By Magaly Blas. Can cell-phones be used to improve maternal health in Peru? The answer is Yes. Peru has one of the highest mortality rates in the Americas, 240 per 100,000 women die in childbirth. In Peru, 75% of homes have a cell-phone. Thus, the use of cell-phones to reach pregnant women with health messages seems a good strategy.

WawaRed (wawa means baby in Quechua language) is a pilot project of Cayetano Heredia Peruvian University that provides pregnant women with access to health information through a cell-phone-based interactive system. Women can access for free information about what to do if they have warning signs during their pregnancy such as vaginal bleeding or severe vomiting. The system also provides them with SMS reminders for their clinical appointments and with motivational messages.

The project will soon develop an electronic medical record that will interact with a mobile phone platform. Initially, the project was focused only on health information before the delivery. Given that women expressed their desire to continuing receiving messages to remind them about clinical appointments for their newborn, vaccinations, and nutritional tips, the project is being extended to cover one year after the delivery.

The project is being conducted under the leadership of Dr. García and Dr. Curioso and it is financed by the Mobile Citizen Program of the Science and Technology Division of the Inter-American Development Bank.

Wawared has established strategic alliances with the Regional Government, through the Callao Health Division, and with Telefónica Movistar of Peru. The project has now additional support from UNICEF to include an Electronic medical record for the baby`s first year of life.

Video of the project: WaWaRed: Getting connected for a better maternal and child health in Peru by IDB’s Mobile Citizen

The following is a guest post by Saundra Pelletier the CEO of WomanCare Global, a UK-based charity.  Saundra is an international marketing expert, published author, keynote speaker and executive coach.

By Saundra Pelletier. Big numbers always make people stop and think. Big birthdays, anniversaries or milestone are moments to reflect on what once was, and what could be.

Over the last few months, media coverage of the population reaching seven billion people has been especially ponderous, causing wonder about what the pressure of so many people will do to our planet. Questions abound. What will the carbon footprint of seven billion plus people be? Will there be enough food to feed everyone?  What can we do about population growth? How many people can the planet manage?

One of the ways we can help our planet is by investing in family planning. Family planning is one of the most cost-effective, high-yield interventions that exists today. Countries that invest in family planning can reap immediate health benefits, investment savings in health and education sectors, and social and environmental benefits that extend well beyond a single generation.

As I wrote in an earlier post, the ability for women here in the U.S. to use birth control to prevent or delay pregnancy gave every woman  the power to decide if and when she wanted to have children, and how many to have. And with the ability to keep families smaller, came the ability to provide for their present and future well-being. (more…)

The following is a guest post by WomanCare Global CEO Saundra Pelletier. Besides serving as the founding CEO of WomanCare Global, Saundra is an international marketing expert, published author, keynote speaker and executive coach.

By Saundra Pelletier. In 1965, Griswold v. Connecticut gave a married woman the right to use birth control to prevent or delay pregnancy as she saw fit. This guarantee of a basic human right led to other reforms that allowed millions more American women to decide the direction of their own reproductive lives.  This summer, we are proud to see another key reform go through: starting next year, the Affordable Care Act will allow even more women in the United States to be in charge of their own health by requiring new health plans to provide free birth control without a co-payment. These are hard-fought wins for women’s health and for women’s rights of which we can all be proud, but sadly the ability of a woman to choose when and whether to become pregnant is far from assured in other parts of the world.

Pause for a moment and imagine you’re not American, but from Sub-Saharan Africa – Ethiopia for example. You are 20 years old and have four children – the first of which you had when you were 15 and newly married. You’re worried about becoming pregnant again. You tried to get birth control once, but arrived at the clinic only to find the shelves bare and no way to access any form of birth control.  The thought of another pregnancy, whether by a husband who won’t take no for an answer, or by a stranger who might force his way upon you while making your way to fetch water for the family is overwhelming. You’re not in great health, and another pregnancy would take its toll on your weakened body. The chances are high that you might not survive pregnancy or labor to be able to take care of your family.

Globally, 215 million women would like to be able to prevent or delay pregnancy, but do not have access to the supplies that would allow them to take control of their lives. As American women, we know from our own experience that the ability to make our own fertility decisions has made an immeasurable impact on our own lives. For women in the developing world, access to reproductive health supplies would save lives and improve health, as well as the economic and social well-being of families and communities.

