During the past several weeks, you would be hard-pressed not to find an article about the dismal maternal mortality rates in this country. In fact, it was a study published in our very own Green Journal that sparked the latest national conversation (with Texas at the epicenter) about why the most modern, industrialized country in the world is failing so miserably at reducing the numbers of deaths associated with pregnancy and childbirth. However, the truth of the matter is, we already know why.
Working in the field of global health has been a passion of mine since my wife, Melanie, and I served on a medical mission in the Dominican Republic many years ago. I saw first-hand the need to increase the quality of health care provided to women in other countries. All women require access to quality health care no matter where they live, and training and educating health workers is key to ensuring that care is available.
The World Health Organization reports that almost all (99 percent) of the nearly 300,000 maternal deaths every year occur in developing countries. Two of the most common cancers affecting women – breast and cervical cancers – are of growing global concern. These alarming statistics are what make our partnership with Health Volunteer Overseas (HVO) so important. For nearly 30 years, HVO has empowered health care professionals in resource-scarce countries with knowledge and skills to address the health care needs of their communities.
A woman dies from pregnancy or childbirth every two minutes. Almost all of these deaths (99%) are in developing countries. The most heartbreaking part is that the vast majority of these deaths are preventable.
As the nation’s leading group of physicians providing health care for women, ACOG strongly advocates for quality health care for women – everywhere.
That’s why, in an effort to demonstrate the urgency of global action to protect maternal health and rights, ACOG recognizes today as the International Day for Maternal Health and Rights.
I am proud of what ACOG is doing in so many areas of women’s health, but I have particular pride in our global health initiatives. On June 13-14, I participated with a very dedicated group of ACOG Fellows in the Global Operations Advisory Group meeting to develop a strategic plan for our global operations. For two rewarding days, we created plans to help extend ACOG’s contributions to our ob-gyn colleagues in other countries and the women in those countries who are so in need of improvements in health care.
Millions of women around the globe lack basic rights—rights to health care, rights to family planning services, and the right to lead long, healthy lives. Pregnancy and childbirth are major threats to women in underserved areas of the world with over 300,000 women dying yearly from their associated complications, unattended by trained medical professionals. While most of these deaths are preventable, these women need a voice to bring the world’s attention to what is truly a global crisis in women’s health.
As ob-gyns, awareness of the scope of issues faced by women internationally should be integral to our education. Only with this foundation can we prepare ourselves for the monumental challenges of global health care delivery. Ultimately, it is our collective responsibility as women’s health care providers to give voice to and promote care for these women, whether or not we choose to work at home or abroad.
It has been my work and passion over the last seven years to develop educational resources for health care providers interested in global women’s health, including a new online course. Preparing for cultural and ethical aspects of health care delivery abroad is critical and just as essential as our medical knowledge. These skills can also allow us to take better care of women here in the US.
All women’s health providers should educate themselves on these global women’s health topics, including maternal mortality, obstetric fistula, family planning, and female genital cutting.
I encourage you to be part of a global voice for women.
Taraneh Shirazian, MD, is assistant professor and director of Global Health in the department of ob/gyn and reproductive sciences at Mount Sinai School of Medicine in New York.
As ACOG president, I have the honor and privilege of representing US ob-gyns on an international level. This has been most exciting. In the last two weeks, I have attended the annual meetings of the Society of Obstetrics and Gynaecology of Canada (SOGC) in Calgary, and the Royal College of Obstetrics and Gynecology (RCOG) in Liverpool. It was particularly rewarding to watch our very own Dr. James Martin, an ACOG past president, become an honorary fellow of RCOG for his extensive work in hypertension. At these meetings, I was struck by the diversity of the attendees and the deep interest in global women’s health. I was also surprised and inspired by the similarities in priorities we share with our overseas colleagues.
RCOG is working toward a goal of improving maternal outcomes. RCOG President Dr. Tony Falconer, shared reports and responses to the UK’s National Health System and discussed safety in labor and delivery. He referred to all of the fellows as the “eyes and ears of the profession” who will need to address lifelong leadership and quality goals. RCOG is also setting expectations at UK delivery centers for all who provide care. Just as they are looking to improve outcomes, so are we. With our National Maternal Health Initiative, we can focus on both quality and safety in every delivery center in the US by developing standards and expectations on how to provide the best care.
Dr. Chiara Benedetto, the first female president of the European Board and College of Obstetrics and Gynaecology, is working with each of the European nations to develop expectations for the well-woman visit. We hope to accomplish the same thing in the US with our partners in family practice, internal medicine, and pediatrics, including nurse practitioners, nurse-midwives, and physician assistants. Clearly, we all agree that we must address the health of women BEFORE they conceive through improved well-woman care and contraception.
