Soroptimist International’s Programme Director, Reilly Dempsey,
is attending the 10th World Congress on Maternal and Neonatal Health in
Rome. Here is her report from the third day of events, seminars and debate:
Today
was the third and final day of the 10th World Congress on Maternal and Neonatal
Health, where we shifted focus slightly from the “maternal”
side to the “neonatal”
side. There were two sessions today; the
first looking at infections, reproduction, and maternal and infant health. The second session focussed on prevention of
prematurity and care of the premature.
Prevention of Mother to Child
Transmission
Although
new infections of HIV have stabilised somewhat, because of the wider
availability of treatment, we live in a world with a vastly increasing number
of people living with HIV, the majority of whom are women of reproductive
age. Much research is going into ensuring
that these women can safely become pregnant (if desired) and have a happy and
healthy baby. This is no small
task. HIV can be transmitted to a baby
at three stages: in utero, during labour and delivery, or through breast
milk.
Interventions
specific to each stage have been shown to greatly reduce transmission, but not
without cost or challenges. We learned
about the latest WHO recommendations on prevention of transmission through
breast milk. This is an interesting
challenge – a balancing
act if you will. While there is a risk of transmission through breast milk,
there is just as great a risk of poor health outcomes and infant mortality
through switching to formula when there is a lack of access to safe clean
water. Weaning is also a time of great
risk. For example, mixing breast milk with solids carries the same risk as
having unprotected sex with an infected partner six times a week. The weaning
process disrupts the digestive tract in such a way that babies are much more
vulnerable and exposed to the virus via the breast milk.
So
what to do? Well, the latest WHO
guidelines recommend ARVs for the mother while breastfeeding (even if she does
not “qualify”
for her own health, it is critical to keep viral load down and CD4 count up
while breastfeeding), exclusive breastfeeding for at least 18 months, and a
shortened weaning period of 1 month. The
previous recommendations were to wean abruptly, but this has been found to be
too challenging both physically and socially/culturally. Abrupt weaning is extremely difficult and, if
a mother has not disclosed her status, can cause many problems.
Pre-Term Babies: Why?
There
are 13 million pre-term births per year (pre-term defined as before 37
weeks). The rate of pre-term births
globally is increasing (though some countries have shown a slight decrease in
recent years). Although the cause is
unknown, or speculative, we do know that there is a psycho-social
dimension. Women living in high stress
environments or experiencing socio-economic hardship or discrimination are more
likely to deliver pre-term. There is
also a huge disparity in treatment. Pre-term babies in Tanzania
are four times more likely to die than black American babies and eight times
more likely to die than white American babies.
While
there are some very interesting clinical and research programmes exploring the
causes of pre-term birth, we also need to look to immediate and cost-effective
solutions to avoid infant mortality in both resource rich and resource poor
settings. In some countries, it can cost
up to 40,000 Euros to keep just one pre-term infant alive. Notably, some of the most promising solutions
are the same as those to save the lives of the mothers: Access to both skilled
birth attendants (with skills for both the mother and the baby) and access to a
properly resourced health care facility.
There are other low cost interventions, such as a tool to measure cervix
length to differentiate between false labour and actual onset of pre-term
labour (http://www.cervilenz.com/), new
training guidelines for birth attendants, and, of critical importance in Papua
New Guinea (the location of the SI December 10th Appeal), hygiene
measures.
Kangaroo Mother Care
One
of the final talks was on Kangaroo Mother Care (KMC), an incredible programme
developed in Colombia
in the 1970s. This is the perfect
example of the lessons the entire world can learn from solutions developed in
resource poor settings. The concept is
based on three main primary principles: skin to skin contact, exclusive
breastfeeding, and support/early discharge from hospital. Though developed in response to a shortage of
incubators and hospital space for pre-term and pre-mature babies, KMC has been
shown to have many positive health and development effects on both the baby and
the mother – and the father. I would encourage everyone to read more on
the KMC website! http://www.kangaroomothercare.com/home.aspx
Today
we are off to meet our Rome SI UN Rep Cinzia, colleagues from the FAO, and
Italian Soroptimists.
Stay tuned for one more report from this
educational experience in Rome!