• Goal: Improve maternal health
  Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
  Target 5.B: Achieve, by 2015, universal access to reproductive health
  5.1 Maternal mortality ratio
  5.2 Proportion of births attended by skilled health personnel
  5.3 Contraceptive prevalence rate
  5.4 Adolescent birth rate
  5.5 Antenatal care coverage (at least one visit and at least four visits)
  5.6 Unmet need for family planning

Jeff Hessburg, Ethan Nauman,Megan Starry, Nick Berg

• 99% of all maternal deaths occur in developing countries.
• Every year 2 million deaths among mothers and newborns occur at the time of birth.
• Skilled health workers lead to a 54% reduction in mortality at birth.
• About 16 million girls aged between 15 and 19 give birth each year, accounting for more that 10% of all births.

Stats from Care.org

Overall Latin America and the Caribbean has made great strides in achieving goals set by the millennium development goals, but MDG 5 has been an up and down battle for most of the region. In 2012 a lot of progress made was reversed and this can be attributed to a number of factors. The leading issues associated with an increase in mortality include: direct obstetric complications such as the postpartum hemorrhage disease and eclampsia, and indirectly due to heart disease and HIV. After 2012 The data was essentially very similar to the 1990 baseline data essentially showing little progress.

According to an article by the Pan American Health Organization (PAHO), the World Health Organization (WHO) have pinpointed the main cause and other causes of maternal mortality in the Latin American and Caribbean regions. The main cause of maternal mortality is “pre-existing medical conditions exacerbated by pregnancy (such as diabetes, malaria, HIV, obesity) caused 28% of the [maternal] deaths” (WHO).

Other causes the WHO have found related to these women's death include some of the following:

• Severe bleeding
• Infections
• Obstructed labor
• Abortion complications
• Blood clots

Most fatalities took place in rural areas often times involving women that only had a primary school education and sometimes less than that. This relates back to many of the other MDGs but mainly MDG3. Education is perhaps one of the most valuable tools a person can possess and specifically education regarding one’s body and human development can be especially vital. It makes sense women in rural areas are having issues with more fatalities. Often times these women do not have access to educational resources surrounding pregnancy and may have no idea about some of the issues that may occur and the best ways to care for their unborn child.

In addition the number of contraceptives used from the beginning of the MDG has been just over 50%. This is associated with many things including, religion, cultural norms, legal barriers and again education.  With many girls being forced into marriage at a young age it is not uncommon for early pregnancies at well, contraceptives are particularly difficult to get at younger ages and if someone is not educated on the use and importance of contraceptives they are setup for failure before even getting pregnant.

Progress has been affected by many facets in the region, a few of the major facets include cultural norms and religion. Up until very recently and still in many situations men essentially had final say in many decisions including what happened in women’s lives. This affects many aspects of everyday life but especially regarding the health of women and children. Men may make it extremely tough for their partner to use contraceptives and this may lead to many unsafe pregnancies and the spread of disease not only to a woman but ultimately the child as well. Also, if a woman is having issues with a pregnancy and needs medical attention throughout, that woman may rely on a man to ensure she gets the medical attention she needs and if a man does not make that a priority the woman and child may suffer unneededly. Religion also plays a major factor, in much of the region religion is a very important part of life. In some religions such as Christianity, contraceptives have been sort of frowned upon and there are apparent issues associated with that. Faith may also be used as a sort of “medicine” but in some instances, modern medicine is an absolute necessity.     

Although the fifth Millennium Development Goal has not remotely reached its objective, decisions regarding improving maternal health start by taking action with the four initiatives within “4 Pillars” (created by Family Care International and Women Deliver) to prevent additional maternal deaths. Susan Cohen, an author for the Guttmacher Institute (a nonprofit organization that researches and advances reproductive health), writes that the founded “4 Pillars” are:

• “Family planning and other reproductive health services;”
• “Skilled care during and immediately following pregnancy and childbirth;”
• “Emergency obstetric care when life-threatening complications develop; and”
• “Immediate postnatal care for mothers and newborns.” (Cohen).