The take-home message: We are all facing the same pressures. Ob-gyns around the globe are extremely dedicated physicians who want what is best for our patients. We need training, standards, and support in developing the systems to provide the best care, and time is of the essence. As many have said, “We do not need to reinvent the wheel.” This is an especially important point as we share our global initiatives and recognize the importance of engaging each country in improving maternal health care and outcomes. We can make changes for Every Woman, Every Time, because—no matter where we live—if we put our patients first, we will succeed.
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For most families, the arrival of a new child is a joyous and celebrated occasion. However, in many countries in the developing world, having a baby can be a dangerous undertaking: Approximately 800 women die during childbirth each day; 99% of all maternal deaths occur in the developing world. The loss of a mother is a tragedy for her family and her community.
Imagine you are a physician in rural Uganda: You know there is a high-risk patient who lives in a village several hours away from your regional hospital. She has no transportation, no running water, no electricity, and no cell phone access. Despite the fact that you have the skills to assist in a safe delivery, the barriers to access will likely prevent this woman from coming to the hospital, greatly increasing the chance she will die in childbirth.
Complications that cause most maternal deaths in the developing world are severe bleeding, high blood pressure, obstructed labor, and infections. Our challenge and our hope is this: We have proven life-saving interventions routinely used in the US and other industrialized nations to prevent these deaths. And while they have the potential to dramatically improve maternal outcomes, it has been very difficult to implement these interventions in low-resource settings.
We now have a wonderful window of opportunity with a groundswell of support to develop initiatives to improve maternal and infant health. The American College of Obstetricians and Gynecologists (The College) is playing an integral role in Saving Mothers, Giving Life (SMGL), an innovative public-private partnership that aims to reduce maternal mortality in the developing world. As a founding member of SMGL, The College has joined with the governments of US and Norway, Merck for Mothers, and Every Mother Counts to dramatically accelerate progress in preventing maternal death. Work has already begun in Uganda and Zambia with a goal to reduce the number of maternal deaths by up to 50% in a year, and plans are under way to expand our reach into other developing nations disproportionately affected by maternal mortality.
I’m both honored and excited to represent The College and be a part of SMGL. This coalition has a unique opportunity to make a difference. I firmly believe we can and we will. Watch for updates and opportunities on The College website to get involved in these important initiatives.
According to a recent New York Times article, maternal deaths have plunged from more than half a million per year in the 1990s to roughly 287,000 in 2010. A report released by the United Nations attributes the decline to better access to and use of contraceptives and of antiretroviral therapies among mothers with AIDS, and more births being attended by doctors, nurses, and medically trained midwives. Though this number is still far too high, the drop in maternal mortality is dramatic and serves as a powerful reminder that we’re heading in the right direction.
Contraceptive access is essential for all women because, according to the World Health Organization, if the 215 million women desiring contraception could get it, each year unintended pregnancies would drop by 71% and maternal deaths would decrease by 67%. In a world of limited resources and 7+ billion people, helping women control their fertility is the right thing to do. By providing women with options that help them make better reproductive choices and protect their health, and by making childbirth safer, women, families, and their communities become stronger and more empowered. The decline is confirmation that inroads can be made and that small changes can make a huge difference.
Maternal mortality remains a major threat to women of all backgrounds. ACOG continues to explore methods of lowering maternal deaths at home and abroad. In the meantime, this good news puts wind in the sails of physicians, women’s health advocates, and communities who tackle this problem from the front lines. And during National Women’s Health Week, it’s an especially fitting time to celebrate.
I talked recently about the excitement leading up to ACOG’s upcoming Annual Clinical Meeting (ACM). As in every year, attendees can look forward to a thoughtful and comprehensive scientific program. I wanted to share two of the sessions that have particularly piqued my interest from this year’s line-up.
While I admit to being a stargazer, the special session on maternal and child mortality headlined by Christy Turlington Burns and Tonya Lewis Lee promises to offer much, much more than a celebrity sighting. Both are activists and documentary filmmakers who have used their star power to raise awareness about maternal and child health in the US and around the world. Maternal and infant mortality is an issue that ACOG continuously works to address and improve. With all the advances in medicine and obstetrics available to us, it is a travesty that mothers and babies around the world are still dying every day. In fact, the US has the highest rate of maternal mortality among industrialized nations. Ms. Turlington Burns and Ms. Lewis Lee will share the insights that they have gained from their time spent on the front lines with at-risk women and children.
Switching gears, the second session I won’t miss addresses cosmetic gynecology—a hot topic in ob-gyn. We are a society preoccupied with appearances, and procedures that promise to give our looks a boost generally receive a lot of attention. Some ob-gyns have stepped into the cosmetic surgery arena, performing cosmetic gynecologic procedures such as labioplasty, “revirgination,” and other forms of vaginal “rejuvenation” as well as aesthetic procedures such as injecting Botox. A four-expert panel will discuss the pros, cons, and ethics of ob-gyns performing these surgeries and the controversies that surround some of these procedures.
These are just two highlights in a scientific program studded with clinical pearls. Check back from May 5–9 to hear more about the happenings at the ACM.