Laos plan to reverse region's worst maternal mortality rates

Updated September 2, 2010 12:46:26

Women in Laos have a one in 33 chance of dying as a result of childbirth.

That rate is among the worst in the region, considerably higher than neighbouring Cambodia, where it's one in 48 or Vietnam where it's one in 280. So why are so many women and their children dying? Many argue that a lack of midwives could be largely to blame. Now - after a 23 year break - Laos is re-introducing specialised mid-wifery training.

Presenter: Helene Hofman
Speakers: Dr Monir Islam, Director, Family Health and Research Program, World Health Organisation, South-East Asia Regional Office; Della Sherrat, Field Birth Attendant Co-ordinator, United Nations Population Fund (UNFPA), Laos; Boathip Phongsavath, Program Officer for Laos, United Nations Population Fund (UNFPA); Magdalen Drani, International Nurse-midwife Trainer, United Nations

HOFFMAN: Two mothers and 20 newborns. Laos has a population of just over 6-point-2 million, but it loses that many mothers and babies to childbirth every day. Now the local government, with the backing of the United Nations Population Fund, is seeking to turn that trend around. They've conducted an assessment, and concluded that access to affordable and reliable ante-natal services and midwives is largely to blame.

Dr Monir Islam, Director of the Family Health and Research Program with the World Health Organisation's South-East Asia regional office, explains:

ISLAM: If you look at the access to skilled care for pregnant women it's very low. It would be say about 20 per cent. So women do not have access to the right care during pregnancy and childbirth and particularly access to emergency obstrical care services so there is a lack of skilled care and where they have services, we also have to look at the quality of services. The training of midwives and people with midwifery skills for making a difference in countries.

HOFMAN: About 80 per cent of births in Laos take place outside of a hospital environment and many are assisted only by untrained birthing assistants. In fact, its been 23 years since the Laos government stopped offering specialised training for midwives. Today - there are fewer than 100 midwives working in the country. Della Sherrat, a field birth attendant co-ordinator working with the United Nations Population Fund Laos office has been helping to identify issues with the system.

SHERRAT: In Laos, they've really not had any midwives trained since 1986 and the reason why - and it happened in many countries - was the move to make this all singing all dancing health worker, which unfortunately sounds good until you realise that most of them are trained exclusively in hospitals and in hospitals many women are not giving birth so the nurses were simply not getting hands on training.

HOFMAN: Since 2007, Della Sherrat has been working with the Laos Ministry for Health to reduce maternal mortality. They've come up with a series of intiatives to introduce more, fully-qualified midwives into communities. They are currently training about 160 midwives across eight schools, with the first intake due to graduate in November. There are also plans to introduce a National Licensing system and encourage more members of ethnic minorities to consider completing the training. That's something the the United Nations Population Fund's program officer for Laos, Boathip Phongsavath, says is essential to reach out to those most at risk.

PHONGSAVATH: Most of the people that die, it's in the remote areas. If at some point they need help and they need to get to the health care facility, well, they cannot because it takes a long time and that's why they prefer to do it at home with their friends and family. And another thing, it's about the costing. It means that they come from far away and they need to pay for the transportation service and their speaking language is another issue that you have to consider, because most of them are from ethnic minorities.

HOFMAN: These are all issues that Della Sherrat and her team have considered.

Efforts will be made to retrain nurses who have already studied basic midwifery skills as part of their training, but all of those that graduate later this year will be sent to work in community-based health facilities.

Questions have been raised about whether the women will move away from the tradition of giving birth largely unassisted.

One of those responsible for training the midwives, Magdalen Drani, says she's certain they will.

DRANI: The situation I've seen is I think the lives of mothers and newborns are in very great risk. If you go down on the ground at grassroots level, you never see a trained midwife, it is only auxilary trained people that are doing the birthing. So right now we have student midwives going into the community but you know we visited many communities and many of them are coming, bringing children to the health centre for immunisation, coming to deliver to the health facility.