Safer births mark nation’s new start

By volunteering abroad an Australian nurse and midwife will begin documenting the health of women in the aftermath of the Rwandan genocide. By Linda Belardi.

Rebeccah Bartlett is preparing to embark on a journey of a lifetime. With an academic background in genocide studies and human rights, she is preparing for a trip to Rwanda and the Democratic Republic of Congo later this year to examine the health needs of the local women.

In particular, Bartlett says she’ll be working with rape victims to assess their mental and reproductive health following both the genocide in Rwanda and the current civil war in the Congo.

“I’ll be looking at what kind of health services are available to women who potentially become pregnant or contract HIV from their experiences, and the support systems that are in place,” she tells Nursing Review.

Through her global nursing and midwifery skills, Bartlett aims to better understand events that have been the object of her study and academic reading for years.

“I got into nursing, and now I’m a midwife, to work in developing countries with women who don’t have access to healthcare facilities. That’s my passion. My other goal is to try to raise awareness both here and overseas of maternal death issues,” she says.

After a one-month stint in a hospital in Senegal in a local midwifery unit, Bartlett will then travel to central and eastern Africa. While abroad, she hopes to film an independent documentary or conduct small-scale research about the ways in which people with skills in Western countries can meaningfully help other struggling nations, especially in the area of maternal and women’s health.

“I think that looking after women is the key to looking after a whole community,” she says.

“People take for granted Australia’s commitment to good maternal health. Working at a women’s hospital in this country - you wouldn’t tolerate a maternal death.

“Although, unfortunately, we tolerate indigenous maternal death more than we do non-indigenous. They have a maternal death rate five times ours. At the same time, you look overseas and there’s no respect for a woman’s life.

“But the evidence shows that if you protect a woman and give her good antenatal care, she can in turn give her child good healthcare, reduce poverty, improve literacy and improve trade. It’s all linked. It’s necessary to try to tackle poverty and disadvantage at the source, rather than looking for Band-Aid solutions.”

It was only three years ago that maternal mortality and morbidity achieved recognition on the world stage as a significant human rights issue and garnered the commitment of governments to protect women, Bartlett says.

To pursue her interests in this area, in December, she helped organise a birthing kit assembly day in the University of Sydney’s Great Hall for more than 5000 women. The kits, which aim to provide women with a hygienic and clean birth, are currently on their way to a private hospital in Boroko, Papua New Guinea, with others going to Kenya, Rwanda and the Congo.

This means Bartlett will be able to see for herself what difference the kits are making to the lives of local women, when she visits these countries this year.

The kits include gloves, soap, gauze and a sterile cutter for the umbilical cord. They were purchased from the Birthing Kit Foundation in Adelaide to try to improve the neonatal sepsis rate in developing countries. “However, what we’re also finding is that with a lot of the kits comes education about safe, best practices both for the women and some of the traditional birth and skilled birth attendants that are working in these countries,” says Bartlett.

The nurse will be part of another assembly day in partnership with the Stillbirth Foundation later this year.

While not designed to be reusable, these kits also are not a substitute for obstetric emergency care, Bartlett says. “There’s a belief in some low-resource countries that if you have these kits nothing will go wrong. But they are just one tool in a range of strategies. A kit is not going to stop a haemorrhage, hypertensive disorders, or stop an unsafe abortion, which are the other killers [in] maternal health.”

She says there are also recent trends in countries such as Bangladesh where women have begun paying for these kits. “In some cases the birthing kit becomes an access point for a lot of women to begin antenatal care by coming to the hospital and getting a kit.

“We are trying to encourage the women to take that responsibility upon themselves and create a demand, so that the women are saying ‘we deserve these kits, we want these kits, we’ll even pay for these kits’ …or they say they are willing to pay for them at their next birth because they know they provide a cleaner environment.”

While more research needs to be done to assess their use and impact in destination countries, Bartlett says they are effective in promoting advocacy and public awareness of maternal health issues.

“It’s really important that it’s not just about putting together kits but drawing attention and getting the community caring about a cause. The kits are getting people writing to AUSAID and demanding more attention be brought to maternal health.”

An avoidable crisis

Far too many women continue to die avoidable deaths during childbirth, said Kara Blackburn, women’s health adviser for Medecins Sans Frontieres (MSF).

Coinciding with International Women’s Day on March 8, the medical-humanitarian organisation released a report in Sydney on the global crisis in maternal death. “We know that 15 per cent of all pregnancies worldwide will face a life-threatening complication,” said Blackburn.

“These women need access to quality emergency obstetric care whether they live in Sydney, Port-au-Prince or Mogadishu.

“The reality is the same for women in a modern hospital in an international city or in a conflict zone, refugee camp or under plastic sheeting after a devastating earthquake.”

Every day around the world, about 1000 women die in childbirth or from a pregnancy-related complication. However, many are avoidable with appropriate access to skilled birth attendants, drugs and equipment.

“It is an ongoing tragedy that we are still seeing so many women die in childbirth, when we know that the provision of quality care at the time of delivery can have a direct impact,” Blackburn said.

“We must always remind ourselves that a maternal death is an avoidable death.”

The report details the situation for pregnant women in 12 countries where Medecins Sans Frontieres works, including Pakistan, Somalia, South Sudan and Haiti, and highlights the necessity of emergency medical assistance, particularly when complications occur.

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