The Urban Disadvantage – State of the World’s Mothers 2015

state of the worlds mothers 2Every year around Mother’s Day a report is released from Save the Children called the “State of the World’s Mothers.” And every year, I write about it.

Because it is so important to me. If I could spend all day every day with moms and babies, I would. There are so many reasons for this – but partly its because I have five of my own and I learned so much from those younger days. I know what helped and I definitely know what didn’t help. Healthy moms and babies are critical to a healthy world.

In the last 60 plus years, the number of city dwellers in the world has increased by over 20%, so that half the world’s population now lives in the city. While this creates incredible advantages for many of us, there are many others who live in extreme poverty where disease is prevalent, nutrition poor, and violence high. The World Health Organization (WHO)estimates that nearly a billion people live in urban slums, shantytowns, on sidewalks, under bridges, or along the railroad tracks.” One of the worst places in the world for a mom and a baby to be is in a city slum. 

state of the worlds mothersThis year’s report is on mothers in urban settings and is appropriately called “The Urban Disadvantage.” Here are some summary findings, taken directly from the report:

“Every day, 17,000 children die before reaching their fifth birthday. Increasingly, these preventable deaths are occurring in city slums, where overcrowding and poor sanitation exist alongside skyscrapers and shopping malls. Lifesaving health care may be only a stone’s throw away, but the poorest mothers and children often cannot get the care they need.”

  • The world, especially the developing world, is becoming urbanized at a breathtaking pace. Virtually all future population growth in developing countries is expected to happen in cities, resulting in a greater share of child deaths taking place in urban areas.
  • In developing countries, the urban poor are often as bad as, or worse off than, the average rural family, and for many rural families, moving to the city may result in more – rather than less – hardship
  • Few countries have invested sufficiently in the infrastructure and systems, including water and sanitation, which are critical to addressing the basic health needs of the urban poor. More countries need to adopt universal health care as a national policy to help address the unmet needs of the urban poor.
  • While great progress has been made in reducing urban under-5 mortality around the world, inequality is worsening in too many cities.
  • The poorest children in almost every city face alarmingly high risks of death.
  • High child death rates in slums are rooted in disadvantage, deprivation and discrimination.
  • Malnutrition is the underlying cause of 45 percent of deaths of children under 5, leading to over 3 million deaths each year, 800,000 of which occur among newborn babies.
  • Among capital cities in high-income countries, Washington, DC has the highest infant death risk and great inequality. Save the Children examined infant mortality rates in 25 capital cities of wealthy countries and found that Washington, DC had the highest infant mortality rate at 6.6 deaths per 1,000 live births in 2013. While this rate is an all-time low for the District of Columbia, it is still 3 times the rates found in Tokyo and Stockholm.

Here’s the good news: We know what works! This is huge. Save the Children looked at six cities that, despite significant population growth, have made strides in saving children. Again, from the report:

The cities are: Addis Ababa (Ethiopia), Cairo (Egypt), Manila (Philippines), Kampala (Uganda), Guatemala City (Guatemala) and Phnom Penh (Cambodia). These cities have achieved success through a variety of strategies to extend access to high impact services, strengthen health systems, lower costs, increase health awareness and make care more accessible to the poorest urban residents.  1) Better care for mothers and babies before, during and after childbirth; 2) Increased use of modern contraception to prevent or postpone pregnancy; and 3) Effective strategies to provide free or subsidized quality health services for the poor. 

The yearly report always ends with recommendations, and this year is no exception. As a public health nurse, I am always encouraged and discouraged about this report. On the one hand, the statistics are depressing and overwhelming. On the same hand, its all well for a group like Save the Children to talk about what needs to be done, but it is completely different convincing country, state, and city governments that money needs to be given to these efforts.

So where’s the good news? The good news is in places like Heartline Ministries in Haiti. I’ve never been there, but feel like I know two of the midwives who work with Heartline – Beth and Tara – through our email and online interaction. They are two of my “sheros.” Heartline’s mission statement is “Intentionally walking alongside the impoverished men, women, and children of Haiti during their life journeys, meeting critical physical, emotional, financial, educational, and most importantly spiritual needs.” Their maternity center exists to provide prenatal, labor and delivery, and postpartum care to women in Port-au-Prince, Haiti. If you want to know where your money is going to, and want to make a difference, I highly recommend this group. Connect with them on Facebook here.

