Maternal health refers to the health of women during pregnancy, childbirth and the puerperium. Each stage should be a positive experience that ensures the full potential of health and well-being for women and their babies. Unfortunately, this is not always the case.
Venezuela's public health system, formerly renowned as one of the best in Latin America, has been undergoing a prolonged state of decline. According to the Venezuelan Medical Federation, recent years have witnessed an exodus of around half of the country's doctors — approximately 30,000 professionals — due to a desperate need to secure their families' well-being. Although the full extent of its repercussions remain uncertain, the most recent data from 2016 reveals a staggering 65% surge in maternal mortality rates while infant mortality experienced a 30% escalation within a year.
One of the Sustainable Development goals set by the United Nations for 2016-2030 is to reduce the worldwide maternal mortality ratio to less than 70 per 100,000 live births. Unfortunately, Venezuela falls short of achieving these goals. According to the World Health Organization's 2017 estimates, Venezuela's maternal mortality ratio was 125 in 100,000 live births, marking only a -5% change. Meanwhile, the world witnessed a commendable 38% reduction in maternal mortality rates.
The increase in maternal mortality is alarming because it reflects the vulnerability of pregnant women due to the absence of essential and protective health provisions. This multifaceted issue intertwines geographic, socioeconomic, cultural, educational, and health factors, collectively forming a chain of circumstances that inevitably ends in maternal death. These critical junctures, often referred to as “fatal delays” demand urgent attention. A large part of fatal delays can be substantially reduced by establishing educational measures that teach women to recognize the symptoms, access appropriate care centers, and receive essential obstetric support.
Most maternal deaths are preventable. To achieve this, it is imperative that all women have access to antenatal care, skilled care during childbirth, and support during the first weeks after delivery. It is particularly important that all deliveries are attended by trained health professionals, as timely care and treatment can determine life or death for both mother and child. To prevent maternal death, it is also essential to avoid unplanned or early-age pregnancies. Every woman, especially adolescent girls, must have unhindered access to contraception, safe abortion services within the limits of the law, and comprehensive post-abortion care. Furthermore, in order to enhance maternal health, barriers to access quality maternal health services at all levels of the health system must be identified and removed.
A lack of medical staff, medical equipment, supplies, operational beds, and the a deteriorating infrastructure are among the many challenges that the Venezuelan health system faces. As described by a pregnant woman, she “had to go to 5 hospitals so that they could finally treat (her) because there was no incubator for (her) baby."
The consequences of Venezuela’s dire situation are acutely felt by pregnant women and their babies, who face significant challenges in accessing adequate care. Unable to afford the high cost of private centers, expectant mothers often have no choice but to rely on public hospitals. However, the reality of seeking treatment in public facilities can be disheartening, as many patients report instances of poor treatment by medical and nursing staff.
One woman who gave birth in a hospital in Caracas shared her distressing experience:“I received terrible treatment from the nurses, who did not allow my family to see my newborn daughter. It's chaos, I really wouldn't have another baby, I couldn't bear to live that experience again.”
Within hospital walls, the prevalence of misinformation (and the lack of information given to mothers and families) has reached alarming levels. A grieving mother shared her devastating experience, recalling:"My baby was born premature, 31 weeks old, I couldn't see her because they took her as soon as she was born, nobody gave me information, until two days later, when they told me that she had died."
Some distressing incidents highlight a critical issue that extends beyond health policies — it speaks to the essence of humanity and empathy. The absence of timely and transparent communication, the lack of support, and emotional disconnect experienced by patients and their families are all indications that Venezuela's system is in dire need of reinvention and compassion.
Blog Written by Dr. Nestor Ferrer, Ob/Gyn; Edited by Kaitlyn Gosakti and Juan López
The BiliDx is a novel system for diagnosing jaundice. The device uniquely meets the Target Product Profile (TPP) developed as part of the NEST 360 initiative in that it allows blood-based testing at the bedside. This initiative is part of an emerging global consensus in the Every Newborn Action Plan that countries need functional WHO level-2 inpatient units to care for "small and sick newborns."
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.