Bolivia has just instituted a new initiative that would grant pregnant women $258 over the course of gestation contingent on them attending regular pre- and post-natal medical appointments. As it stands, two women die in the country every day due to pregnancy or childbirth-related complications. The government hopes the new measure will dramatically lower this mortality rate.

Named the Juana Azurduy mother-child subsidy, the payment is transferred to women in such a way that they must consistently interact with health services, making it much easier for the government to register and track pregnancies. In its first year, the stipend will be paid to about 550,000 women and children. Women receive $7 after each pre-natal checkup and $17 following their first post-natal checkup. The rest is divided into twelve payments of $17.70 guaranteed as long as the parents continue to bring the child in for regular doctor visits.

Bolivia has reported that its medical facilities are underutilized. It hopes that this program will encourage more people to take advantage of these facilities, helping them to strengthen their infrastructure and modernize at the same time. So far, the subsidy has fielded positive reviews from maternal health nonprofits.

An article appearing in today’s New York Times by Denise Grady sheds light on the challenges faced by struggling medical facilities in Tanzania. Not only is there a shortage of qualified practitioners in the country, but also a dearth of prenatal care and education — problems contributing to the 13,000 deaths related to pregnancy and childbirth that occur in the country every year. You can read the full article at the link above, but here’s a short summary of what seem to be the biggest hurdles standing between Tanzanian women and the life-saving care they need:

Hundreds more medical assistants, midwives, traditional birth attendants and rural clinics are needed to cover all of the women seeking obstetric care.

Most women need to travel too far to receive adequate care during childbirth, discouraging many from going to professional and sanitary facilities (only about 20 percent do).

Traditional practices jeopardize healthy deliveries (i.e. taking herbs to speed labor).

Many patients require cesarean sections, an incredibly dangerous procedure outside of the hospital environment without trained physicians.

The article highlights a hospital in Berega that serves a community of 200,000 without a single obstetrician or pediatrician. In addition to highlighting the magnitude of the problem, Grady pitches several solutions, including long-term housing for women who live far away leading up to delivery, incentive packages for doctors, and ideas for educational programs.

Celebrated New York Times columnist Nicholas Kristof has traveled extensively through West Africa as the benefactor of the newspaper’s “Win-a-Trip” contest, a program that gives students the opportunity to join him on an international reporting trip. Today, his column focused on the broken maternal health system he has observed in Sierra Leone, the country with the highest maternal mortality rate in the world.

Drawing on moving anecdotes about actual women who died or lost a baby in childbirth, he illuminates the problems that prevent the administration of adequate healthcare in the region. You can read his excellent, stirring column here. Kudos to Mr. Kristof for consistently championing a higher quality of care for the women who need it most. This isn’t the first time he’s used his column to promote maternal and women’s health issues. Check out his past coverage below:

A “P.S.” on Maternal Health and Abortion — A rundown of the organizations at the front lines in the battle for better maternal healthcare.
Saving Mothers, One at a Time — A guest column from missionary doctor Sue Makin about the maternal health situation in Malawi.
Childbirth by flashlight — The influence of lighting technology on healthy deliveries.
Pregnant (Again) and Poor — A call for effective global family planning efforts.
The Illiterate Surgeon — A look at the devastating impact of obstetric fistulae on women’s lives.

The New York Times put together an incisive (and much needed) collection of editorials today in honor of Mother’s Day — each looking at a different possible solution for the growing problem posed by maternal morbidity and mortality. We’ve reposted the articles below:

A Birth Pill by Amy Grossman
An analysis of misoprostol, an inexpensive and hardy drug that prevents and treats postpartum hemorrhage (and a major focal point for us here at Saving Mothers). Grossman, a communications manager at Venture Strategies for Health and Development, asserts that the drug has the potential to save thousands of lives every year.

A Dose of Care by Helen Epstein
A gap in education for new mothers, especially in relation to feeding practices, leaves many babies in developing regions malnourished. Many refuse to eat due to a lack of attachment to their mothers, others go hungry when new parents aren’t aware of healthy feeding schedules. Epstein is the author of “The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa.” She recommends counseling for mothers centered on this important and often overlooked issue.

An Education by Esther Duflo
An argument for better, more cost effective education for young girls as a strategy for delaying pregnancy. Duflo advises a nonprofit called Innovation for Poverty Action that implemented a program to provide 5,000 adolescent girls with free school uniforms, decreasing the dropout rate by a third and the pregnancy rate by 4 percent.

A Safer Labor by L. Lewis Wall
With so many women in developing countries requiring cesarean sections to ensure healthy deliveries for both them and their babies, it is crucial the more medical facilities have the tools and trained personnel needed to carry out safe procedures. As a professor of obstetrics and gynecology and anthropology at Washington University, Wall has operated on many fistula patients injured during obstructed labor that could have easily been avoided by proper cesareans.