These initiatives have been accepted worldwide and have received full and equal attention and support.

Determinants of health for maternal health.

Most women die during pregnancy and childbirth because they had no access to skilled routine and emergency care. The determinants of health that this is closely linked to are; political/economic and social.  Economic and political factors that contribute to maternal health are care facilities available. Countries don’t have facilities or medical technicians available for these women, making it impossible for them to getting the help they need. Socially, many women simply aren't educated about the help available.  

Interventions

CARE (Cooperative for Assistance and Relief Everywhere) “is a leading humanitarian organization fighting global poverty.” CARE works in 90 countries worldwide and 6 countries in Latin America and the caribbean. They focus on working with women. They believe that with the right tools, women have the ability to lift their family and community out of poverty. CARE’s mission is to help the poorest places in the world through: “Strengthening capacity for self-help, providing economic opportunity, delivering relief in emergencies, influencing policy decisions at all levels, and addressing discrimination in all its forms.” CARE believes that access to quality sexual, reproductive and maternal health is both a fundamental human right and a critical development issue. Care has a central commitment to gender equality and reducing global poverty. A nation that has better gender equality and less poverty has a much better average of healthy mothers than nations that have worse gender equality and greater poverty.

This chart shows only a handful of progress within countries of the Latin American and Caribbean region. Within the last 25 years, most countries in the region have made slow but steady enhancements of reducing maternal mortality per 100,000 births, yet there is a few countries that have actually have not shown progression towards this goal.

Question: What two factors does CARE focus on and believe is most directly related to healthy mothers and infants in Latin America and the Caribbean?

Sources

https://www.guttmacher.org/about/gpr/2009/05/promoting-sexual-and-reproductive-health-advances-maternal-health

http://mdgs.un.org/unsd/mdg/Data.aspx

http://www.paho.org/hq/index.php?option=com_content&view=article&id=9552%3A2014-11-countries-latin-america-caribbean-reduced-maternal-mortality-new-data-show&catid=740%3Apress-releases&Itemid=1926&lang=en

http://www.care.org/work/health/maternal-health

http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2015/Snapshots/Latin%20America%20and%20the%20Caribbean.pdf

Millennium Development Goal 4

Reduce Child Mortality Rate

Ethan Nauman, Nick Berg, Jeff Hessburg, Megan Starry

Figure 1.

Goal: Reduce child mortality

Target 4.A: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

4.1 Under-five mortality rate

4.2 Infant mortality rate

4.3 Proportion of 1 year-old children immunized against measles

As far as humans go, childhood is a very important and crucial step in development. This is a period in a person's life where they are potentially most vulnerable but at the same time, every experience is an opportunity and what MDG4 does is focuses on making sure the experiences children have, specifically in dealing with health are positive. Childhood is a period of time that really sets the tone for the sort of health and life that person is going to have at a general basis. In terms of vulnerability this is a time period where children are very susceptible to sickness and diseases that we may only consider common colds, but for these children if left untreated can leave to life altering disabilities or even death.

In talking about the previous MDGs we’ve primarily focused on adults and children who have reached the age 5 and higher. This goal focuses on children below that milestone and ways in ensuring they not only make it to age 5, but are healthy and have a good foundation healthwise for the rest of their life. Studies have shown that with proper nutrition and health at an early age, the more likely that person is productive and better off in the long run as they become independent and begin having families of their own later in life.

Figure 2. shows the key risk factors for three countries in LAC: Cuba, Bolivia, and Haiti. There is five different risk factors that this chart is looking at ranging from delivery care to breastfeeding. 

For our region there has been significant progress in terms of childhood health starting before the MDGs were even established. About 50 years ago approximately 150 out of 1000 children did not survive until they reached the age of five. Through various initiatives and focus on this horrific statistic, that number had been reduced to about 30 out of 1000 by the turn of the 21st century. During the 1990s LA&C made great progress unlike many other regions and used methods that worked in some places to enhance the entire region and spread progress.

Figure 3. shows different countries throughout the region and were they stood before, during, and after MGD4.

