When each of my three children was born, a stream of nurses and doctors made sure that my wife and children would be safe. In many countries around the world, however, the situation is far different: the availability of medicines and skilled health workers are not assured. Therefore, there are no guarantees of a mother or a newborn's safety. Most children will never see a doctor attend their birth and thus skilled care via nurses and midwives is the realistic standard to aspire towards. And today, in a country like Nigeria, many women deliver their children completely alone, relying only on traditional practices of newborn care.
As a husband, father, and now grandfather, my heart goes out to these women. But in countries like Nigeria, solitary births are more than just lonely--they're deadly.
Each year, 1-in-5 women, equivalent to over one million births in Nigeria--are completely alone when they deliver their children, whether for logistical or cultural reasons. This common practice leaves women defenseless against birth complications and trauma and many die from severe blood loss. Currently, Nigeria ranks second highest in the world for rates of maternal deaths--14% of the global total.
Unassisted births are often deadly to newborns as well, who are dependent on their mother's care during their crucial first hours and days of life.
The UN calculates that every year, 2.9 million infants around the world die in their first 28 days due to infection and other preventable conditions. In Nigeria, 241,000 newborns of the 5.9 million born die each year--that is 700 per day and 30 each hour--according to the Nigeria Population Commission and the 2008 Nigerian Health and Demographic survey. The high death rate among newborns is partially the result of a traditional practice of umbilical cord care. For hundreds of years, charcoal, cow dung, or mustard seed oil has been spread on newborns' umbilical cord stumps after birth, causing rather than preventing infections.
In reality, with support from donors such as USAID, JSI is pioneering a two-drug initiative that uses low-tech and high-impact methods to protect both mother and newborn during and after birth.
The first drug, misoprostol, is for the mother to take immediately after delivery. Just three orally ingested pills prevent postpartum hemorrhage, a leading cause of maternal mortality around the world.
A second medicine, chlorhexidine, is an easy-to-use antiseptic to replace traditional umbilical cord care. Pioneered for infant use in Nepal, the gel is spread on the infant's cord stump within an hour after birth, sealing the wound, preventing bacteria from latching on the cord, and allowing it to heal.
When used together, misoprostol and chlorhexidine have the potential to dramatically lower the newborn and maternal mortality rates for women who deliver alone. In fact, the approaches were recently endorsed by Melinda Gates in an impassioned plea in the Wall Street Journal. A new video maps out how these drugs are changing maternal and child health in Nigeria.
So far, two of Nigeria's 36 states, Sokoto and Bauchi, have officially adopted the widespread use of the two medicines, and others are taking notice. Four states have set aside funds and plan to launch distribution projects in the near future, and three states have submitted proposals to implement the initiative. And JSI has joined forces with UNFPA to support four states to introduce the use of these medicines at scale. Learning from the model that the Nepal government implemented in partnership with JSI, a local private sector pharmaceutical company has begun producing chlorhexidine in Nigeria.
Meanwhile, it is critical that we inform women, health care providers, and their communities that there are low-cost ways to save mothers and newborns even if women do deliver alone. Important, too, is drawing global attention to the fact that seemingly insurmountable problems have simple solutions--in this case, as simple as three small white pills and a gel. JSI continues to actively advocate for women to choose to deliver at the health facility.
By ensuring that more newborns live and fewer mothers die, chlorhexidine and misoprostol promise families better futures and Nigeria better opportunities.