An ADB-supported project in Lao PDR helps keep mothers and babies safe and healthy during childbirth.
Luang Prabang, Lao PDR─Inthadouth Sisouphanh has been working in medicine for more than a decade. The 42-year old nurse in the northwestern Lao People's Democratic Republic (Lao PDR) province of Luang Prabang has seen dramatic changes in health care in the small villages where she cares for patients.
In years past, babies were often delivered by midwives with little training, or in some cases by relatives with no experience at all in childbirth. There were frequently complications during delivery, sometimes for very simple reasons. A tangled umbilical cord or bleeding by the mother often threatened the life of the mother or the baby - sometimes both.
"These complications are easily preventable when giving birth in a clinic with a skilled birth attendant," she says.
Sisouphanh received training in childbirth, maternal care, women's health, and family planning in 2008 and 2009. The training, along with new and appropriately equipped health centers at the district level, has made pregnancies and childbirth safer. Sisouphanh delivers about 30 babies a month.
"It is rare that a child dies during childbirth now," she says. "It used to be fairly common, not only that the baby died during childbirth, but that the mother would die as well. Now it is rare for the mother or the baby to die in childbirth in our area."
Gender equality, health equality
Sisouphanh was trained under the Health System Development Project, which was administered by the Lao PDR Ministry of Health. The project was supported by an ADB grant of $13 million.
The project was designed to improve health status and nutrition in eight northern provinces of Lao PDR, particularly among the poor, women and children, and ethnic minorities. It has improved health and nutrition behavior; increased the use of health services; and made the provincial health system more effective, efficient, and equitable.
A gender strategy and action plan was incorporated into the project to make it more responsive to the primary health care and nutritional needs of women and ethnic minorities.
"Gender equality and health care are strongly interrelated," says Barbara Lochmann, a senior social sector specialist based at ADB's Lao PDR Resident Mission.
Women and girls often suffer from nutritional deficiencies because of unequal allocation of food within the family and food taboos related to pregnancy and child birth. Similarly, women are often victims of gender-based violence. They are also more vulnerable and at a higher risk of acquiring a sexually transmitted infection, because of limited power to make decisions and negotiate safer sex. Women and girls from ethnic minorities are particularly vulnerable because of traditional gender norms and poverty.
In rural and underserved areas, obstetric emergency services are available at only a few hospitals because of a shortage in trained staff and equipment. A majority of women also deliver without the help of skilled birth attendants. Studies have shown that Lao women prefer female health care providers, who are in short supply. The ADB-supported project has helped address these concerns by training women health practitioners and building clinics in rural areas.
"The project gives particular focus to addressing maternal and neonatal care through targeted local interventions," said ADB's Lochman. "Village health volunteers, paramedics, and other local health workers have been trained to function as skilled birth attendants, to help identify pregnant women and educate them about pregnancy related risks, better nutrition, delivery, and danger signs. They also assist with routine deliveries and refer patients with obstetric complications to referral hospitals."
Cutting the cord with the past
The project has improved the experience of delivery, something 64-year-old Phiel (who goes by one name) thought she would never see. When she gave birth more than 30 years ago, only her husband was there to take care of her. They used bamboo to cut the umbilical cord.
"I delivered my babies on a mat on the floor of my house," she says. "We used the grass under the mat on the floor to stop the umbilical cord from bleeding."
She gave birth to seven children between 1965 and 1974. All were delivered at home with no professional medical care. Three died during childbirth.
"I don't know why they died," she says. "They just didn't cry when they were born. They just died. There was no doctor to ask why."
For 19-year-old Boualoy Oulaysone, the situation is very different. It was raining when her 2-month-old baby boy was born. She named him Namphol, which means "rain" in her language.
In her third month of pregnancy, her parents told her to come to the clinic for an examination. The nurse advised her how to eat properly to provide the child proper nutrition and gave her monthly checkups through her pregnancy. She delivered a healthy baby in the clinic.
"It is safer to have the baby here in the clinic than to have the baby at home without medical care," she says, clutching her healthy baby boy. "We are lucky to have this clinic here."