Annotated Bibliography

Problem Statement:

In developing nations in Africa, the quality of newborn and maternal care needs to be improved and standardized. Under the status quo, the lack of sufficient care leads to loss of many lives that were just beginning. Pregnant women going into labor often have unrealistically far distances to travel if they wish to give birth in a proper facility, and even those who make it to one are often faced with unideal care practices. The first week of life is a particularly vulnerable time and 73% of neonatal deaths occur during this period. By improving neonatal care practices, millions of lives can be saved throughout the developing regions of Africa. Right now, newborn care practices are not up to par because resources are not being distributed where they need to be. More health care facilities are required in rural parts of Africa and knowledge of newer practices that have been proven to save more lives need to be spread to health care providers throughout the continent. Every year, 2.9 million neonates die and saving even some of these newborns would improve the freedom of life and help achieve the goals of human development.

Source 1:

Armstrong, Corinne E., et al. “Subnational Variation for Care at Birth in Tanzania: Is This Explained by Place, People, Money or Drugs?” BMC Public Health, vol. 16, no. S2, 2016.

This article seeks to explain the true story behind Tanzania’s care at birth practices across the nation. Although Tanzania won the Millennium Development Goal for Child Survival, the country has not been progressing their maternal and neonatal care methods. In fact, Tanzania ranks in the top ten countries with the highest number of stillbirths, newborn deaths, and maternal deaths annually. The primary issue is that Tanzania has so much variation between its borders that national studies often do not show the whole story. In Hans Rosling’s TED Talk, he discussed the danger of treating countries as their average value and this study is following the same principle. Rather than averaging the statistics throughout Tanzania, this article researches subnational variation for care at birth in 21 regions of the country.

The authors set out to investigate the differences in quality of care in various parts of Tanzania. In order to achieve this, they focused on three goals. First, they described the situation in each of the 21 regions of Tanzania. They did so by using indicators such as GDP, population, women’s education levels, total fertility rate (TFR), number of live births, number of rural births, birth density, and rural birth density. Second, they performed a correlation analysis to see what inputs into the healthcare system were effectively improving survival rates and successes and which were not. Finally, they used GIS mapping methods to visualize the variation between the different regions of Tanzania. Through these methods, they found drastic differences in lifestyle and care at birth at the subnational level. They discovered that in Mwanza 27% of women had reported birth complications as compared to the 80% in Dar es Salaam. In Ruvuma, 83% of rural births take place in health facilities, but in Rukwa the number is a mere 21%.

Amartya Sen’s definition of human development fits well with this article because it shows the inequity of freedoms that can exist within one nation. Everyone living in Tanzania ought to have the same right to life regardless of what region they were born in. This inequality infringes on people’s rights to the human development dimensions of social opportunity and protective security. Sustainable development goal 3, which values healthy lives and well-being for all at all ages can only be upheld when there are more standardized and effective care at birth practices being implemented across Tanzania. Goal number 10, which strives to reduce inequality within and among countries fits perfectly with this article because Tanzania has so much variation and inequality throughout its different regions. The authors of this article attempted to answer the question: How do regional parts of Tanzania differ in care at birth practices and methods? They succeeded in this goal and simultaneously reinforced Rosling’s idea that an average is not always a reliable value.

Source 2:

Bee, Margaret, et al. “Neonatal Care Practices in Sub-Saharan Africa: a Systematic Review of Quantitative and Qualitative Data.” Journal of Health, Population and Nutrition, vol. 37, no. 1, 2018.

