Sanitation is a comfort long taken for granted in modern western delivery rooms, but a recently released study by the World Health Organization (WHO) links the lack of access to good hygiene during pregnancy and childbirth, to increased risk for many third world women and newborns. Appearing in the PLOS Medicine journal on Dec. 12, 2014, the study found that the expected rate of infection and mortality for both mother and infant is significantly higher in low-income birth settings, many of which take place at home in impoverished areas of the world. Even in healthcare facilities, the lack of clean water and sanitation can cause serious complications. The WHO aims to strategically intervene in the growing problem of women’s health and preventable infant mortality.
WHO researchers assessed the availability of water, sanitation and hygiene (WASH) in both at-home births and healthcare childbirth facilities, in 54 poverty-stricken nations. Their results show that 38 percent of health care facilities lacked access to a clean water source. The statistics for Bangladesh, Tanzania, Malawi and India home births found an average of just over eight percent take place in homes without clean water or proper sanitation. Sub-Saharan Africa and Southern Asia record the lowest levels of WASH to support maternal and infant health. Therefore, they also have the highest rates of childbirth related disease. They cite another study by Gon, et al. that shows a similar link between maternal and natal health in Afghanistan.
Although related studies have not considered the accessibility of basic sanitation and hygiene tools, and water in particular, several have established a possible link between “clean birth practices” and reduced rates of neonatal death from sepsis, tetanus and cord infection. Practices include handwashing with soap by healthcare providers and the expectant mother. A Nepalese study found that when both mother and healthcare workers washed their hands with soap and water, the infant mortality rate plummeted by 41 percent.
The study points out that existing measures striving to improve childbirth conditions in distressed areas of the world have aimed to encourage women to seek prenatal care and to go to a health care facility to give birth while strengthening the indigenous healthcare system without considering the conditions of the childbirth areas, whether at home or in a facility. Therefore, improving access to hygiene basics such as soap and clean water is an important next step in the WHO’s vision to create a safer environment for childbirth in third world countries. Without being able to show that a healthcare facility provides a significantly cleaner and safer setting for delivery and post-partum recovery, women will have little incentive to leave their homes during childbirth. The lack of sanitation may also contribute to a problem recruiting and retaining the best qualified healthcare professionals because they cannot properly carry out their jobs without something as basic as clean water.
In order to combat some ambiguity in its WASH recommendations that interfere with full implementation, the WHO will be issuing a strategy initiative, urging governments and agencies to incorporate the hygiene and sanitation standards as a national policy for improving mother and infant health and shrinking the mortality rate. Governmental recognition and commitment of leaders and money to equip facilities with hygienic supplies and train healthcare workers and the public are essential to putting the standards into action. They characterize a woman’s right to a safe, clean and sanitary environment before, during and after childbirth as a basic human right, easily fulfilled through the measures they recommend for basic sanitation and hygiene. WHO researchers call on the international community to link together to stem the tide of newborn and maternal mortality in the most vulnerable of the world’s populations and effect lasting change that saves lives one sanitation procedure at a time.
By Tamara Christine Van Hooser
The Free Press Journal
Image courtesy of Roger Heath/Department for International Development – Flickr License