Millennium Development Goals
Saving women’s lives
By Aigul Azimova and Nazgul Abazbekova
Improvement of maternal health is the 5th of the UN Millennium Development Goals. This is a big and urgent challenge for the healthcare systems in Central Asia. Despite the fact that some improvements were achieved in the past 10 years, maternal mortality rates remain high in all of the region’s countries.
According to official statistics, 37 mothers died per 100,000 live births in Kazakhstan in 2009. The figure for Tajikistan was 31. In both countries, the maternal mortality rate had gone down slightly in comparison to 2008. In Kyrgyzstan, however, it rose by more than 15 % to 62 deaths per 100,000 births from 2008 to 2009. According to non-governmental studies, things are worse than the official data indicate. In Europe, the maternal mortality rate amounts to merely 15 deaths per 100,000 births.
The main reasons for the high maternal mortality in Central Asia are
– poor infrastructure,
– shortage of skilled personnel in maternal healthcare and
– inadequate access to health services, especially in rural areas.
Poverty is another issue that contributes to maternal mortality. Persons who are not well nourished are more likely to suffer health problems. Poor education, moreover, means that many patients do not understand what is going on with their bodies.
Maternal health is a crucial challenge for any healthcare system, and women have an important role to play. Many female patients in Central Asia have access neither to professional healthcare in general nor to reproductive healthcare in particular. The vast majority of them live in rural areas – in Tajikistan, for instance, more than 70 % of the female population lives in villages where traditions still matter very much.
Due to cultural and religious rules, many women will not consult male physicians at all, and they will certainly not discuss questions relating to reproductive health with a man. Therefore, female healthcare providers play a key role in providing services and information on maternal health. The principle must be “woman to woman”.
Caring for women’s health
Women perform their duties at all levels of maternal healthcare, including
– antenatal and postnatal care and maintenance,
– assistance in childbirth and
– provision of information on family planning, reproductive health, the risks of sexually transmitted infections (STI) and how to treat them.
In secondary and tertiary care, women provide highly skilled and specialised services, performing complex obstetric and gynaecological surgery. However, there are too few female medical doctors and, more often than not, they lack state-of-the-art equipment. The WHO (2010) mentions a “currently existing shortage of personnel that is forecast to remain in the future”.
In Central Asia, women who work in the health sector face many obstacles. Anara Eshhodzhaeva heads the Department for Motherhood and Childhood Welfare in Kyrgyzstan’s Ministry of Health. She has been working in this field for 25 years. She emphasises the following challenges:
– the buildings and physical infrastructure of healthcare facilities tend to be in a poor shape and often lack heating, sewerage and even water supply,
– equipment tends to be outdated or even unusable, and
– there is a brain drain of qualified specialists to other countries that offer better working conditions and higher incomes.
Health workers face health hazards. They are exposed to the risk of occupational contagion when they take care of patients that suffer from tuberculosis (TB) and HIV/AIDS. Central Asian countries have comparatively high TB prevalence according to the WHO, and they figure among the top seven countries with a rapid increase of HIV-infections according to UNAIDS.
Tough working conditions are exacerbated by complicated shift schedules and heavy workloads. The fact that there are too few health workers makes the situation even worse. These people are constantly responsible for the lives of women and children. Many suffer from stress symptoms and burnout.
Too few opportunities to upgrade skills
Particularly in rural areas, there are few opportunities for medical staff to continuously upgrade their professional qualifications. They cannot simply participate in advanced vocational training, because no such programmes are on offer.
Village women, moreover, are often forced to contribute to their families livelihood by doing small-scale agriculture, and since they also manage the household, they cannot afford to leave home for any extend period of time for training purposes. Moreover, there often is nobody who could competently substitute them at work while they are away. If they leave their jobs to upgrade their skills, patients are left without medical care.
E-learning can be a useful instrument to overcome this situation. There are online trainings for health professionals in the region that have proved successful already. The self-directed learning method enables medical professionals to improve their knowledge without leaving their workplaces and households. However, the participants need access to a computer with internet connection to fully make use of these opportunities – and such access cannot be taken for granted. It would make sense to equip health facilities and homes with digital infrastructure. Both would make working in the field of maternal health more attractive – and contribute to better performance.
Of course, the women who work in healthcare are expected to somehow maintain a good work-life-balance. Society considers women as the ones with the main responsibility for housework and raising children. But the demands of their professional work make it difficult for female health workers to fulfil all family duties. Therefore, female employees often leave maternal health and change to other, less demanding branches of the health sector.
Making matters worse, in most Central Asian countries, governments do not sufficiently support working mothers. There is a lack of daycare facilities, for instance. In Kyrgyzstan, there are not even any social allowances for childbirth and childcare.
The challenges are obviously huge. So far, however, no systematic studies have been done to understand them better and find ways to improve matters.
It is high time, nonetheless, to introduce strategic approaches to improve working conditions for women in Central Asia, and especially in the health sector.
For the health sector with its predominantly female staff, the issues of maternal health are of high priority, given the obstacles faced by women working in this sector. These obstacles have a negative impact both on health and quality of life of female health workers as well as on the quality of the medical care they deliver.