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Maternal Health

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Maternal Health

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Question:
Write an essay answering the following question:What are the possible explanations for failure to advance maternal, health globally and what needs to be done to improve the situation? Briefly describe whether there is evidence available of what needs to be done, and then discuss whether, or why not, this evidence is being applied in practice. Illustrate with a case study from a particular country, whilst also discussing the emerging debates or next steps in this agenda.This assignment requires that you select one of the topics below. You are expected to critically examine the question presented and put forward an argument drawing on your conceptual understanding from the course and using the literature to support your response. illustrate aspects of your discussion through a country case study but this should NOT be the main focus of the assignment. A broader discussion of the topic with a global focus is required. 
 
Answer:

The term “maternal age” is defined as the age of the mother during the time of delivery of the offspring. According to Benzies (2008), the maternal health is not an issue associated with women rather it is about the uprightness of communities, nations and the societies and also the well-being of every single individual whose prospects of life depends completely on a healthy mother. According to (Kahraman et al. 2000), the global society is not yet so advanced and insufficiently galvanized in terms of addressing neonatal and maternal mortality. Certain areas in the healthcare sector and the government sector needs to be improved in order to reduce this complication. In this context, we are going to discuss the failure to advances in maternal health globally and interventions to improve these (Pearson et al., 2000).
“Political will and strong leadership make innovative, cost-efficient interventions possible. Because women are often marginalized economically, politically and socially, sustained leadership on gender equality is required to advance maternal health. Strong leadership at the highest levels promotes accountability within ministries and enables them to find reliable partners to drive and champion progress in maternal health” (Fisk & Atun, 2008).
In order to reduce the ill effects or the factors that affect advanced maternal health, the first thing that needs to be done is the identification of the factors that contributes to the negative impact of the advanced maternal health. The main two factors that are accountable for the failure of the advanced maternal and neonatal health are both the global donor community and national governments (Aldous & Edmonson,1993).
As stated by Davis et al. (1989), the adaptation of the eight “Millennium Development   goal” was for the improvement in the health areas. The MDG 5 target involved the achievement of universal access to reproductive health but inadequate funding for family planning was the key failure in fulfilling commitments in order to improve the reproductive health of women. (Jacobsson et al., 2004).
“The major causes of stillbirth vary by gestational age. Infection is the most common contributor between 24 and 27 weeks’ gestation, and unexplained stillbirth is the most common contributor after 28 weeks. In the study by Fretts, rates of unexplained late fetal loss were more pronounced among women aged 35 years or older. This rate is similar to that reported among women aged 45 years and older in a population-based Swedish study. Together, these studies clearly suggest a multifactorial cause of stillbirth and a clear need for prospective studies that include lifestyle and socioeconomic risk factors” (Croen et al., 2007).
One of the study done by, Huang and his colleagues reveals that 225 million women yet to meet the requirement for modern contraception. Moreover, poor sexual and reproductive health reported to be almost around fourteen percent. One of the major failures of maternal health is that in certain developing nations ninety five percent of the adolescent females are forced to get married. Thus, at this age maternal reproduction can lead to complications where they have not reached the full potential. Such actions lead to death of the adolescent. As stated by Dong et al. (2013), the other barriers include feeble health systems, elevation of inequalities in access and exploitation of reproductive and sexual health services, poor excellence of such services, ingrained gender inequalities, and cultural challenges.  (Bauer et al., 2013).
Huang and his colleagues are to be highly praised for the width of their evaluation, which involves thirty seven studies from four different continents accounted in five languages. Although medical, methodological and numerical heterogeneity banned meta-analysis, Huang and his colleagues discovered that seventy seven percentages of the thirty one retrospective cohorts learning and all six of the case manage studies point out a statistically important connection between stillbirth rate and advanced maternal age. As stated by Huisman et al. (2013), they established an alike connection in all fifteen populace based on cohort studies. They accomplished that advanced maternal age credible has a self-governing result on stillbirth (Dong et al., 2013).
“One of the majority severe challenges in conducting assessments in this part is the inconsistency in characterizations of advanced maternal age and the threshold for accounting stillbirth. At a minimum, consensus about definitions and standardized reporting across jurisdictions would lead to more definitive results from systematic reviews. According to Donofrio et al. (2014), additional study variability arises from differences in health care and cultural contexts, which are not sufficiently captured in epidemiologic or hospital-based administrative data sets. This limits the ability to generalize findings to other populations. However, as Huang and colleagues8 correctly point out, there remains a great deal to learn about the impact of lifestyle and socioeconomic factors on stillbirth risk. Although large, prospective studies that include information about pregnancy health of the mother and father, maternal stress and socioeconomic factors are expensive, a clear understanding of the risk of stillbirth will require this level of investment in research” (Carey, 2015).
In order to reduce these gaps and bring about improvement in the maternal and neonatal health cost for the package of sexual and also the reproductive health including modern contraception could impact on the reduction of pregnant related causes and neonatal deaths. Secondly, in order to delay the age of the childbearing education and paid employment plans should be implemented. The last and one f the significant intervention that can change the whole structure of reproductive health would be the attendance of births delivery with skilled health care professionals. 
 