(more…)

By Cynthia Flynn. One day several thousand years ago, a Columbia mammoth (larger than his woolly mammoth cousin) died.  His bones have lain in a rural area south of Kennewick, WA.  I recently met a paleontologist at his dig, where this mammoth was being unearthed.  Eastern Washington, he told me, has probably 300 sites with at least some mammoth bones, so this dig is hardly unique in that regard.  However, there are important differences between his dig and what is ordinarily done.  He explained that usually, the goal of a paleontologist’s dig is to get the bones out and back to a museum for preparation and analysis as quickly as possible.  It would not be unusual for a paleontologist to do test bores, identify where the limits of the bones were, and dynamite the earth beyond those limits to loosen the earth from the bones.  A site such as the one he was digging might take two months to excavate, however if the bones were thought to be fragile, perhaps it would take two years (seasons, actually, as digging does not occur in the winter in this part of the country). 

Interestingly, he said he hoped to spend 5-10 years at this site.  He wanted to excavate the bones using archeological techniques, i.e., careful delineation and recording of the exact locations of extracted items, carefully taking down the hillside in 2 meter by 2 meter by 10 centimeter layers using levels and small brushes and tools that looked like they belonged to a dentist, washing all the soil that is removed from the hillside to expose anything that remained of living things, and reviewing all the residue under a microscope back at the Burke Museum in Seattle where he works.

Why does he want to conduct the dig in this way?  Ordinarily, people just want to get the bones out.  So if he comes to a dig after most paleontologists have been there, everything (except the bones) is essentially destroyed.  In one case, he was able to get data from a 5% core sample before the bones were extracted, which gave him unique information that he was interested in, but this sample had all the limitations of any small sample as far as understanding the full universe of data from which it was drawn.  Even with this small sample, though, he was able to create a unique data base that received scholarly notice.

So why does he care?  He replied that most people actually don’t care, which is why this project is self-funded, uses volunteer staff, and occurs on the week-end, when everyone is not at their “day job.”  But exactly what does he want to find out?  The answer is that he wants the full story, or as much of the story as is still available after thousands of years, about what happened around the day the mammoth died.  Did the mammoth die here?  Or were the bones washed here by a flood?  Did they end up here due to a mud slide?  What can we learn about what else was going on at that time by examining the environment around the bones?  Were there rodents (which kinds?), insects, seeds (of what?), nests?  How much of the story of this mammoth can we reconstruct if we do a careful analysis of the site?  In other words, how fully can we describe this particular mammoth’s story?  And what happened before this animal died? What happened later?  The point is that context matters, the story matters if we really want to understand “the bones.” (more…)

Imagine life without your mother. For many around the world this is a reality.  Every 90 seconds a mother dies during pregnancy or childbirth, and 99% of these deaths take place in developing countries where a lack of access to basic medicines and services is taking mothers from their children. VSI is trying to end this.

VSI is a California-based nonprofit organization committed to improving women’s health in developing countries by creating access to life-saving and affordable health solutions for all. Their largest safe motherhood program brings life-saving generic tablets to rural women for management of excessive bleeding after childbirth, or postpartum hemorrhage. VSI has assisted 17 developing countries in the integration of life-saving maternal health solutions, trained over 18,000 health care providers on safer childbirth, and educated over 130,000 women and their families on safer childbirth.

Here is one mother’s story…There are many faces of motherhood.  Mariye from Ethiopia is both a mother to her own seven children as well as a mother to the countless women she helps through labor and childbirth.  She confidently fulfills her role as a traditional birth attendant (TBA) in a world that often overlooks the importance of these essential community health workers.  Mariye is a vital resource to the women in her community, providing care and compassion to women who deliver at home, who would otherwise be alone. Her strength and her wisdom are derived from her own experiences in childbirth and her own inspirational story.  Mariye’s first child was delivered stillborn.  As time passed she grew weak and began to realize that her afterbirth still had not come.  In order to save her own life, she found the strength to pull out the placenta herself, thereby saving her own life. Mariye sees her story as a gift. Without strong and supportive women like Mariye, VSI’s work to reach women at the margins would be left unaccomplished.

Maternal Mortality Facts:

• Each year, over 340,000 women die of causes related to pregnancy and childbirth; 99 percent of these deaths occur in developing countries.
• This means that every 90 seconds, a woman dies in pregnancy or childbirth. This is unacceptable and preventable.
• In many developing countries, large numbers of women deliver at home, sometimes alone and many without the aid of a skilled attendant.
• Because women are social and economic providers, saving women’s lives and improving their health strengthens their communities and gives their children greater security.
• In Ethiopia, 94% of women give birth at home.  And only 6% of births are attended by a skilled provider.
• In the communities that VSI serves, becoming pregnant is one of the most dangerous things a woman can do.