And the other place I’ve written about before. Shikarpur Christian Hospital has met the needs of moms and babies for years with little recognition and a lot of perseverance. Pakistani and Western staff work hard to give great care to moms and babies in Shikarpur and surrounding areas.

In my public health heart, I know that for real and lasting change to happen, policies are needed at the highest levels. I know that some things are completely impossible without the support of local government. I know in my soul that for real and lasting change, hearts have to change. But while some may say these places are bandaids on a gushing wound, I would say that until we live in a perfect world, thank God for the people who are willing to put on bandaids.

Photo Credit –

State of the World’s Mothers 2014 #SOWM

English: mothers day photo, Pakistani mother a...

I was 13 when I first witnessed the miracle of birth at a women’s and children’s hospital in Pakistan. Ever since I have had a part of my heart reserved for mothers and babies.

The picture of two seeming opposites, strength and fragility, in both mom and baby broke through my insufferable teenage arrogance and I was captivated.

I went on to witness many births – first as a student nurse, then as a maternal-child health nurse, until finally I began having my own babies. I remember vividly the line on the pregnancy test showing up, dark and clear. I remember the first flutter of movement and the excitement I felt early on a spring morning in Chicago. I was barely awake, but the flutter sounded louder than an alarm clock and I woke my husband to share the excitement, to rejoice in the miracle. As a mom there are some things you don’t forget – and those were just two of them.

My babies were born all over the world. Beginning in a birthing room in Chicago; moving on to a hospital in Islamabad, Pakistan; still further to Daytona Beach, Florida; ending in Cairo, Egypt in a hospital on the banks of the Nile where my last two took their first breaths of life, and saw the world for the first time. I was so fortunate. I was so privileged.

And so every year I pay attention to the report released by Save the Children: The State of the World’s Mothers. This report has come out yearly since 2000 and is always released just before western Mother’s Day. It is considered a reliable tool across the world to show where mother’s and children do best and which areas they face hardships, often to the extreme. The report always ends with recommendations, calling on the world to make mothers and children a priority, to make moms and kids healthier worldwide.  

“In this report, Save the Children examines the causes of maternal and child deaths in crisis settings, and suggests urgent actions needed to support mothers who are raising the world’s future generations under some of the most difficult and horrific circumstances imaginable.” from the 2014 report.

This year the focus of the report is on mothers in areas of humanitarian crisis. Here are just a couple of the things that stood out to me from the report:

  • More than 60 million women and children are in need of humanitarian assistance this year.
  • Over half of maternal and child deaths worldwide occur in crisis-affected places yet still the majority of these deaths are preventable.
  • Worldwide women and children are 14 times more likely to die in disaster settings than men.
  • For every person killed by armed violence, anywhere from 3-15 die indirectly from malnutrition, diseases and medical complications.
  • Over three-quarters of the projected 80 million people in need of humanitarian assistance in 2014 are women and children.
  • Areas of most concern include Democratic Republic of th Congo where civil war has caused terrible violence against women and children as well as high rates of disease and death from diarrhea, malaria, pneumonia and general new-born difficulties brought about from too few health workers and pregnancies and births in these difficult situations; Syria where data on how bad things are can’t even be gathered as the countries enters its fourth year of horrific conflict; Philippines where Typhoon Hainan ravaged the country in November affecting infrastructure and health care access.
  • The first day of life is the riskiest day of life for the newborn everywhere, but complicating this with all that comes with a fragile situations — lack of medical help, poor sanitation, violence, disease, insufficient water supply, living in close quarters with hundreds of others — makes it even riskier.

So where is the hope? 

First off it’s in the mothers themselves, because no matter where you go moms want to keep their babies and children healthy – they will do anything to make life better for their kids. Moms want a better and more secure future for their children. That is a strength. Second – there’s hope in breastfeeding. This, as a natural source of vitamin-filled nutrition, keeps the baby full of nutrients that fight infection and malnutrition. It also works as a way to prevent postpartum hemorrhaging, helping the uterus to return to its normal state pre-pregnancy.

Hear this: When formula is distributed where it shouldn’t be it hurts everyone!