Although there has been substantial growth of child mortality within the Latin American and Caribbean region, the region still face economic and social issues that keep the  improvement of child mortality at a stand-still. The first Millennium Development Goal: Reducing Poverty and Hunger plays a role into these issues as there has been unequally dispersed health benefits for impoverished children. For example, according to Marianela Jarroud, in her article ‘Inequality Blocks Further Reduction in Child Mortality in Latin America, she researched that “five premature infants from poor families died of septic shock in a public hospital in Vina del Mar… after the preterm formula they were given through feeding tubes was contaminated by wastewater that dripped from the floor above”. This shows that there remains hidden issues within national average successes, especially in “unequal regions”. (Jarroud). But, thankfully, the region has established a handful of health initiatives and interventions to steadily get back on track of reducing child mortality.

Interventions

Here we find a young child getting a vaccination.
www.idrc.ca)

One example of a health initiative that has taken place is the drafting of vaccination legislations. 27 of the 44 countries and territories in the region have proposed or enacted vaccination legislations. Legal frameworks protect the sustainability of these programs, the individual's right to immunize, and the state’s responsibility to provide these immunizations as a public good. “Of the legislation from countries and territories included in the analysis, 44 per cent protects a budget line for vaccines, 96 per cent mandates immunization, 63 per cent declares immunization a public good, and 78 per cent explicitly defines the national vaccine schedule” (NCBI)

Figure 4. LAC is one of two regions that reached MGD 4 before 2015. Although  they reached the goal still 196,000 children died in the region in 2013. 1 child dies every 3 minutes in the region, 60% of the children die before the age of 1 and 50% of these children die within the first 28 days.

Program for Appropriate Technology in Health, also known as PATH, is the leader in global health innovation. PATH is an international nonprofit organization. “We save lives and improve health, especially among women and children. We accelerate innovation across five platforms—vaccines, drugs, diagnostics, devices, and system and service innovations.” Each platform is designed to solve health problems, in Latin America, and throughout other parts of the world in need. Vaccines are given to children to give them a healthy start in life. They aim to help supply drugs to treat diseases at a more affordable cost. PATH invents and supports the development of “point-of-care” diagnostic tests, these tests are affordable, portable, and easy to use. They give a much more accurate diagnosis than just evaluating symptoms. The devices platform PATH focuses on development of  appropriate, available, and affordable technologies for the people in need. Technologies such as “water filters and pre filled, non reusable syringes.” The final platform, system and service innovations,  “ensure that all these tools reach the people who need them.” This means improving the infrastructure and supply systems so technologies can be used properly. Advocating and informing these lifesaving priorities. Also training workers to understand these technologies. All of these technologies, especially vaccines and drugs, can largely impact the health young children under the age of five and help them have a much larger chance of surviving.

Sources

http://www.who.int/maternal_child_adolescent/topics/child/development/en/

http://content.healthaffairs.org/content/27/2/487.full

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898047/

http://www.cepal.org/en/print/33725

http://www.ncbi.nlm.nih.gov/pubmed/23407412

http://www.path.org/our-work/latin-america.php

http://www.ipsnews.net/2015/06/inequality-blocks-further-reduction-in-child-mortality-in-latin-america/

http://static1.squarespace.com/static/55ad3eb9e4b0c474cfc665cf/t/569844d0d82d5e518d163995/1452819665130/about-logo-PATH.jpg

Millennium Development Goal 3

Promoting Gender Equality and Empowering Women
Ethan Nauman, Nick Berg, Megan Starry, Jeff Hessburg

As history has shown women's rights have almost never been up to the same level as a man’s. This is especially true in developing countries and regions including Latin America and the Caribbean. Regarding MDG 3 there are a couple of goals to be hit by 2015, and they are:

Target 3.A: Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015

Indicator 3.1 Ratios of girls to boys in primary, secondary and tertiary education

Indicator 3.2 Share of women in wage employment in the non-agricultural sector

Indicator 3.3 Proportion of seats held by women in national parliament

The results for these indicators in Latin America and the Caribbean can be seen below.
MDG 3 Progress in Latin America & Caribbean

this picture represents the MGD goals of Latin America and the Carribean.