The intervention policies of advanced maternal health globally would involve the following strategies strengthening of the skills and also the assistance of the local advocates that would enable nations to elevate the use of the health saving medical interventions, awareness of the overlooked factors associated with this problem for the maternal and the newborn should be raised and also expansion of the effective and essential medicines. A global agreement should be designed on a set of consistent standards for the goal of health and also measurements. Moreover, these measurements would help to plan, monitor and informed verdict making (Sliwa et al., 2006). 
To address the main risk factors for newborn and maternal mortality, practices should be adapted for obtainable preventive and healing tools, technologies, and treatment as well as expand new ones which would be more effectual and reasonable and would be additional readily customary for families and health practitioners in rural and society clinics, hospitals and health centers. These involve ways to treat infant infections by means of easy antibiotic treatment regimens, handle postpartum hemorrhage and sanitize the umbilical cord (Wanderer et al., 2013).
The evidence reflects that “Bill & Melinda Gates Foundation’s Maternal, Newborn & Child Health program” performs to inflate coverage of high affect interventions to guarantee that women and infants stay alive and be healthy at the time of childbirth and further than that. This program invests in efforts to adjust and build up innovative tools, treatments and technologies. Additional to this they aim to improve the excellence of healthcare services and practices and the connections between health practitioners and relatives and advocate for nationwide and global policies that advantage maternal, child survival, newborn and health (Campbell et al., 2013).
As stated by Timofeev et al. (2013), on the basis of a meta-analysis of three different studies carried out by a group of researchers, women living in poor hygiene surroundings are three times as probable to die from maternal physical condition related issues contrast to female who do not, while women existing under deprived water circumstances have a motherly mortality ratio fifty percent more than persons that do not. Partially the malnutrition cases universally can be accredited to poor water, hygiene and sanitation. As discussed by (Campbell et al. (2013), several of these deaths are consequences from vaccine avoidable diseases, since impediments like as cost and convenience has hindered efforts to distribute effective vaccines to individuals mainly in need. In addition, a lot of vaccines known to mothers and children below age five are not appropriate for infants, since their growing immune systems do not respond optimally throughout the primary few months of existence. Maternal immunization is the procedure by which an expectant woman’s immune structure is equipped with an exacting disease, and the shield is then transferred to her child expected to take birth. Moreover, strategies have emerged to avert many redundant maternal and baby deaths (Schoolcraft & Katz-Jaffe, 2013).
Older women have greater chances of children born with chromosomal aberration.  One such major aberration is Down Syndrome. According to researches, it is observed that in 80% of the babies affected with Down syndrome are born to women above the age of 35. Susan a Hispanic woman of 37 years of age, who had a normal pregnancy. A screening test was done after a period of gestation of 16 weeks, which was normal and indicated a 1/275 probability of Down Syndrome. On the basis of this result, the prenatal diagnostic tests were not conducted. Additionally,  ultrasonography examination showed no anomalies. Susan’s family background reveals that the first cousin from her maternal side who is 12 years old is affected with Down Syndrome (Timofeev et al., 2013).
During the birth of Susan’s daughter showed probable features of Down Syndrome, such as Mongolian facial features and “floppy baby syndrome” that is reduced the strength of muscles. Susan shared her suspicion with her physician. Blood was collected to determine the chromosome number. It was confirmed, after a week, that the child was affected with Down Syndrome and the genotype of the child was (47, XX, +21).
Clinical diagnosis of the mother  -Examination of the maternal serum could help in the detection of maximum cases of Down Syndrome. In this case, the triple screening of Susan, which was obtained as 1/275, revealed higher chances of risk as compared to other risks related to her age which is 1/826. The results in her case were not considered as positive by the laboratory, but usually in such cases, the cut off for a positive test is determined as 1/200 (Roos-Hesselink et al., 2013).
Clinical diagnosis of the neonate – Evaluation of a discrete set of issues is necessary for neonates with Down Syndrome- There are about a 50% of chance for the child to suffer from inherent heart disease.Vomiting is persistent in such children, and they also show symptoms of duodenal atresia or obstruction in the movement of bowel. They also suffer from hearing loss, visual disability, polycythemia and inherent hypothyroidism
Assessment of risks – Postbirth of newborn with Down Syndrome it is a main concern which arises is the chances of reoccurrence of Down Syndrome in future pregnancies. However, in this case, there is a minimal risk for Susan and her partner since the disease is caused by nondisjunction of chromosome 21, but if the disease is caused due to translocation of the chromosome, the chances of occurrence increases.  Since in this case Susan already had a relative affected by Down Syndrome, this though was treated as a critical case accounted for unbalanced translocation of chromosomes which depict inheritance (Timofeev et al. 2013). 
Probability in this case – Trisomy of chromosome 21 is noninherent and is infrequent in occurrence. Hence, Susan and her partner need not go through further examinations. In future, if Susan decides to have a child,  the risk of having another case of Down Syndrome is approximately less than 1%  and is completely unrelated to her cousin having the disease. However, since Susan age has exceeded 35, there remains a danger of having a child with chromosomal aberrations (Mhyre et al., 2014).  
 
