Mother’s day- How do we save our mothers?

We have recently celebrated the woman who has helped us cope with life not only during our childhood, but also adulthood. We showed our appreciation to the superwoman, who shields us from everything that could cause us pain, and sometimes, to our embarrassment and sometimes joy, tries to guard us even when we are supposed to have found our own footing in the big world outside home. She is universally revered across cultures, religions, countries or the n number of divisions we have made to segregate ourselves.

But something isn’t right. Why are our mothers dying and why haven’t we been able to curtail this, even in 2017?  Maternal death is a serious issue especially in developing countries. Although we have brought down global maternal mortality by 47% since the 90s, as per the World Health Organization (WHO), about 830 women die due to pregnancy/delivery related problems around the world each day. These are mostly preventable. 99% of these deaths occur in the developing countries.  The odds of a 15 year old dying due to pregnancy/delivery related issue in developed countries is 1 in 4,990. In the developing nations, it is 1 in 180. Sadly most of these deaths occur due to reasons that are within our control.

Severe blood loss during pregnancy and post delivery is the main reason, followed closely by infections. In most cases of severe hemorrhage, injections of Oxytocin are enough to slow down blood loss. The many reasons for maternal death are health inequities, aka, basic services are not available to those who cannot pay for care. Distance to the nearest health care facility, availability of medicines in the facility, inadequate services are also key reasons adding up to the issue. A UNICEF led project in 6 states in India based on verbal autopsy of family members and community members of mothers who had lost their lives during child delivery, showed that cost for transport to the nearest health facility, literacy level of the mother, community awareness were leading cause of maternal deaths.

Personally I find the lack of awareness and non adherence to hygienic practices during childbirth and subsequent death of mothers due to infections, is most unsettling. Sepsis is a major problem, both in maternal as well as neonatal death. These defy all norms for extent of negligence. Additionally, through our incessant use of antibiotics we have successfully created microbes which are now resistant to most drugs, hence can easily compromise an infected mother and her newborn.

The WHO has recently adopted a resolution on sepsis that urges member nations to be more cognizant regarding causes, prevention and treatment of sepsis and tighten policies and regulations of activities leading to Antimicrobial resistance (AMR), to develop AMR stewardship activities and strengthen hygienic practices, clean childbirth practices and improvement in sanitation and nutrition.

Some of the basic things that we could do at our levels would be to create awareness amongst everyone we come in contact with. Every time we visit a clinic or a hospital, we could inquire about guidelines followed in infection management, waste management and AMR. We could also remind the health practitioners about hand hygiene and seek their advice in ways to prevent infections at our homes.

Every family needs a mother and every mother deserves a good healthy life, especially one that can be met by a few prevention steps

 

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Intergenerational transmission of poverty and escaping the poverty trap

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Last weekend I watched a delightful movie on something quite close to my heart. ‘Nil Battey Sannata’ depicted a mother and daughter’s journey through life. There were several moments which I could totally identify with. It was superb acting by a very able cast and although the subject was very down to earth, of a mother’s trials to provide a good future for her daughter, the cinema did do justice to balance all emotions very well. The teenage daughter had already resigned to the fact that her mother wouldn’t be able to put her through an expensive higher education, and had gone ahead and explored options of choosing a career as a nanny, something within her realms and ability.

A few days ago I was involved in a project dealing with intergenerational transmission of poverty and some of the dialogues in the movie brought back thoughts from work. The mother depicted in the movie was a daily wage earner, working in the informal sector. In India and many other lower and middle income countries, there is a huge section of population working in the informal sector and most survive on day to day earnings. Some don’t have enough to meet their daily needs and most do not have anything to save for the future. And this brings in another worry of a huge population of elderly people resulting from the same informal sector, without any sort of retirement savings.

I strongly feel that every human has a right to dream a rosy future and somewhere when one is consumed with thoughts solely of how they/their family can survive the next day, life is not completely justified. There is some information from research and mostly from the field of economics that intergenerational poverty is transmitted from parent to children especially in those living below the poverty line (BPL). Somewhere, there is a little mismatch, since the huge middle class strata of India, which extends from those just above the poverty line to those doing very well, often times demonstrate examples of children capable of attaining their dreams through hard work and education loans and scholarships and being able to climb from one strata to that higher. This is somehow extremely difficult for the poorest of the poor (BPL), even though many of the schools have very similar opportunities for growth. Additional aspects such as health and nutrition have been implied to add to lower school attendance in children and the reasons for being unable to escape the poverty trap become complex with multiple compounding factors.

What has been seen to work to some extent is conditional cash transfers (CCT). And more evidence from research is needed in this area. Pilot projects where cash transfers were made to the BPL families, tagged with compulsory school attendance, or availing government immunization/health programmes were seen to effect family nutrition and quality of life in a positive manner. School attendance also improved due to better nutrition and health. This would probably be a mechanism to escape the poverty trap. However, much more needs to be done in a proper structured manner. Also the process for CCT needs to be efficient without involving too many intermediaries that can raise avenues for corruption or bureaucracy or both (one stop mobile money transfer has worked well in Kenya). Community cooperatives also work to some extent, however, a strong community engagement, community participatory action methods are needed to be explored.

I am often frustrated that researchers do not come together to build sustainable projects. Grants are mostly driven with motivation for a few publications, or a PhD degree or obtaining a faculty position. Sustainable projects can be made possible only by a multidisciplinary team and until researchers stop working in silos where an economist only works with another economist and a qualitative researcher only with their own folks, it will be very difficult to achieve anything meaningful on the ground. One can generate multiple models of why things are not working, but ground level realities require tangible practical solutions and most importantly, ones which are sustainable in minimum resource settings.

Picture acknowledgement- Asian Development Bank

Anja and Hope

We are surrounded by it. No matter what steps we have taken, nationally, internationally, through government or through not for profit sectors, there has been no escape from it, nor will be for the next decade to come. Poverty will remain, so will the hunger in the emaciated bellies and eyes of little children and mothers will continue to weep, watching their conditions or abandon them out of sheer desperation and frustration of not being able to keep their promise to the little ones.

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This picture is of a two year old Nigerian boy, abandoned by his family and of Anja Loven, a care worker. I am sure her profession would have presented her with many similar occasions to come in contact with undernourished and emaciated children. However, something about this particular boy was different. It’s the sixth sense we all have, of knowing that with a little care, sometimes, the cycle of life can be reversed.

Anja named him Hope, and she and her colleagues took care of the boy, sent him to a medical facility and helped him heal. Today Hope is better. One cannot distinguish him from other children his age (Pic 2).  It just took proper medical care and kind attention to reverse the child’s state within months. Anja’s plea over internet also allowed for 1 million USD in donations to take care of Hope’s expensive medical bills.

Instead of asking why there’s not enough being done for the many other little ones who need all our support, I would state that this beautiful story shows that one person can make a difference in one more person’s life. That’s all it takes. We don’t have to save the world, we can leave that to the others. What we can do is to help just one more life. Be it a human, a bird, a tree or an animal.

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We do not have to provide monetary assistance always. A few students at my friend’s university campus got together to teach children of lesser salaried staff, during their free time. All it takes is time and a will to do something. The important thing is to make the effort. I am encouraged to see that the next generation of youngsters are immensely motivated and creative and moreover aware of their environment. They can design what’s best for the future of our country.

If we really cannot do much by ourselves, we should at least try and encourage those who are making a difference.