keep patients, beds and instruments clean, women are reluctant to seek them out for fear of exposing themselves and their babies to deadly infection.

“As governments work to help women and their babies survive childbirth, they must not neglect these basic building blocks of health care. In coming months, there is a chance to address these desperate needs in new Sustainable Development Goals now under discussion at the UN.”

About the UN Millennium Development Goals:

[1] ‘A recent World Health Organization rapid assessment of WASH coverage in health facilities in 54 low-income countries found that 38% of these facilities lacked a readily available improved water source,’ PLOS Medicine, ‘From Joint Thinking to Joint Action’ p 2, cited from WHO Landscape report on the status of water, sanitation and hygiene and environmental conditions in healthcare facilities, to be published early 2015.


Image: Registered Nurse Mwamini Fussi holds a young child during a post natal clinic at the Mlali Health Centre, Mlali Village, Mvomero District, Morogoro, Tanzania. Credit: WaterAid/ Eliza Deacon

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