In emergency situations it is near impossible to prepare formula properly. It’s irresponsible to send formula and randomly distribute it thinking you are doing people a service. If it is distributed, it must be done carefully with extra attention given to how to prepare. To quote the report directly:

“In all situations, children who are fed infant formula are more likely to become ill and die than those who are breastfed. In an emergency context such as the Syrian conflict, where the risk of dying is already high for children, breastfeeding saves lives, providing critical protection from infections and death.”

Third – what Save the Children’s report does not highlight is the amazing work going on throughout the world by unacknowledged women’s and children’s hospitals. I know people in Pakistan, Haiti, India that work with no need for recognition, daily doing their part to assist with healthy births, to teach breast-feeding techniques, to vaccinate children. A project in a rural area of Pakistan teaches literacy and hygiene to women and children. Community health workers in many parts of the world take on the role of educating their communities. All is not hopeless.

I’m convinced and the data itself shows that when you invest in women and children you make the entire community healthier and more economically stable. For every dollar spent on key interventions for reproductive, maternal, newborn and child health, about US$ 20 in benefits could be generated.*

Readers of Communicating Across Boundaries live all over the world. And so I’ll close this by saying wherever you are in the world, work to spread the word that mothers and children matter and are worth investing in. They matter to their families, to their communities, and to society as a whole. 

*If you use twitter tweet the report using this tag #SOWM

On my travels I’ve met with mothers recovering from the devastation of ongoing conflict, mothers trying to make a refugee camp feel like home, and mothers who fled from violence with their children on their backs. Despite the horrors of the past, every mother I meet is focused on the future and how to make it brighter for her children. – Jasmine Whitbread CEO of Save the Children International

To download a full copy of the report go here.

*A study by Victoria University in Melbourne in six Asian countries

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We Have Work to Do! State of the World’s Mothers – #SOWM

During my flood relief trip in Pakistan a couple of years ago I witnessed severe malnutrition among babies and toddlers. Break your heart malnutrition and hunger. Shout for joy Plumpy’nut solution in some cases. Moms and babies have my heart – probably because I am one and I had five. Getting a good start in life changes a generation and with catastrophes like floods and earthquakes, the chances of having that good start decrease.

For the past 14 years Save the Children has published an annual report on the state of the world’s mothers. The report is long and detailed, providing key findings as well as giving recommendations. The data includes information from 176 countries on the health of children, health of mothers, and economic well-being. Finland came in first and Congo came in last.

This year’s report was released yesterday. Here are just a few of the findings:

The birth day is the most dangerous day for babies world-wide.

More than a million babies die on the first day of life, usually from preventable causes. While great progress has been made around maternal/child mortality, newborns continue to be the most vulnerable of all with little progress made around their health and survival.

Three primary causes of death were identified.

These include complications during birth, prematurity and infections. For all three of these there are interventions that work, that are effective, that can change these statistics. The number of newborn deaths could be reduced by 75% if these preventive measures were put into place. That’s a staggering success rate!

The interventions cost pennies to put into place – from 13 cents a day to $6 a day.*

  • steroid injections for women in preterm labor (to reduce deaths due to premature babies’ breathing problems);
  • resuscitation devices (to save babies who do not breathe at birth);
  • chlorhexidine cord cleansing (to prevent umbilical cord infections); and
  • injectable antibiotics (to treat newborn sepsis and pneumonia).

This is a big deal. Give a baby a healthy start and you change a generation, one baby at a time. Where it stands now is a public health crisis. 

So what do we do? How can we help? If you’re pregnant you help by taking care of yourself, of your baby; by eating right and getting prenatal care. Others of us can pass this information on – if we live in countries that fall at the bottom of the list find out what we can do in both big and small ways. If we live in the United Kingdom or the United States – take a look! The United States falls 30th despite spending approximately 18% of its GDP on health care. This is just sad.

  • 1 of 2,400 women in the United States will die from a maternal cause. This statistic is the same as Iran.
  • In the United States 60% of newborn deaths occur on that critical first day of life.
  • The United Kingdom fares better but not great at number 22 on the list. 

Take a look at the report linked below and the Save the Children website. Learning about this is the first step in making a difference! I’ve also included a link to a Huffington Post article that has a great infographic you can share. Huffington Post infographic.

What do you think of the statistics and the low cost interventions? Have you had maternal child health experience where you have seen these interventions work? Would love to hear from you in the comments!