Health Phone saves lives

By Brenda Zulu

With the high penetration of mobile phones in Africa, a newly launched HealthPhone in India would save the purpose of creating awareness and capacity building on health issues. The HealthPhone which is preloaded with audio and video content on low cost mobile phones would reach the unreached in that not all mothers have access to a health centre.

According to Nand Wadhwani Founding Trustee of The Mother and Child Health and Education Trust, the HealthPhone information can reach the excluded, the illiterate, all those women, men and children who were only visible in tragic statistics. Information can reach families and communities as a whole - something that has not been done before.

The Health Phone’s health and nutrition content is scripted on knowledge prepared jointly by UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and The World Bank. It addresses the main areas of concern; Timing Births, Safe Motherhood and Newborn Health, Child Development and Early Learning, Breastfeeding, Nutrition and Growth, Immunisation, Diarrhoea, Coughs Colds and More Serious Illnesses, Hygiene, Malaria, HIV, Child Protection, Injury Prevention, Emergencies: preparedness and response.

Below are a few extracts from the HealthPhone on information related to reproductive health and family planning upon pressing the different areas of concern applications.

Breastfeeding

Babies who are breastfed are generally healthier and achieve optimal growth and development compared to those who are fed formula milk.

If the vast majority of babies were exclusively fed breast milk in their first six months of life – meaning only breast milk and no other liquids or solids, not even water – it is estimated that the lives of at least 1.2 million children would be saved every year. If children continue to be breastfed up to two years and beyond, the health and development of millions of children would be greatly improved.
Infants who are not breastfed are at an increased risk of illness that can compromise their growth and raise the risk of death or disability. Breastfed babies receive protection from illnesses through the mother's milk.
Breastfeeding is the natural and recommended way of feeding all infants, even when artificial feeding is affordable, clean water is available, and good hygienic conditions for preparing and feeding infant formula exist.

If a mother is HIV-positive, there is a risk that she can transmit HIV to her baby through breastfeeding. Counselling can help her carefully weigh the risks and make an informed decision on which feeding option is best for her baby and most manageable for her.

Almost every mother can breastfeed successfully. All mothers, particularly those who might lack the confidence to breastfeed need the encouragement and practical support of the baby's father and their families, friends and relatives. Health workers, community workers, women's organisations and employers can also provide support.
Everyone has the right to information about the benefits of breastfeeding and the risks of artificial feeding. Governments have a responsibility to provide this information. Communities as well as media and other channels of communication can play a key role in promoting breastfeeding.

Timing Births

Too many births, births too close together and births to adolescent girls under 18 and women over 35 endanger the lives of women and adolescents and their infants.
Family planning is one of the most effective ways to improve women's and children's health and survival. Family planning services provide women and men with information, education and the means to plan when to begin having children, how many to have, how far apart to have them and when to stop. However, millions of women of childbearing age, including adolescent girls, do not have control over limiting pregnancies or spacing births, nor do they have access to effective family planning methods.

Both women and men have the right to choose how many children to have and when to have them. With family planning services they are enabled to make informed decisions on pregnancy by taking into account the benefits and risks, including those related to age and level of access to health services.

Ensuring access to family planning services for women and men, and to education for all children would help prevent many maternal and child deaths and disabilities, particularly in countries where marriage occurs early in life. Together these measures can contribute to women, adolescent girls and children's rights to survival, health and well-being.

Malaria
Malaria is a serious disease spread through mosquito bites. The World Health Organisation estimates that around 250 million malaria episodes occurred in 2006, resulting in nearly one million deaths. About 90 per cent of all malaria deaths occur in sub-Saharan Africa, mostly among children under age five.

Malaria is found in many regions of the world. In sub-Saharan Africa, it is a leading cause of death, illness, and poor growth and development among young children. It is estimated that a child dies of malaria every 30 seconds in this area.
Malaria is particularly dangerous for pregnant women. Some 50 million pregnant women are exposed to malaria each year. Malaria during pregnancy contributes to nearly 20 per cent of low-birth weight babies in endemic areas, plus anaemia, stillbirth and even maternal deaths.

Malaria is spread by the bite of an Anopheles mosquito. The mosquito transfers the malaria parasite, Plasmodium, from person to person. People get very sick with high fevers, diarrhoea, vomiting, headache, chills and flu-like illness. Especially in children, the disease can worsen rapidly, causing coma and death. Children under five years old are most susceptible to malaria because they have very little acquired immunity to resist it.

Many lives can be saved by preventing malaria and treating it early. Children and their family members have the right to quality health care for prompt and effective treatment and malaria prevention.

Governments, in collaboration with communities and non-governmental and community-based organisations, can minimise the number of malaria cases. They need to support preventive actions, such as distributing long-lasting insecticide-treated mosquito nets for families to sleep under.

