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Ending needless tragedy

Dan Toole
***There are bright sparks of hope stretching across South Asia from Kathmandu, Karachi to Colombo. Across the globe too there's an exciting momentum as governments and donors see the value in supporting maternal and newborn health initiatives beginning at minus nine months and continuing until the child is five years old.***
THERE can be nothing quite as brutal as when a birth brings death, instead of life. Yet this is exactly what happens across South Asia. Every hour of every day in South Asia, 22 mothers die in child birth — lives that matter, deaths that matter, leaving orphaned babies who in turn face a much greater risk of death themselves.
This is a region bursting with potential but held back by cruel contradictions -where despite the global financial crisis that has bruised the region's economy, growth continues and there are worldclass medical institutions. Yet every minute three newborn babies die across the region — the highest neonatal mortality in the world.
Linked to this tragedy is another. South Asia has more child marriages than anywhere else in the world -- nearly half of all women between the ages of 20 and 24 were narried before they turned 18. Early marriage leads to early motherhood and which can lead to early death of baby and mother.
When children themselves have chil-
dren, their babies' risk of dying in the first year of life shoots up by 60% compared to an infant born to a mother older than 19 years. If that baby doe^ survive he or she is more likely to be undernourished and uneducated.
Mothers die in childbirth -- slowly, painfully bleeding to death — because they do not get help when they need it. Women often have no say. In Bangladesh and Nepal about half of all women reported their husbands make all decisions about their healthcare.
In Afghanistan, astonishingly one in eight women risk death by having a baby, the second highest rate in the world. Women there will not see a male health worker, yet due to the country's recent history, there is only 28% female literacy and a massive scarcity of female trained birth attendants, or midwives.
To end this horrible pattern, there is no need to wait for a scientific breakthrough, or for the economic crisis to pass. We know now what needs to be done and we know it needs to be done now. Waiting is not an option.
A shinning example in South Asia comes from Sri Lanka. In spite of three
decades of ongoing civil conflict and the devastating effects of the 2004 Indian Ocean Tsunami, the country has slashed the number of women dying in childbirth from 340 per 100 000 live births in 1960, one of the world's highest at the time, to 44 per 100,000 in 2005. Latest figures show just 8 newborns dying per 1,000 live births -- similar to a developed country.
It was that magic tipping point that made Sri Lanka a model for health care delivery in developing nations — since the 60s the country invested in educating girls who were then in no hurry to ger married early; critically education was free for all. Training of midwives was a priority; midwives started to go out to where it mattered, got women to plan the births of their babies, go to health centers and hospitals to give birth, told them how to eat well and significantly, to breastfeed exclusively and right away.
Today, remarkably 95% of births in Sri Lanka take place in hospitals with a skilled nurse, midwife or doctor attending and immunization coverage is almost universal.
There are bright sparks of hope stretching across South Asia from Kathmandu, Karachi to Colombo. Across the globe too there's an exciting momentum as governments and donors see the value in supporting maternal and newborn health initiatives beginning at minus nine months and continuing until the child is five years old.
Nepal has done some great things by making health services free for mothers and has cut child mortality by two thirds; India gives cash transfers to mothers to give birth in institutions; Bangladesh has cut deaths of its newborns from tetanus down to just one death in 1000. And in Pakistan 'Lady Health Workers' map and monitor mothers-to-be and their babies in their communities.
Unicef and its partners in government are behind many of these initiatives and we pledge to make even greater strides for mothers and their babies. South Asia will rise or fall on investing and caring for mothers - minus 9 months -- and their newborns. This is the bedrock of any society. Making mothers and their newborns count, adds up to a society that matters, a nation that flourishes, and a region that starts to reap the rewards of its labour.