A Custom Drug by Ruth Faden, Anne Drapkin Lyerly and Maggie Little
The three authors shed light on a little-discussed problem: the fact that many women around the world are unable to get the drugs they need due to pregnancy. Because pregnancy is a contraindication for so many medications, women are often exposed to the dangers of illnesses and infections that have a many more negative ramifications.

Happy reading, and happy Mother’s Day!

Today, the U.S. State Department released its projected International Affairs Budget for the 2010 fiscal year. It totals $53.9 million. While very little was said regarding its impact on maternal health services around the world, the amount going toward maternal health, child health and family planning services has been substantially increased.

Over the next six years, the U.S. government plans to devote “$12 billion to other global health priorities, including maternal and child health, family planning and neglected tropical diseases.” In this period, spending for maternal and child health programs will jump from $494 million to $524 million — and family planning initiatives will receive $48 million more. This is the most the government has ever earmarked for this area of health care.

We applaud President Obama and Secretary Hilary Clinton for making this issues a financial priority.

See a summarized breakdown of the budget here.

Finally, the New York Times has turned its spotlight on the prevalence of obstetric fistulae in Tanzania and other developing countries. Far too few people realize that poor medical care and birthing practices have left 2 million women and girls wounded and incontinent around the world — a condition that not only destroys their quality of life, but ostracizes them from their communities. The vast majority of them are in sub-Saharan Africa.

The article puts a human face on the issue, telling the story of several young girls seeking help for their injuries after losing their babies during obstructed labor, or being abandoned by their families. While several groups have risen to the challenge — the African Medical and Research Foundation prime among them — there are still countless limitations and complications standing in the way of widespread quality care for these women. Resources, personnel and facilities are scarce. And even when fistulae are successfully repaired, post-surgical care is often insufficient, resulting in infection, nerve damage and recurrence.

Still, teams of surgeons continue to work in Tanzania and elsewhere undeterred, simply wishing there were more doctors willing to pitch in. To learn more about the African Medical and Research Foundation’s effort to help fistula patients, please visit the project’s web site.

And here are a few other groups working to alleviate the problem:

• The Fistula Foundation
• End Fistula (backed by the United Nations Population Fund)
• International Organization for Women and Development
• EngenderHealth
• Campaign to End Fistula
• USAID: Obstetric Fistula Strategy
• The Worldwide Fistula Fund
• AMDD: Fistula Repair Projects (through Columbia University)

Also highly recommended is PBS’s documentary on the subject, “A Walk to Beautiful,” which earned top honors at several film festivals in the last year. Watch the trailer here.

Tanzania remains dangerous for young moms — A new report on the State of the World’s Children lists Tanzania among the world’s countries with the highest rates of maternal mortality. Among other findings, it shows that pregnant girls under age 18 are five times more likely to die due to complications.

UNICEF releases maternal health survey results — A report released yesterday by UNICEF says that women in developing countries are 300 times more likely to die in childbirth or for related reasons than women in industrial nations. While many of these countries have made progress in reducing child mortality, rates of mothers dying have remained largely unchanged.

Sierra Leone debates new health care plan — The government of Sierra Leone is busy deciding whether or not to implement a new health care plan that would combine national insurance with free care for the country’s most impoverished citizens. Responding to high maternal mortality rates, the plan would eliminate premiums for children and pregnant and lactating women.

USAID graduates maternal health workers — 24 health and population managers just graduated from a USAID training program, and will apply their new skills in the field to bring health support and family planning services to communities in Pakistan. The course was part of the agency’s $60 million Family Advancement for Life and Health program.

Girls rule at Davos — A session at the World Economic Forum in Davos last week, titled The Girl Effect, called attention to the plight and importance of adolescent girls in developing communities and countries. The event was followed by the “Important Dinner for Women,” hosted by Wendi Murdoch and Pepsi CEO Indra Nooyi, which focused on the improvement of maternal health around the world. Sarah Brown, wife of England’s Prime Minister Gordon Brown, gave a speech on the results of her white ribbon campaign.

Maternal mortality soars in Nepal — 2,000 women die every year in Nepal due to pregnancy-related complications (281 women out of every 100,000 live births). According to UNICEF, basic obstetric and hygienic health care could prevent death in an overwhelming number of these cases. A fourth of fatalities result from high-risk abortions.

India records highest mortality rate in South Asia — A new study shows that 136,000 mothers and mothers-to-be die in India every year, the most by far of any South Asian country. The leading cause of these tragedies: Unskilled birth attendants.

Canada borrows best practices from Cuba — A report authored by Canadian senator and physician Wilbert Keon says that the country stands to learn a lot about maternal health care and childhood development from its Caribbean neighbor. Cuba is known for providing support services to mothers starting at conception and lasting for years after they give birth

Tele-health promotes safe birth in Zambia — In Zambia, where the shocking maternal mortality rate tops 72 percent, an information technology system called Tele-Health is gradually being adopted in health clinics to ensure safer deliveries. Tele-health allows doctors to communicate with and provide care through traditional birth attendants.