Safe motherhood
1. Girls who are educated and healthy and who have a nutritious diet throughout their childhood and teenage years are more likely to have healthy babies and go through pregnancy and childbirth safely if childbearing begins after they are 18 years old.
2. The risks associated with childbearing for the mother and her baby can be greatly reduced if a woman is healthy and well nourished before becoming pregnant. During pregnancy and while breastfeeding, all women need more nutritious meals, increased quantities of food, more rest than usual, iron-folic acid or multiple micronutrient supplements, even if they are consuming fortified foods, and iodised salt to ensure the proper mental development of their babies.
3. Every pregnancy is special. All pregnant women need at least four prenatal care visits to help ensure a safe and healthy pregnancy. Pregnant women and their families need to be able to recognise the signs of labour and the warning signs of pregnancy complications. They need to have plans and resources for obtaining skilled care for the birth and immediate help if problems arise.
4. Childbirth is the most critical period for the mother and her baby. Every pregnant woman must have a skilled birth attendant, such as a midwife, doctor or nurse, assisting her during childbirth, and she must also have timely access to specialized care if complications should occur.
5. Post-natal care for the mother and child reduces the risk of complications and supports mothers and fathers or other caregivers to help their new baby get a healthy start in life. The mother and child should be checked regularly during the first 24 hours after childbirth, in the first week, and again six weeks after birth. If there are complications, more frequent checkups are necessary.
6. A healthy mother, a safe birth, essential newborn care and attention, a loving family and a clean home environment contribute greatly to newborn health and survival.
7. Smoking, alcohol, drugs, poisons and pollutants are particularly harmful to pregnant women, the developing fetus, babies and young children.
8. Violence against women is a serious public health problem in most communities. When a woman is pregnant, violence is very dangerous to both the woman and her pregnancy. It increases the risk of miscarriage, premature labour and having a low-birth weight baby.
9. In the workplace, pregnant women and mothers should be protected from discrimination and exposure to health risks and granted time to breastfeed or express breast milk. They should be entitled to maternity leave, employment protection, and medical benefits and, where applicable, cash support.
10. Every woman has the right to quality health care, especially a pregnant woman or a new mother. Health workers should be technically competent and sensitive to cultural practices and should treat all women, including adolescent girls, with respect.

Family Planning in Zambia

By Brenda Zulu 

The focus on this article is on women who are sexually active because these women have the greatest risk of exposure to pregnancy and the need for regulating their fertility. 

According to the Zambia Demographic Health Survey (ZDHS) 2007, contraceptive methods are grouped into two types: modern and traditional methods. Modern methods include female sterilisation, male sterilisation, the pill, intrauterine device (IUD), injectables, implants, male condoms, female condoms, diaphragm, foam/jelly, lactational amenorrhoea (LAM) and emergency contraception. Traditional methods include the rhythm methods (periodic abstinence) and withdrawal. 

This also includes folk methods. Zambians widely know modern than traditional methods. Among traditional methods, withdrawal is the most commonly known among women. Similarly to women, the most common known method among men is the male condom. It is worth noting that among the men they are as likely as the women to know of implants. 

Younger women aged between 15 and 19 and women living in western province are least likely to know of a contraceptive method. For men, knowledge of any family planning method is almost uniform regardless of age, residence, province, educational level or wealth quintile. The pill is the most common method of contraception followed by the condom and injectables. Implants, IUD and the emergency contraception are the least used methods with less than 1% of women having ever used any of these methods. Cycle beads are the least used. 

Among males less than 1% have used sterilisation. For the traditional methods, withdrawal is more common than rthym method. On the knowledge of family planning preference, Elijah Kabwe, a married man with two children said he did not trust the Norplant which his wife has inserted on her arm and as a result he has continued to use the withdrawal method as he did not want to have another child. Asked if he would then choose to go for vasectomy, Mr Kabwe said he wouldn’t as he was already satisfied with his family planning method of choice. 

 For Zambia, the use of family planning method increases with age from 10% in the age group 15 to 19 years to 40% in the age group 25 to 29 years and then starts to decline to 24% in the 45 to 49 age group. The female condom is the least used modern method for women (1%). The contraceptive prevalence rate for modern methods has increased from 7% in 1992 to 25% in 2007. Contraceptive use is higher among women in urban areas than among women in rural areas. Eastern province has the highest proportion of women currently using family planning methods, followed by Copperbelt. The lowest proportion of married women using a family planning method is in Luapula. In general, women do not beg to use contraception until they have had at least one child. Contraceptive use among women increases with educational attainment compared to women who are uneducated. Condom use has more than doubled from 2% in 1992 to six percent in 2007. 

The proportion of married women undergoing female sterlisation has remained relatively stable between 1992 and 2007 at 2%. Among pill users the brand commonly used are safe plan and Microgynon and Oralcon. Among women using injectables, 56 % use DepoProvera and 42% use Noristerst. The most common brand of male condom used is the Maximum classic. 

 “From one menstrual period to the next, are there certain days when a woman is more likely to get pregnant if she has sexual relations?” 

A woman is most likely to conceive halfway between two periods. Users of natural family planning methods are more knowledgeable about their fertility period. Couples use family planning methods to limit family size or delay the next birth. Couples using family planning as a means to control family size adopt contraception when they have already had the number of children they want. When contraception is used to space birth, couples may start to use family planning earlier with the intention to delay a pregnancy. This may be done before a couple has had their desired number of children. In a culture where smaller family size is becoming a norm, young women adopt family planning at an earlier age than their older counterparts. 

 Women start using contraception at a younger age while some use contraception before they have any children. Timing of sterilisation for many women is at 34 years. The many women who use modern methods contraceptives obtain them from the public sector, mostly government health centres while private medical institutions are the second most common source of contraception with non medial sources being the least common. There has been a shift away from reliance on private medical sources for contraceptive methods. 

The proportion of current users relying on private medical sources has declined from 32% in 1992 to 17% in 2007. Contraceptions for people who use modern methods get them for free and or not so many people buy contraceptions. About 8 in 10 women who obtained their family planning methods from public sector facilities were informed people while about two thirds of women who used methods with related problems were taught on how to address the problems should they occur. 

There are some married women who have no intention of using any method in the future and 5% are unsure of their intentions. Reasons for women not intending to use contraception in the future include fertility related reasons which include infrequent sex, no sex, menopausal, had hysterectomy, sub fecund, in fecund and wants as many children as possible. Opposition to using contraceptives is also prevalent due to many other reasons which include religion and the fact that some people are no longer sexually active.