World Mother's Report

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By Marcela Sanchez
Special to washingtonpost.com
Friday, May 12, 2006; 12:00 AM

WASHINGTON -- Becoming a mother in the United States is a little bit like enrolling in a crash course on prenatal medicine while simultaneously acting as lab rat for health-care professionals. In nine short months the expectant mother learns an entire new vocabulary and is poked and prodded in every imaginable, albeit well-intentioned, fashion.

But as we are reminded from time to time, mothers here are in the minority when it comes to women's access to sophisticated care. What may come as a surprise, however, is that high-tech and specialized hospital care may not be the single great hurdle for reducing infant mortality rates around the world. According to the latest annual State of the World's Mothers report, issued this week by the U.S.-based organization Save the Children, low-cost interventions could reduce newborn deaths by up to 70 percent.

The report describes several such interventions involving members of local communities who convey basic medical knowledge in order to improve current childbirth practices while respecting cultural and religious beliefs.

In Bolivia, for example, some communities continue to use a sharp stone or a piece of clay from a ceremonial pot to cut the umbilical cord because, according to tradition, a knife or a blade will cause the baby to grow up to be a thief. Rather than trying to stop the practice altogether to prevent deadly infections spread by unclean instruments, mothers are learning about the importance of boiling the stone or sterilizing the clay.

In indigenous communities of Guatemala, families have long bathed their babies immediately after birth to ensure that they do not grow up to be philanderers or harlots. Thanks to the work of community leaders such as Ana Guzman Cobo, who received training from Save the Children, mothers are learning that the initial bath ritual can dangerously reduce a baby's body temperature. Although she has faced some reluctance, much of it from her husband and other men in her Mayan town of Nebaj, Guzman can now declare "we are saving lives," as mothers are agreeing to wait 24 hours before performing the ritual.

For most children in developing countries, those first 24 hours are in fact the most dangerous of their lives. In its report, Save the Children found that "a child's risk of dying on the first day of life is about 500 times greater than their risk of dying when they are 1 month old." Every year, 2 million children around the world die in the first 24 hours of life, half the total of newborns in the United States annually.

Some developing countries are finding solutions to this neglected health problem, despite low national wealth. Nicaragua -- the poorest country in the hemisphere after Haiti -- outperforms much wealthier developing countries such as China, the Dominican Republic and South Africa in saving newborns.

One key factor in Nicaragua's success is the widespread use of modern methods of family planning. Simple and inexpensive contraception can give women greater control over when they get pregnant, thereby establishing intervals between pregnancies that are healthier for mother and child. Today, two in three Nicaraguan women use a modern method of contraception.

A combination of the free flow of information from nongovernmental organizations and a high literacy rate among women has made Nicaraguans far more knowledgeable about reproductive health than some of their Latin American neighbors. Ironically, the persistence of misinformation in Nicaragua keeps its adolescent women at risk.

Ana Maria Pizarro, a Nicaraguan obstetrician and women's reproductive rights activist, says that the country's influential Catholic and evangelical churches have largely succeeded in withdrawing sex education from schools. Moreover, she says both the Sandinistas and the subsequent conservative governments have opposed family planning, either because it was seen as a tactic of U.S. imperialism or because motherhood is "the female destiny." Pizarro said the country has the highest rate of adolescent pregnancy in Latin America, with many adolescent women dying in their efforts to provoke a miscarriage.

A world away in terms of the sophistication of care, the United States is not unlike Nicaragua in its contradictory state of reproductive health. The world's wealthiest nation has one of the highest newborn mortality rates of industrialized countries. While little is known about the reasons behind this contradiction, Save the Children found an unequivocal link between lower educational achievement and higher rates of newborn mortality.

This connection seems to clearly underscore one of the report's main conclusions that "a major barrier to progress on newborn survival has been the erroneous perception that only expensive, high-level technology and specialized, hospital-based care can save newborn lives.''

Marcela Sanchez's e-mail address is desdewash@washpost.com.


© 2006 The Washington Post Company

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