For more information on VSI including how to become involved in their efforts visit: http://www.vsinnovations.org/.

By Glenna Crooks. Having been engaged in rare disease research and orphan drug development for many decades and as one who continues behind-the-scenes to encourage the work, events of the last few weeks about Makena’s launch sent chills through me. 

The firestorm that followed created some heat but none sufficient to help relieve the shivers. Others might declare the outcome a “win” but the more I read, the worse it seems. I’m not privy to what really happened, only what the press reports. It does not look good… for virtually anyone of the players involved, especially the critics. 

Those critics raised tough questions and to date only the company has faced them. It’s about time the critics themselves –and perhaps others as well – face some.   

For those who’ve missed the story, on February 3, 2011, the FDA approved a drug intended to reduce the risk of certain pre-term births in women who’d already had at least one pre-term birth. 

In truth, a number of treatments are already available for women in this situation. None of them sound easy. They include certain other medications (including IV medications) and restricted activity (like bed rest) that prevent women from going to work, making meals or providing care for other children or family members. Oh, and they can’t have sex, either. In some cases, women are hospitalized and, when all else fails the birth is premature. If they survive, the babies then receive care in neonatal intensive care units at the high costs we all know and frequently bemoan. 

One of the treatments already available was an injection that compounding pharmacies—perhaps one down the street from you—made at a fairly low cost. Though there is no indication the FDA had concerns about this particular pharmacy-compounded product, the American Journal of Perinatology in March 2009 reported on a study of OBs saying they were “very concerned;” apparently it made care for these women more difficult. Perhaps understandably, the women did not want to take a product the FDA had not approved. Add to that, other FDA studies had indicated a third of pharmacy-compounded products (in general) had doses higher or lower than the physician prescribed. Perhaps that is why FDA was interested in a product they could regulate.     

NIH had been interested, too, had studied the drug in question and apparently found it was effective and prevented premature labor. 

Somehow a company got involved, but then it sold its rights to another company. Press reports don’t say why. That second company bought the rights, paying $92M up front and promising another $107M in payments over time. 

The second company then committed over $250M, including more than $60M in research and clinical trials involving multi-year follow-on studies of 1,700 mothers and 500 babies. The second company says the studies were four times larger than the previous NIH studies and twelve times more expensive. When it appeared the FDA would approve their version, they built relationships with specialty pharmacies to make sure that patients could get access, set up patient assistance programs and started the launch.  (more…)

By Ruth Lubic. It is my distinct honor to be an awardee of this prestigious organization along with Dr. Omega Logan Silva and Diane Rehm.  I thank Katharine Weymouth for her enlightening opening words as well.

We awardees have been asked to speak briefly about “… how times have changed (or not) for women over the years.”  I would like to do this from two perspectives, first that of the management of the childbirth experience in the 1950′s when my son, Douglas, was born and also from that of the acceptance and utilization of midwives in this country in a similar time frame.  Keep in mind that my husband, Bill and I are “children of the Great Depression” and were taught to live frugally and to care about folks less fortunate than ourselves.

BIRTH IN THE 1950′s was often managed by the routine use of Demerol, a pain killer and scopalomine, an amnesiac, so that women would not “remember” the experience.   Laboring women, (there were no family members permitted), were restricted to a bed with padded side rails so their erratic drug-induced behavior would not harm them or their fetuses and when moved to the delivery room, had their hands cuffed in leather bracelets to the side of the delivery table so that they could not touch their “clean” baby with their “dirty” hands.  How destructive of a  mother’s instincts to hold and provide needed bonding with the new baby!  And how destructive of her perceptions of her ability to be a “good” mother when she might have vague memories of her negative behavior in labor.    Today, there are differing settings to cater to the mother’s and family’s  choices, with the nurse-midwifery operated freestanding birth center being the one with which I am most familiar.  The original Childbearing Center in Manhattan’s Carnegie Hill neighborhood was set up to offer sensitive care to young families who, disenchanted with conventional care, were engaging in “do-it-yourself” home birth, with little or no prenatal care and fathers catching their babies, a potentially very unsafe plan.  The success of the CbC evoked a response from hospitals in the form of in-hospital birth rooms, which, for the most part convert to standard delivery rooms and, even when fathers are present, usually do not offer any control, or even partnership, to the laboring family. (more…)

By Ruth Lubic. The release this week of Amnesty International’s new report, Deadly Delivery: The Maternal Health Care Crisis in the USA,  highlights the poor outcomes of African American women in particular. 

