Maternal mortality rate. Infant mortality rate. MMR and IMR. Acronyms describing the most disturbing of phenomena – women dying due to pregnancy and birth-related causes, and the youngest of all human beings dying due to causes such as infection and malnutrition. About twenty percent of the world’s maternal deaths occur in India – that’s about 56 000 women every year. Half of Cape Breton. Most of those deaths are preventable. The infant number is perhaps even more tragic – 1.3 million infants die each year in India. More than all of Nova Scotia.
In Canada the infant mortality rate in 2012 was 5 infant deaths (under 1 year old) for every 1000 live births. In India there are 47 infant deaths for every 1000 live births.
Any mother or infant dying is a tragedy, but at least in Canada it is a relatively abnormal occurrence. Although even within the low Canadian rate there are differences – higher rates of infant death are seen in First Nations people and people living in poverty than in other groups in Canada. Those deaths represent a failure on many fronts, not just during the time of giving birth. Specifically for India, Dr. Anant Bhan and Bhavna Dhingra have co-written an excellent article on the comprehensive approach needed to address women’s health issues in India.
In India, I am working with an organization called the Child in Need Institute. This organization has been in existence for decades, started by a pediatrician, Dr. Samir Chaudhuri. CINI works in many areas, but primarily maternal and child malnutrition. CINI has been delivering programs, working with government and NGO partners, and influencing policies with the goal of improving the nutritional health of families. Beyond that, it has advocated in many areas relevant to health, such as education and housing. CINI also works extensively with HIV prevention. In 2003, it because the first community site (outside of a hospital) to offer HIV testing in West Bengal (the state in which Kolkata is located). Currently it has a network of community-based initiatives occurring across the state.
I have been working with CINI on a grant application for this initiative: Grand Challenges: Saving Lives at Birth. The intent of the proposed initiative is to build on CINI’s previous work in general maternal and infant health, and to create better linkages to the healthcare system so women and infants have quality medical care when it is time to give birth. All of this using a smartphone data system that will allow better tracking of the health status of pregnant women and create better links to the healthcare system.
The philosophy of much of CINI’s activities is similar to the Healthy Beginnings work done by public health health in Cape Breton. Healthy Beginnings staff work to deliver programs that support women, children, and their families to optimize the most influential early years of a child’s life – one way in which this can be done is through home visits or working with other organizations that provide care to families. There is also a focus on adopting and changing policies that help create environments conducive to child health – this could include seeking more accessible daycare options, or addressing legislation that unfairly disadvantages pregnant teenagers.
However, despite the similarities, it is a change in mindset for me to be thinking of the most basic of mother and infant needs – how not to die while giving birth/being born. Being here with my son, with whom I’ve known nothing but pleasure and excellent healthcare through the pregnancy, birth, and infant stages, makes the contrast even more striking. All women and infants should be able to have that.
Public Health in Cape Breton 