World Health Day Diabetes and RMNCAH in Africa: R for Reproductive Health

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1 World Health Day Diabetes and RMNCAH in Africa: R for Reproductive Health Managing diabetes and reproductive health in developing contexts. The 2016 World Health Day theme to scale up prevention, strengthen care, and enhance surveillance of diabetes, and its staggering burden in low-middle income countries requires us to reflect on the untold impacts of diabetes on reproductive, maternal, newborn, child and adolescent health (RMNCAH). The number of people with diabetes in Africa is predicted to double by 2035, posing a serious threat to sustainable development. This coupled with the fact maternal mortality among pregnant women with type 1 diabetes in some countries is 5 20 times higher than than for women without diabetes. This makes this years World Health Day theme more important than ever. Currently more than two-thirds of those who have diabetes in Africa are unaware they have have it - meaning the continent has the highest proportion of undiagnosed diabetes, and last year more than 321,100 deaths on the continent was attributed to the disease. This includes mothers and pregnant women already at risk of death and longterm illnesses due to limited paternal care and health information. At the Wellbeing Foundation Africa we focus on attaining Sustainable Development Goal 3 (SDG 3) and Goal 5 (SDG 5), to ensure healthy lives and promote well-being for all at all ages and to end all forms of discrimination against women and girls. Noncommunicable diseases like diabetes for a woman in a country like Nigeria can be life threatening and if she chooses to have a family her chances of conceiving, surviving her pregnancy and delivering a healthy baby, can be hugely influenced by a skilled midwife. For instance, a pregnant woman is at risk of getting gestational diabetes - a form of the illness that is caused by pregnancy, and while most women go back to normal health after delivery, more than 50% of women develop type 2 diabetes within 5-10 years of delivery. Additionally, their children are more likely to be overweight or obese, and have a higher risk of developing type 2 diabetes at some stage in their life. For many women this is serious but can be managed through their country s healthcare system. For women in a developing country, this can be life-threatening. Midwifery is a proven force for preventing and treating gestational diabetes, and transforming reproductive, maternal, newborn, child and adolescent health (RMNCAH) in low and middle income countries. The care provided by midwives is one of the most strategic interventions for health and the world s most powerful weapons in improving RMNCAH. A Lancet Series report from June 2014, backed this claim by finding that an increase of access to midwives by just 25% could halve maternal mortality. As we move

2 towards achieving SDG 3, we need more skilled midwives to improve RMNCAH and wellbeing for all, at all ages. We know that investing in reproductive health services pays off. For every $1 that is spent on family planning services, up to $4 is saved on maternal or newborn health costs. Yet, in developing regions, a quarter of women who want to access contraception are unable to do so. This unmet need for modern contraception and reproductive health advice can be cost-effectively met by access to skilled midwives. Coupled with extra spending on diabetes screening tests, this could transform the impact of gestational diabetes in low and middle-income countries. Skilled local midwives understand the communities they serve, the mothers they treat, and the solutions needed for their patients. As a trusted source for advice, skilled midwives can provide locally available and culturally acceptable contraceptive methods, as well as advising mothers on important health issues such as diet, breastfeeding, early childhood health and how to manage illnesses like diabetes. Moreover, midwives are uniquely placed to educate women about how to identify abnormalities in their body, which could lead to a diagnosis of an illness, meaning they can then receive the necessary care to mange their symptoms. And education starts in adolescent girls, helping them to understand their reproductive health and options for delaying pregnancy. In Nigeria and other sub-saharan African nations, educating our girls about their reproductive health is vital to ensuring they can survive childbirth, and is even more crucial for women with long term illnesses like diabetes, whether known or unknown to them. We make sure that every woman and every adolescent girl has access this life-saving care and information. At present many African countries offer selective screening for gestational diabetes, although it s unclear how many pregnant women receive this, as the data on this form of the disease is very limited, making it difficult to suggest improvements and policy changes for screening. We must urgently implement frameworks that enable countries to apply global best practice models to improve national policies and programmes for midwifery services and ensure such services include diabetes care and information. For example the WBFA s Personal Health Records (PHR), which is a detailed health record for mother and child from pregnancy until the child is five, capturing valuable data which allows for disease prevention and management. The PHR can pick up factors which increase the risk of gestational diabetes, such as family health history, age, previous maternal experience and obesity, making it a life-saving mechanism to fight diabetes in developing countries. Frameworks such as these will enable women to know how and when to call their

3 midwife for reproductive care, especially if they are managing a non-communicable disease like diabetes. So, through the incredible work of midwives, mothers and pregnant women can be taught how to identify and manage symptoms of gestational diabetes and type 2. And over the next five pieces, we continue to look at how we can scale up prevention, strengthen care, and enhance surveillance of diabetes specifically in relation to maternal, newborn, child and adolescent health. Toyin Saraki, Founder- President The Wellbeing Foundation Africa

4 World Health Day 2016 Diabetes and RMNCAH in Africa: M for Maternal Health Diabetes in Pregnancy and the Role of Midwives As we gear up for World Health Day with the theme Beat Diabetes: Scale up prevention, strengthen care, and enhance surveillance; it is vital to understand the role of midwives in helping diabetic pregnant women. Women and newborns are the heart of midwifery. To a midwife, nothing is more important than making sure that each woman and newborn access to the best possible care before, during and after pregnancy and childbirth. And to the best partnership to a woman who is pregnant or giving birth, is one with skilled midwife. This is something that every woman must have access to. Although progress is being made, thousands of women continue to be affected from complications during pregnancy such as gestational diabetes which could be detected early and treated or managed with proper antenatal, delivery and post-natal care all services which are provided by midwives. The World Health Organization (WHO) predicts that diabetes will become the seventh leading cause of death in the world by the year Pregnant women are at risk of getting gestational diabetes and are at an increased risk of complications during pregnancy and after delivery. They are also at increased risk of getting type 2 diabetes. If left untreated or uncontrolled, gestational diabetes can cause health problems to both mother and child; such as: - Baby being born very large with extra fat, this can make delivery difficult and more dangerous for the baby thus a need for caesarean section. - Increase the risk of high blood pressure during pregnancy, low blood glucose right after birth and breathing problems for the baby. Gestational diabetes is serious, so it is important for pregnant women to have access to care and services to ensure the best health outcomes for them and their babies. Evidence shows that well-trained and skilled midwives could deliver 87 percent of essential care needed for all women and newborns. Where available, a qualified midwife in collaboration with other skilled health workers can partner with pregnant women to help prevent, detect and treat gestational diabetes. Worldwide, there are over 400,000 pregnancies per day, and each of these women need and must access quality maternal health services, to ensure her well-being throughout her pregnancy. Every woman regardless of their background has a right to these quality reproductive health services, which is ideally provided by a midwife. However, many of these women, especially in the developing world, do not get these important services and therefore may be at risk for developing complications.

5 Midwives play a unique role for pregnant women and their families through partnership with women to promote self-care and the health of mothers, infants and families; and a focus on health promotion and disease prevention that views pregnancy as a normal life event. Well-educated, regulated, and supported providers are also a key to progress, because midwives and others through professional associations can be a profound and powerful voice for change in countries. Therefore, on this World Health Day, the International Confederation of Midwives emphasizes the need for increased investment in midwifery services thus contributing to early detection of complications such as gestational diabetes. It is our vision that every childbearing woman has access to a midwife s care for herself and her newborn. Frances Ganges Chief Executive International Confederation of Midwives