Preventing a mother from death during childbirth is cheap, but treatment may cost you your life

Across Kyrgyzstan delivery rooms, women lose litres of blood after giving birth. As women haemorrhage, medical staff try desperately to stop the bleeding. The new mother’s blood pressure drops. Her heart stops. Blood covers the bed and floor. This scene plays out every day across the country. The problem is treatable. And preventable. But in Kyrgyzstan, haemorrhaging is often a death sentence.

In Kyrgyzstan, almost all births were attended by skilled personnel over the last 5 years, but the country is the most dangerous place to give birth in Central Asia since 2000. Hiring more medical staff has not fixed the problem. In 1999, Kyrgyzstan and Kazakhstan rates were equal, but since then a pregnant woman in Kyrgyzstan is six times as likely to die than a Kazakh mother. 

Source

Stopping hemorrhages requires skill and speed: Kyrgyz medical staff has neither

The Postpartum hemorrhage (PPH) refers to a woman’s heavy bleeding after giving birth which can cause a severe drop in blood pressure. Hemorrhage is one of the most common and preventable causes of mother’s death. If not treated quickly, usually with medication and stitches, this can lead to shock and death.

Women in Kyrgyzstan die mainly because of complications that occur during their pregnancy or delivery. While Kyrgyzstan has enough nurses – with 50 nurses per 10000 population, which is twice more than  the WHO recommendation, it does not have enough doctors to take care of mothers suffering during a childbirth. Several international organizations also note that there is lack of pathologists in hospitals to detect properly the cause of mother’s death.

3 out of 4 mothers die because of severe bleeding, infections, high blood pressure, unsafe abortions. All these conditions require advanced medical procedures to treat and save the mother’s life. The World Health organization has recommendations for treating PPH but medical staff require training first.

There are only 7 gynecologists for every 10000 women in Kyrgyzstan, down from 10 in 1990. The number of specialists is insufficient to deal with problems during pregnancy.

Moreover, in Kyrgyzstan, hospitals in rural and urban areas have imbalanced supply of doctors, who work mostly in cities and oblast administrations. More than half of all obstetricians-gynecologists and neonatologists of Kyrgyzstan work in big cities.

Erkaiym Isaeva, who works as an obstetrician gynaecologist in Bishkek confirms the importance of proper medical treatment of pregnancy: “ If a pregnant woman is seeing a gynecologist regularly, it is possible to trace every and deterioration of her condition, from anemia to placenta condition, and prevent the tragic outcomes”.

She points out that it is essential to explain woman’s responsibility to register with the doctor during pregnancy: “If a woman attends a doctor and gets tested, she decreases risks of deterioration during pregnancy and childbirth by 85-90%”.

Early detection requires testing and a quick fix: mothers slip through the cracks

Studies prove that severe bleeding and high blood pressure are connected with anemia. This is why one of the six essential components of an antenatal care visit includes a test for anemia. Most pregnant women get antenatal check. Yet most pregnant women have anemia that goes undetected.

Anemia is a condition in which a person’s blood has too few red blood cells or hemoglobin to transport oxygen to cells in the body. Poor nutrition and anemia are the reason of 1 in 5 cases of mothers dying during childbirth.  Severe anemia, when hemoglobin levels are much less than normal, causes a significant risk of mortality for women, especially when they are pregnant. On the other hand, pregnancy itself increases the risk of maternal anemia (specifically iron deficiency anemia), as both baby and mother need iron as a fundamental element for the development of a body. There is also growing evidence that anemia is linked to increased blood loss during delivery and hence puts women at greater risk of postpartum hemorrhage.

According to WHO, almost all pregnant women in Kyrgyzstan received antenatal care (95%). But when trying to evaluate its quality, experts found a lack of continuity in care that extends from family planning, pre-conception, gestation and birth to the antenatal period. WHO recommends six steps in basic antenatal care visit, one of which is testing of anemia and treatment with iron pills.The World Health Organization’s recommendations were aimed to improve the quality of antenatal care in order to reduce problems and complications during pregnancy and birth.

WHO reports that  anemia during pregnancy is highly prevalent in developing countries. For every two anemic pregnant women in Central Asia, there are 3 in Kyrgyzstan. Studies proved that in pregnancy, anemia is mainly nutritional due to dietary deficiency of iron. However, proper medical care of a pregnant woman can treat her anemia in time before the childbirth.

Erkaiym Isaeva notes that, during pregnancy the gynecologist gives the recommendations and assigns folic acid, vitamins, and antianemic means. “in general, 70% of women living in the city visit a doctor and follow instructions. But rural women and most of the non-urban residents rarely visit gynecologist. And all the problems are starting from the first months”.

Know your risk and protect yourself

Source

For every women who died during childbirth in Talas, almost 4 died in Jalal-Abad. Note that women in Jalal-Abad get pregnant at the age of 22 on average, which is much earlier than  in Bishkek, Yssyk-Kul oblast, and Chui oblast, where the average age of first pregnancy is 24. According to a World Bank survey, married women in Jalal-Abad have the highest need for contraceptives.  Insufficient family planning and early pregnancies contribute to the fact that Jalal-Abad is the most dangerous region in Kyrgyzstan for childbearing.

With insufficient specialized care and holes in antenatal checks, women are left with no option but to ensure they aren’t anemic in the first place. To prevent anemia, some should eat enough products that contain iron, one of them is meat. In 2011, people in KG consumed twice less meat, and three times less dairy products than in1990.  Other iron rich products: beef, chicken, lamb, sweet potatoes, broccoli, etc.

“Anemia is the result of iron deficiency in body, this element is crucial and fundamental for the development of healthy blood cells. At the moment prevalence of anemia among pregnant and children is number one problem in Kyrgyzstan. And it is important to know that anemia does not come along, it contributes to other more dangerous diseases”, – said Duishe Kudayarov, academician.

Maternal mortality rate counts all mothers who died while being pregnant or within 1,5 months  after  termination of pregnancy, irrespective of the duration and site of the pregnancy. Maternal mortality ratio is always counted per 100 000 live births, and hence represents the risk of dying associated with pregnancy. The risks vary dramatically around the globe. Women in developing countries are 20 times more likely to die during childbirth than in developed ones.

The quality of registered cases of death is, however, a problem that leads to different data depending on the agency that has published it. In 2015, National Statistics committee reported 38 deaths per 100 000 births, while the World Bank and WHO – 76 which is twice more.

Tackling nutrition instead of healthcare

One of the solutions to prevent iron deficiency anemia was flour fortification. It means that the flour is artificially enriched with group of vitamins (iron, vitamin B, etc.). The components could differ from country to country, taking into account the major concerns in health of the region.

A law on the flour fortification was  passed in 2009 in Kyrgyzstan, by the recommendations of WHO. According to the law, both local flour companies and importing companies have to enrich  the flour. But in 2014 only 17% of flour was enriched. Experts note, that the implementation of the law did not reach its goal, and since 2014  the number of fortified flour is even decreasing. One of the main problems is that Kyrgyzstan imports most of its flour from Kazakhstan and Russia and cannot control the quality of imported flour since country entered Customs Union in 2014.

Amendments to the law that would allow Kyrgyzstan to have its import flour enriched are still in progress, and discussions continue at the parliament, while citizens are suffering, and mostly the Kyrgyz mothers who risk their life. If the law is implemented, many lives could have been saved, since at the moment flour enrichment is the most effective yet cheapest way to prevent iron deficiency anemia in Kyrgyzstan.