November 16, 2011 — When Aparna Chandrasekhar traveled from the United States to India at age 13 to visit family, she spent time shadowing her aunt, an obstetrician. Chandrasekhar, who’s working toward a master of science in global health at Harvard Public School of Public Health (HSPH), still vividly recalls a woman who had missed an appointment late in her pregnancy. When Chandrasekhar’s aunt finally examined the woman, it was too late; the baby was delivered stillborn. The woman was bereft, berating herself for not understanding that she should have come to see her doctor sooner.
Chandrasekhar’s story was a telling example of the tragic situations facing hundreds of thousands of women, particularly in developing countries, surrounding pregnancy and childbirth.
On November 7, 2011, Chandrasekhar and HSPH faculty spoke about their efforts to boost the health of mothers around the globe and prevent unnecessary maternal deaths at a seminar titled “Advancing Maternal Health: Reflections on the Role and Contributions of the Harvard School of Public Health.”
Also at the seminar, HSPH Dean Julio Frenk announced a $2 million gift from Katie Hansen, a longtime supporter of the School, to help the school advance its work in maternal and child health. The gift, which creates “The Hansen Program on Maternal and Child Health,” will support the work of Jennifer Leaning M.D., S.M.H., Francois-Xavier Bagnoud Professor of the Practice of Health and Human Rights at HSPH and director of Harvard’s FXB Center for Health and Human Rights; and Ana Langer, professor of the practice of public health and coordinator of the Dean’s Special Initiative on Women and Health at HSPH.
Helping the children left behind
Maternal death statistics are grim, Leaning said. According to the latest estimates, roughly 342,000 women worldwide died from complications of pregnancy or childbirth in 2008, mostly in poor countries. While that number is down from the 585,000 maternal deaths in 1990, the rate of reduction is still too slow to meet the United Nations’ Millennium Development (MDG) goal, set in 2000, of reducing the 1990 figure by 75 percent by 2015.
Many obstacles make meeting the goal difficult, Leaning said: unstable governments; poor nations; malnutrition; lack of education; low literacy; marriage at young ages; multiple births; and lack of access to preventive health measures, adequate health care facilities, or health care providers.
Leaning described plans by Alicia Yamin, program director of the FXB Center’s Health Rights of Women and Children Program, to study the impact on surviving family members when a woman dies in childbirth. Initial research indicates that a mother’s death can plunge a family into a cycle of loss and impoverishment that erodes the survival chances of the remaining children. Leaning said she hopes gathering new data on this subject will help boost world attention to maternal health.
Coordinating efforts in maternal health
Langer described the efforts of HSPH’s Maternal Health Task Force (MHTF), which she directs. The Task Force acts as a clearinghouse for all maternal health information and research around the world; hosts conferences and academic exchanges; and supports major research and innovation in the field. Langer said one of the task force’s main goals is to develop the next generation of leaders in maternal health; toward that end, the task force supports a program called Young Champions of Maternal Health, through which young people from around the world spend nine months with a mentor in a maternal health setting.
Making childbirth safer
Atul Gawande, whose 2009 book The Checklist Manifesto showed how using a checklist during surgery can significantly reduce errors, described his current efforts to develop a similar checklist for childbirth. Gawande, associate professor in the Department of Health Policy and Management at HSPH, and colleagues have developed a list of 29 items they hope can be checked during “pause points” in the childbirth process. He hopes the checklist, which is being tested in 17 sites across 10 countries, can eventually be used around the world.
Boosting maternal nutrition
Wafaie Fawzi, Richard Saltonstall Professor of Population Sciences, professor of nutrition, epidemiology, and global health, and chair of the Department of Global Health and Population at HSPH, discussed numerous interventions that are known to boost maternal and perinatal health, including iron supplements, Vitamin A, calcium, multivitamins, iodine, Vitamin D, and folic acid. Unfortunately, he said, difficult circumstances in developing nations have made it hard to provide these basic nutrients to women, who are often undernourished to begin with. “There are many interventions that we know work,” he said. “They need to be scaled up.”
photo: Aubrey LaMedica