This article discusses neonatal care practices across sub-Saharan Africa. Some of the most important newborn care practices include thermal care (immediate drying and wrapping), skin-to-skin contact after delivery, hygienic cord care, and early initiation of breastfeeding. This paper assesses how different parts of sub-Saharan Africa are fairing in these practices with their own newborns after delivery. The research was conducted by gathering hundreds of articles from recent years with raw data regarding newborn care in sub-Saharan Africa (primarily Ethiopia, Ghana, Malawi, Tanzania, and Uganda), which were then screened and narrowed to 42. Qualitative data was “extracted and summarized” and the qualitative data was “synthesized through thematic analysis with deductive coding used to identify emergent themes.” With data from dozens of articles, the researchers discovered much variation in newborn care practices across the different countries in sub-Saharan Africa. However, prevalence of skin-to-skin contact after delivery was particularly low throughout the region. As a whole, there was a general understanding of the necessity to keep newborns warm, however, the thermal care practices were not up to par. Drying and wrapping of the child was often postponed because the birth attendant was more focused on the mother. They also often delayed breastfeeding due to a belief that no milk was being produced or that the baby was not hungry.

According to this article, every year, approximately 2.9 million neonatal babies die, and this corresponds to 44% of deaths in children less than 5 years old. This relates directly to Amartya Sen’s definition of human development because newborns that die due to unstandardized and subpar care practices lose their freedom of life. This is related to the human development dimension of social opportunity as well as protective security because newborns need to live in order to enjoy the opportunities of an education, a job, or a family and protective security in part means protecting the right to life. This also upholds sustainable development goal 3, which is to ensure healthy lives and promote well-being for all at all ages, which includes the youngest and most vulnerable in our world. Goal number 10, which strives to reduce inequality within and among countries is also applicable here as a child born in a sub-Saharan country ought not have a decreased chance of survival when compared to someone born in a different, more developed nation.

The authors of this article focused on uncovering how well different parts of sub-Saharan Africa were following crucial neonatal care practices that can mean life or death for many newborns. They sought to discover where these methods are falling short in order to discover what can be done to save more lives. Results from this study could provide the information necessary to implement important neonatal care practices across the sub-Saharan region.

Source 3:

Bosomprah, Samuel, et al. “Spatial Distribution of Emergency Obstetric and Newborn Care Services in Ghana: Using the Evidence to Plan Interventions.” International Journal of Gynecology & Obstetrics, vol. 132, no. 1, 2015.

In this article, data was collected and analyzed regarding the quality of care provided by different facilities in Ghana for women and newborns. The facilities referenced in this article were being rated based on different essential functions regarding Emergency Obstetric and Newborn Care (EmONC). The results of this study uncovered that a mere 21% of births in facilities in Ghana occured in those that were fully functioning. Additionally, 30% occurred in facilities that were close to fully functioning but were missing a couple basic functions such as “assisted vaginal delivery and removal of retained products.” The purpose of this study was to establish a clear way to improve the obstetric care able to be offered to newborns and their mothers throughout the country. This data analysis showed that by just putting a few more resources in the facilities that are close to but not quite fully functioning, the country has the capability to bump their total percentage of fully functioning facilities to over 50% and thus would allow them to meet international standards for EmONC services. This is a method to target resources to where they could be most effective and have the most benefit for the country as a whole.

Amartya Sen’s definition of human development holds freedom at its core. His idea revolves around the idea that the most important part of development is how it expands people’s freedoms in an expansive sense. Bettering the facilities for maternal and newborn care definitely improves the freedom of life because surviving childbirth is far more likely with the proper sterility and doctors. This topic aligns best with the dimension of social opportunities. In his book he includes both education and health facilities as a subset of social opportunities because without these relatively basic necessities people do not have the capability to get a job or work to lift themselves into a more desirable situation. Maternal and newborn health care also relates well to the sustainable development goal 3, which is to ensure healthy lives and promote well-being for all at all ages. To me this goal strives to provide the best healthcare to those who need it including mothers and their babies who may not yet even be born.

The data for this study was collected from the Ghana EmONC survey, which was a “nationwide cross-sectional facility-based survey” that was conducted in 2010. The data analysis included creating maps that showed differences in the quality of health care facilities across the country of Ghana. The authors of this article were seeking to answer the question: How well are different parts of Ghana able to provide access to proper healthcare facilities to mothers and newborns.