When I set up The Developing Families Center in Washington DC’s Ward 5, it was with the goal of addressing this very issue, particularly from the point of view of infant mortality.

At a rate of 12.22 per thousand live births, the District has the highest infant mortality of any of the states, with only Mississippi, at 10.74 also experiencing a double digit rate.

By Tamar Abrams. Ninety-nine years ago, International Women’s Day was founded to honor the accomplishments of women and to press for equality between men and women. All these years later, there is still so much to do. Rather than tackling the overwhelming global needs of women, one organization – Women Deliver – is focusing on maternal health. The statistics are startling: Every minute of every day, a woman dies needlessly of pregnancy-related causes. That means that more than 560,000 women and girls die every year. Almost all of these deaths occur in the developing world, and ten million women are lost in every generation!

What a tragic loss for our planet when at the same time we in the developed world have turned our attention to new ways of obtaining and sharing information, the latest methods to prolong our lives and even how to conceive and deliver babies well into middle-age. I’m guessing that the founders of International Women’s Day probably hoped that 99 years later, the chances of women dying of pregnancy-related causes would be slim to none.

A new study out of California shows that maternal mortality is hardly something we have conquered in our own country; in fact women die after childbirth at a greater rate in our country than in 33 others! Over the past decade, those statistics have grown increasingly grim in California — rising from 5.6 deaths per 100,000 to nearly 17 deaths per 100,000. The reasons for maternal mortality in the U.S. and around the world are complex and varied, but the fact remains that most of the deaths are preventable. Women simply don’t have to die during pregnancy, childbirth or soon after.

(more…)

Disruptive Women blogger Tamar Abrams shared this glimmer of hope from Haiti. It’s an NPR profile of her sister-in-law, AK, who has been delivering babies in Haiti.

Amid Death And Destruction: New Life In Haiti

Despite the grim scene in Haiti, life, for some, goes on. NPR’s John Poole and Joanne Silberner have been embedded with the Massachusetts 1 Disaster Medical Assistance Team in a field hospital in Port-au-Prince.

Obstetrician Anne Kathryn Goodman oversees births at the Health and Human Services field hospital. As of Friday morning, Jan. 22, six babies had been delivered at the field hospital. Poole and Silberner were there to document the delivery of little Sampson Brazile.

Hear Silberner’s story:

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.

View photos on NPR’s Picture Show Blog

Although Sampson’s parents were relieved after 2 1/2 hours of labor, they look to the future with anxiety. The father, Tony Jean, used to work in a textile factory before the earthquake. But the factory has collapsed and he and his wife do not know what they will do after they leave the field hospital. The Haitian government plans to move 400,000 earthquake victims from the shattered capital to camps in outlying areas in the coming weeks. In the meantime, earthquake relief continues to trickle in slowly.

— Claire O’Neill

Source: NPR’s Picture Show Blog

Think you have maternity coverage? Think again.

Welcome to the first entry of the book I’ll be publishing in 2010 entitled: You gotta laugh: Life in the trenches of the health insurance business. Because I think Disruptive Women readers will find it useful, each month I’ll post an example of a health insurance problem that is so maddening and frustrating that we just gotta laugh at its absurdity.

My goal, however, is to find a way to improve health insurance for beneficiaries and I have some suggestions at the end of this post.

This month’s question: What do you do when you have it in writing from your insurance company that you have maternity coverage — but when you go to use the benefit, the customer service department tells you otherwise?

The situation: When our client, Ms. R, found out a few years ago that she was having a baby she was thrilled. Immediately, she called the insurance company to confirm her pregnancy benefits. Making the call was merely a formality. When she originally purchased the policy, she was single and didn’t opt for the maternity rider. After she got married, she added maternity coverage because she wanted a family.

Indeed, when she called the insurance company, they confirmed she had the insurance she needed. However, after her first OB check-up she received a letter saying she was, in fact, not covered.

(more…)

I was stunned to learn that New York City’s Bellevue Hospital was closing its birth center, leaving low income women in the city with no access to a birth center that accepts Medicaid.

