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Make every child count

SAMARKAND, Uzbekistan, 14 May 2010. – A newborn son of Fatima Kulmurodova – Islombek - is only 5 days old. He sleeps quietly in a small cot near his mom’s bed. Appearance of unexpected guests in the room seems not to disturb him. 

It is a second child of a 25-year old teacher from Samarkand lyceum #1. Fatima’s first delivery occurred in the Taylak district maternity five years ago and left the feeling of fear and pain.

“There were too many people around me, putting an ice on my stomach, giving lots of anesthetics. I felt lost”, recalls the young woman.

This time all went differently. Fatima decided to go to Samarkand-based maternity # 3. Her family relied on “the word of mouth” when making the choice and had no clue that the hospital was officially recognized as baby-friendly. It were workmates who told Fatima that it’s warm, the doctors and nurses were good and attentive. They also knew that family members would be admitted to delivery rooms.

Fatima’s expectations turned true. She and her little son feel well and are waiting now only for a birth certificate to come.

“It’s a pity there were no such a place in our times,” admits Fatima’s mother-in-law Rukhsora Normamadova, 48. The mother of four, she lived through that and knows how crucial it is to create the right conditions for pregnant women. Rukhsora-opa has stayed with her daughter-in-law during the delivery and says Fatima will get full support at home.

Fatima Kulmurodova with her newborn son Islombek and mother-in-law Rukhsora Normamadova.

 © UNICEF Uzbekistan/2010/Pirozzi

Life-saving techniques are within reach

Not all stories about childbirth in Uzbekistan would have the same happy ending. Nearly every delivery takes place here in maternities with skilled attendance. Yet, medical support is often inadequate or poor. The country’s maternal and infant mortality rates are therefore high compared to those of the middle-income countries. Poor health of women also serves as a contributing factor. According to MICS 2006, half of the mother and child mortality cases in Uzbekistan are caused by complications before, during and after the delivery.

“Many situations that have led to the death of newborns could be prevented or handled without complex and expensive technologies. There are new “low cost-high impact” strategies that help save more and more babies’ lives all over the world. The main thing is to change the maternal and newborn care practices inherited from Soviet times,” says Dr Hari Krishna Banksnota, MCH Specialist at UNICEF Uzbekistan.

He leads a nationwide project on improving maternal and child health, which is being implemented by the Ministry of Health and UNICEF with the European Union’s funding since 2008.

One of the key goals is to scale up application of the universally recognized standards in emergency obstetric care, neonatal resuscitation, and essential newborn care. Some of them are simple and do not require high-tech equipment: keeping babies warm and with mothers, feeding with breast milk, avoiding over-medication. Training of health specialists is complemented by advocacy at the policy level so that upgraded knowledge and skills sustain over time.

Leading by example

Samarkand maternity # 3 is one of the many beneficiaries of the EU-funded project. Few years ago this institution set an example in the region by supporting safe motherhood principles and the Baby-Friendly Hospital initiative. It also began promotion of exclusive breastfeeding ahead of other local health facilities. It’s not surprising then that the very same maternity took the chance of training its staff in effective perinatal care. Opening of a training centre and a new department on neonatal resuscitation followed.

“Our staff attended different workshops on safe motherhood in the past and felt well prepared. However, the training on neonatal resuscitation turned out very useful and timely. It brought up to our attention lots of nuances we didn’t know about, “says Sayyora Sobirova, Chief Doctor.

For example, they used to underestimate the role of temperature in saving the life of a newborn. Now they know: if it’s below the set minimum, no other invention will help a baby survive. Besides, the old school of medicine placed too much value on drugs in neonatal resuscitation. As a result, prescribing long lists of medicine was rooted in the practices of local neonatologists.

“All medical interventions for neonatal survival should be well justified. Otherwise, they can bring more harm than good,” says Sayyora.

The team she leads is determined to keep adopting the new techniques that proved effective. It doesn’t matter what it will cost them if babies’ lives are at stake.