Source 4:

Neal, Sarah, et al. “Mapping Adolescent First Births within Three East African Countries Using Data from Demographic and Health Surveys: Exploring Geospatial Methods to Inform Policy.” Reproductive Health, vol. 13, no. 1, 23 Aug. 2016.

In order to gain a greater understanding of the quality of maternal and newborn health in developing countries around the world, it is important to have a baseline understanding of the populations that exist in the studied areas. This article focuses on mapping the distributions of women of childbearing age, pregnancies, and births. This is a particularly useful endeavor because discovering methods for safer births and healthier newborns could be improved by more accurate estimations of these populations. This study uses data from WorldPop to analyze and map different statistics in 4 main countries: Afghanistan, Bangladesh, Ethiopia, and Tanzania. UN statistics on age specific fertility rates, live births, stillbirths, and abortions were also included in their data analysis.

The estimates that they calculated for women of childbearing age, live births, pregnancies, and distribution of comprehensive EmONC facilities is crucial information that can be used as the basis for creating new planning services for maternal and newborn healthcare or as denominators in new statistics to track progress. There is certainly a need to see how many people of childbearing age or how many pregnant women live in proximity to an EmONC facility. This is critical for understanding where new ones need to be built, especially in more rural areas of these developing nations.

This article works to investigate estimates of different populations of women and newborns throughout 4 developing countries. By doing so, these researchers are setting a foundation to be used in future studies and endeavors to save more lives of mothers and newborns. This relates to Amartya Sen’s definition of human development because it is working toward providing more people with the freedom of life. This also correlates to sustainable development goal 3, which ensures healthy lives and well-being for all at all ages, as it is helping to establish a framework for better care at birth throughout the world. This article seeked to discover distributions of women of childbearing age, pregnancies, births, and EmONC facilities in order to provide knowledge that can be used to better understand what can be done to fill gaps in our health care systems.

Source 5:

Tatem, Andrew J, et al. “Mapping for Maternal and Newborn Health: the Distributions of Women of Childbearing Age, Pregnancies and Births.” International Journal of Health Geographics, vol. 13, no. 1, 4 Jan. 2014.

Becoming pregnant as an adolescent can create significant complications in the life of a young woman. It has the potential to decrease quality of life and health for the young mother as well as her child. This study maps data on adolescent first births in Uganda, Kenya, and Tanzania in order to gain a better understanding of the distribution that can later be used to inform policy. The data used in this study came from the most recent Demographic and Health Surveys (DHS) in these three east African nations. The researchers analyzed the data from first births before the age of 20 but also disaggregated it into three groups: under 16, 16-17, and 18-19 years of age. Using this data combined with GPS-located cluster data and adaptive bandwidth kernel density estimates, they were able to create descriptive choropleths, and prevalence maps. They also used a Bayesian hierarchical regression modeling approach to map adolescent first births at a district level with estimates of uncertainty. In essence, they used data science techniques to discover the distribution of first births to young mothers in these countries.

They discovered many “hotspots” or areas where prevalence of births were particularly high and found that many of these areas had large problems of underlying poverty. Through this research, the authors of this study are able to supply information that can be used by policy-makers to send resources to areas in which the adolescent first births are most high. They can target the areas that are most in need of education and contraception and help women keep their lives more on track. Becoming pregnant at a young age can lead to lower socio-economic status and educational level for the rest of that woman’s life. Giving her the education and resources needed to decrease the likelihood that it will occur fits with Amarta Sen’s definition of human development because it gives her the education and thus the freedom to choose the outcome of her life. It also gives her the freedom to achieve a greater quality of life and an increase in the human development dimension of social opportunity. If a woman does not get pregnant young, she is more likely to be able to get an education, work, and lead a healthier life. This article fits well with sustainable development goals 4 and 5. Goal 4 states to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, which can only occur if they are able to go to school instead of caring for their child. Goal 5 states to achieve gender equality and empower all women and girls, which is achieved through an education and through providing them the knowledge that they don’t need to have children young that there are alternative paths.