In this context, the meaning and the implications of various strategies of “maternal age” has been discussed. “Maternal age” is defined the age of the mother during the time of delivery of the offspring. As stated by Timofeev et al. (2013), studies reveal those older women above thirty five years are more susceptible to risks associated with pregnancy than a younger woman. The global society is not yet so advanced and insufficiently galvanized in terms of addressing neonatal and maternal mortality. Certain areas in the healthcare sector and the government sector needs to be improved in order to reduce this complication. Cost and accessibility are the two major factors that affect child and mother mortality.   According to researches, it is observed that in 80% of the babies affected with Down syndrome are born to women above the age of 35. Susan a Hispanic woman of 37 years of age, who had a normal pregnancy. During the birth of Susan’s daughter showed probable features of Down Syndrome, such as Mongolian facial features and “floppy baby syndrome” that is reduced the strength of muscles. Susan shared her suspicion with her physician. Examination of the maternal serum could help in the detection of maximum cases of Down Syndrome. Evaluation of a discrete set of issues is necessary for neonates with Down Syndrome- There are about a 50% of chance for the child to suffer from inherent heart disease. Blood was collected to determine the chromosome number. It was confirmed, after a week, that the child was affected with Down Syndrome and the genotype of the child was (47, XX, +21). (Mhyre et al., 2014).
The major causes of stillbirth vary by gestational age. Infection is the most common contributor of mortality. Huang and his colleagues reported that the outcome of a methodical appraisal of retrospective cohort and case organize studies of the link between advanced maternal age and the danger of stillbirth. The evidence reflects that “Bill & Melinda Gates Foundation’s Maternal, Newborn & Child Health program” performs to inflate coverage of high affect interventions to guarantee that women and infants stay alive and be healthy at the time of childbirth and further than that. Partially the malnutrition case universally can be accredited to poor water, hygiene and sanitation. Several of these deaths are consequences from vaccine avoidable diseases since impediments like as cost and convenience have hindered efforts to distribute effective vaccines to individuals mainly in need. Thus, it can be concluded that there are although major risks associated with advanced maternal health in terms of the global scenario, this situation can be controlled by evidence-based practice and innovative policies and tools (Mhyre et al., 2014).  
 