http://mdgs.un.org/unsd/mdg/Host.aspx?Content=Data/snapshots.html 

When countries are in the process of becoming more developed women are necessary to push forth progress and help the country grow in many ways especially in terms of health and economics. In a lot of developing regions women do not feel as if they are at their full potential and this is directly connected to one’s mental health. Education also plays a role in gender equality. If girls and women aren’t being given the same level of education, a lot of time important skills such as reading and math are skipped over and without these two skills it makes it that much harder for them to achieve later on. Another aspect of health and education is educating females on body change and puberty, acceptable forms of contraception and the importance of focusing on one’s own health before others because if they aren’t healthy it makes it that much harder to help other people.

There is a whole goal focused on women because it is of that much importance. Many have said that if MDG 3 was not a success, many of the other goals would fall flat. As mentioned earlier, if a country truly wants to develop and take itself to the next level, gender equality has to be a major focus. For too many years women’s rights have been tossed aside and not made a priority and this is not just an issue in developing regions such as Latin American and the Caribbean. The United States has really only made Women’s rights a focus in the last 100 years and it is still a hot topic even today.  

Telesurtv.net News

According to a report from U.N. women, published on telesurtv.net, in early 2015, Latin America had shown the most progress globally in empowering women through progressive labor laws through experiencing the biggest growth in women's participation in the workforce. Climbing from 40 to 54 percent between 1990 and 2013, but still below the participation of men at 80 percent. This women empowerment increase has a lot to do with the progressive policies and laws implemented by Latin America. For example, the document highlights that since 2014, Argentina, Brazil, Ecuador and Uruguay have laws in place for equal remuneration for work of equal value, that is to say equal pay for men and women for the same job, as well as laws banning gender-based discrimination in hiring and sexual harassment in the workplace. Unfortunately, regardless of the major improvisions and improvement, Latin America still finds that 17% of the “working women…  employed in the domestic sector, traditionally are not covered by the labor laws” (telesurtv.net).

"I deserve respect"

https://nextcity.org/images/made/Sussman_RioWomensRights_10_1200_800_80.jpg

Interventions

World Food Programme and many other organizations

Empowering women and promoting equality also means educating men. For the longest time women were meant to stay home, have children, cook and take care of the living space while the men worked. The issue with that is that it does not allow women time to work on their educating, does not give them fulfilling work outside of the home and does not allow women to earn a livable wage. If men are educated on how to be an equal share of the parenting process and take responsibility for some aspects of raising children this creates time and opportunity for women to obtain educating further than that of which they have and potentially get jobs that creates additional income for the household. It is not necessarily the man’s fault for not having the parenting skills needed as for the longest time that is how things were and there wasn’t the focus on creating opportunities for women. Overall the work being done by WFP has been successful and many men have been willing to take a larger role in the parenting process and have been supportive of their wives seeking higher education and meaningful work. (WFP)

Foundation for the Education and Study of women (FEIM) is a non-governmental, non-profit organization founded in 1989 by a group of professional women specializing in gender. The organization´s mission is to, “work to improve the social, political, labor, education, economic and health status of women and girls in Argentina, defending their rights and promoting better living conditions and equality” between women and men.Argentina.” What they do is train women to develop an understanding for their natural rights. They conduct research to observe the status of the women in Argentina. They advocate for the protection of women and children's rights, especially sexual rights. They coordinate activities with different women’s rights organizations nationally and internationally. They give advice to government and non government organizations about how to improve policies for women. They advocate for better enforcement of and also better laws for women. Lastly they Prepare, collections of print, audiovisual and other media on women, adolescents and children.

(FEIM.org)

Sources:

(WFP)

http://www.wfp.org/

(telesurtv.net) "http://www.telesurtv.net/english/news/Latin-America-Closes-the-Gap-on-Economic-Gender-Inequality-20150510-0023.html".

(FEIM.org)

http://www.feim.org.ar/english/index.html