Why are childbirthing centers in this country struggling to survive when they ought to be spreading? We know that they provide a wellness-model of pregnancy and birthing (as opposed to a disease model that hospitals have traditionally taken), use best practices in birthing, have excellent clinical outcomes, and save money. Staffed and usually managed by certified nurse midwives, childbirthing centers have been endorsed by the American College of Obstetricians and Gynecologists.

At the end of the Bush administration, someone in the Centers for Medicare and Medicaid Services realized that there was no mandate to pay these centers a “facility fee” that provided support for overhead. So, after years of paying this fee, CMS stopped paying it to childbirthing centers and now pays it only to hospitals.

The numbers I’ve seen suggest that a vaginal delivery in a hospital costs 5 to 6 times more than in a childbirthing center. Ruth Watson Lubic, one of the pioneers of the childbirthing movement, founder of the Family Health and Childbirthing Center in Washington, DC, and a Disruptive Woman, has estimated that using these centers for just Medicaid births could save the nation $1-2 billion each year.

As our nation struggles to figure out how to pay for reforming the insurance industry, we can start to reform health care delivery in affordable, quality ways by ensuring that all pregnant women have access to the childbirthing centers. For those who want to act now, you can sign a petition calling for restoration of the Bellevue Hospital center. Or learn more about legislation to require CMS to restore the facility fee to childbirthing centers.

I am not usually one to take on the Vatican. In fact, I toured its lovely treasure-filled buildings only three months ago and marveled at the wealth and power it denoted. However, the Pope’s recent pronouncements during his travels in Africa that condoms and abortions are morally wrong have filled me with righteous indignation. I too have spent time in Africa. But I wasn’t there to make pronouncements from on high. I was there to make a documentary about the increasing number of married women with AIDS in Kenya. I walked through Kibera slum and watched large families crammed into corrugated metal sheds without plumbing or heat.

Even so, I probably wouldn’t take on the Pope…except for an article in today’s Washington Post. Apparently, the Vatican’s top bioethics official said the two Brazilian doctors who performed an abortion on a nine-year-old rape victim “did not merit excommunication, because they acted to save her life.” HELLO! In my book, that’s called a pro-choice stand. Bravo for Archbishop Rino Fisichella, president of the Pontifical Academy for Life. Perhaps he should have a chat with his boss.

Abortion is not a black and white issue for me, despite having worked for the better part of a decade for Planned Parenthood Federation of America and NARAL on reproductive health issues. That’s why the pro-choice position has also seemed to me to be the reasoned one. It allows individuals to make decisions and encourages each of us to define for ourselves what is reasonable and acceptable. There is a trust factor in being pro-choice. For example, if there is the possibility that a nine-year-old may be raped by her stepfather, you want to believe that the pregnancy will be ended as swiftly and humanely as possible.

Good for Archbishop Fisichella for being able to see that issues related to reproductive health have gray areas! And that it is often possible to be both pro-life and pro-choice while having to accept difficult decisions. Is it too much to hope that Pope Benedict XVI might also see the light? If he truly listens to the people of Africa and other continents, and opens his eyes to their hopes for their own lives – I have faith that he may begin to understand the healing power of condoms and the life-affirming necessity for legal, safe abortions.

On Jan. 26, Los Angeles mom, Nadya Suleman, made national news giving birth to octuplets. Now she’s stirred up controversy and debate about whether fertility treatments should be regulated. It turns out Suleman is 33, single, unemployed, lives with her mother — and already has six children. Knowing this, should her doc have allowed her to try and have eight babies at once? According to her mother, she only wanted “one more girl.”

Since the goal of most fertility treatments is to get one healthy baby — doctors usually implant a smaller number of fertilized embryos.

 Loading ...

The following is guest post from Megan Kamerick, a local reporter from Albuquerque, who shares some of her OB/GYN experiences following her diagnosis of infertility.

Let’s start with some numbers.

* Number of women ages 15-44 with impaired ability to have children: 6.1 million
* Number of women who’ve ever used infertility services: 9.2 million
* Number of married couples that are infertile: 2.1 million
* Number of women using infertility services: 9.3 million

These figures, from the National Center for Health Statistics, are a bit dated, but hopefully all of you OB/GYN practitioners and staff out there get the point. A good number of your patients are likely infertile. We’re not very noticeable because many of us walk around in silence, often with serious mental anguish over our inability to conceive. But we’re here. I’d just like you to keep that in mind.

(more…)