Challenges in Global Maternal & Child Health

How Can We Contribute?
Global Health Discussion Forum, Sept. 9th
Speaker: Prof. Zulfiqar A. Bhutta

In the Hollywood Theatre of SickKids Hospital, I sat between a WHO infectious disease policy writer and a PhD candidate in bioethics and theology. Humbled by the impressive members of the audience, I actually felt quite at home.

This was a wonderful talk. An update on where we're at with two of the following Millenium Development Goals (more on those here):

#4: Reduce Child Mortality
#5: Improve Maternal Health

Simple enough. Statistically, we have seen some improvements, but what I really appreciated about Bhutta was when he presented the quote by Albert Einstein:

"Not everything that can be counted counts, and not everything that counts can be counted."

There is great truth to this. Though it is important that programmes are accountable to their funders and to the people to whom they provide a service, sometimes it is difficult to portray quality and outcomes in statistical reports. Certainly, if you have to present your outcomes of a project within a few years of initiation, it is also difficult to foresee future positive impacts. Statistics have no meaning without considering the lived experiences, without considering them as real people. The fact that 70% of countries, according to Bhutta,  are not on track to the Milenium targets is huge. That 350 000 women and 8 million children under 5 die a year is overwhelming.


The second thing I loved about this presentation, was that Bhutta pointed out that there is a lack of consideration for maternal targets/outcomes in much of the research and projects underway. Why is this when maternal health is so closely related to neonatal and child health? This hit me especially, because just that day I had been struggling to come up with any data on maternal outcomes of exposure to toxic chemicals during pregnancy, while there was an overabundance on child outcomes. Why is pregnancy not considered a key developmental stage for both the mother and fetus? The mother's  body undergoes tremendous changes, it grows at phenomenal rate and is hit by a flow of hormones that simultaneously strengthen and weaken it. Increased fat stores, meant to feed the developing fetus and later allow the mother to breastfeed, are a great opportunity for lipophillic (fat soluble) compounds, such as drugs, to settle in the woman's body, for example.

Poverty

Few will deny that what it comes down to is the causes of the causes for global maternal and child health. The needs in maternal health often match with some of the other millenium goals. According to Bhutta, these are:
- Empowerment (social, financial)
- Hope
- Access (breaking the socio-economic gradients down)

Later, Bhutta talked of Family Planning, that this was criminally underfunded. He vented his frustration that, though he felt it was part of the parcel, abortion had created an atmosphere futile to other aspects of Family Planning. This is something that the "Because I am a Girl" campaign has argued as well (see it here), choosing to be non-partisan in the politics of pro-choice/life. Though I can understand where this is coming from, I have much more to say about this, another time...

In terms of innovations, Bhutta spoke of:
1. Conditional cash transfer to remove financial burdens
2. Community health workers and women's groups
3. Use of technology (specific treatments, information and communication e.g. cell phone tele-health nurse)

And so, when answering the question "How can we contribute to change?" he says:
- Evidence Based Practice across continuum of care
- Do things right (consider delivery, especially to women)
- build collaborations
- focus on incremental gains
- advocacy