References: 
Aldous, M. B., & Edmonson, M. B. (1993). Maternal age at first childbirth and risk of low birth weight and preterm delivery in Washington State. Jama,270(21), 2574-2577.
Bauer, M. E., Bateman, B. T., Bauer, S. T., Shanks, A. M., & Mhyre, J. M. (2013). Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis.Anesthesia & Analgesia, 117(4), 944-950.
Benzies, K. M. (2008). Advanced maternal age: Are decisions about the timing of child-bearing a failure to understand the risks?. Canadian Medical Association Journal, 178(2), 183-184.
Campbell, K. H., Savitz, D., Werner, E. F., Pettker, C. M., Goffman, D., Chazotte, C., & Lipkind, H. S. (2013). Maternal morbidity and risk of death at delivery hospitalization. Obstetrics & Gynecology, 122(3), 627-633.
Carey, D. (2015). Pregnancy and advanced maternal age.
Croen, L. A., Najjar, D. V., Fireman, B., & Grether, J. K. (2007). Maternal and paternal age and risk of autism spectrum disorders. Archives of pediatrics & adolescent medicine, 161(4), 334-340.
Davis, L. E., Lucas, M. J., Hankins, G. D., Roark, M. L., & Cunningham, F. G. (1989). Thyrotoxicosis complicating pregnancy. American journal of obstetrics and gynecology, 160(1), 63-70.
Dong, M., Zheng, Q., Ford, S. P., Nathanielsz, P. W., & Ren, J. (2013). Maternal obesity, lipotoxicity and cardiovascular diseases in offspring.Journal of molecular and cellular cardiology, 55, 111-116.
Donofrio, M. T., Moon-Grady, A. J., Hornberger, L. K., Copel, J. A., Sklansky, M. S., Abuhamad, A., … & Lacey, S. (2014). Diagnosis and treatment of fetal cardiac disease a scientific statement from the American Heart Association. Circulation, 129(21), 2183-2242.
Fisk, N. M., & Atun, R. (2008). Market failure and the poverty of new drugs in maternal health. PLoS Med, 5(1), e22.
Huisman, C. M., Zwart, J. J., Roos-Hesselink, J. W., Duvekot, J. J., & van Roosmalen, J. (2013). Incidence and predictors of maternal cardiovascular mortality and severe morbidity in The Netherlands: a prospective cohort study. PLoS One, 8(2), e56494.
Jacobsson, B., Ladfors, L., & Milsom, I. (2004). Advanced maternal age and adverse perinatal outcome. Obstetrics & Gynecology, 104(4), 727-733.
Kahraman, S., Bahce, M., Åžamlı, H., Ä°mirzalıoÄŸlu, N., Yakısn, K., Cengiz, G., & Dönmez, E. (2000). Healthy births and ongoing pregnancies obtained by preimplantation genetic diagnosis in patients with advanced maternal age and recurrent implantation failure. Human Reproduction, 15(9), 2003-2007.
Mhyre, J. M., Tsen, L. C., Einav, S., Kuklina, E. V., Leffert, L. R., & Bateman, B. T. (2014). Cardiac arrest during hospitalization for delivery in the United States, 1998–2011. The Journal of the American Society of Anesthesiologists, 120(4), 810-818.
Pearson, G. D., Veille, J. C., Rahimtoola, S., Hsia, J., Oakley, C. M., Hosenpud, J. D., … & Baughman, K. L. (2000). Peripartum cardiomyopathy: national heart, lung, and blood institute and office of rare diseases (national institutes of health) workshop recommendations and review. Jama, 283(9), 1183-1188.
Roos-Hesselink, J. W., Ruys, T. P., Stein, J. I., Thilén, U., Webb, G. D., Niwa, K., … & Tavazzi, L. (2013). Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. European heart journal, 34(9), 657-665.
Schoolcraft, W. B., & Katz-Jaffe, M. G. (2013). Comprehensive chromosome screening of trophectoderm with vitrification facilitates elective single-embryo transfer for infertile women with advanced maternal age. Fertility and sterility,100(3), 615-619.
Sliwa, K., Anthony, J., & Hilfiker‐Kleiner, D. (2016). Maternal heart health.The Heart of Africa: Clinical profile of an evolving burden of heart disease in Africa, 9-26.
Timofeev, J., Reddy, U. M., Huang, C. C., Driggers, R. W., Landy, H. J., & Laughon, S. K. (2013). Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstetrics and gynecology, 122(6), 1184.
Wanderer, J. P., Leffert, L. R., Mhyre, J. M., Kuklina, E. V., Callaghan, W. M., & Bateman, B. T. (2013). Epidemiology of Obstetric-Related Intensive Care Unit Admissions in Maryland: 1999–2008. Critical care medicine, 41(8), 1844.

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