.........................................................................................................Success story

USAID Mission will soon sign a new contract with John Snow Inc. to roll-out international mother and infant care practices nation-wide. The new project, Mother and Infant Health Project (MIHP) 2, will start this fall and last for four years.

The new project will build on the successes of the USAID-funded Mother and Infant Health Project (MIHP), which has been working in Ukraine since 2002. The first MIHP project focused on developing internationally recognized evidence-based practices and standards for maternal and infant health care in Ukraine.  Launched in four pilot regions - Crimea, Lviv, Donetsk and Volyn – in four years the project has gradually expanded to 20 maternities in 12 oblasts.

The major components of the Project included: training staff in women’s clinics and pediatric clinics; development of standards and protocols with Ukraine’s Ministry of Health; Behavior Change & Communication and development of educational curriculum for medical educational institutions.

In cooperation with the WHO European Division, the project developed effective evidence-based training package on antenatal, perinatal and pediatric care. Postpartum counseling and information for women and family members on contraception, baby care, nutrition, feeding practices etc. were an integral part of all perinatal trainings. 

Major project achievements at pilot sites include: a substantial decrease in incidences of hypothermia in newborns from 70% to 1%; an increase in the presence of companions in the delivery room from 2% to 60%, and an increase of normal deliveries from 28% to 70%; a decrease of Caesarean sections from 26.5% to 16%; decreases in episiotomies  from 22% to 7%; a decrease in infant mortality by approximately 30%; and -- most important -- no cases of maternal mortality in MIHP sites in 2005.

Natalia G. discusses baby care with Larissa P. as they share a meal in the Simferopol Maternity Hospital N2 cafeteria.  They delivered about the same time in, they received the same treatment from medical staff, and now their relatives visit them to help take care of newborns.

One would never see any difference between two women if one didn’t know that Natalia is a HIV positive. “I don’t feel any difference from other women here,” - says Natalia G.  “I eat together with other women and talk about baby care after discharge. My relatives can also come here any time and spend as much time as they want,” she continues.

Natalia G. discusses baby care with Larissa P.

Thanks to USAID-supported Maternal and Infant Health Project implemented in Simferopol maternity N2 since beginning of 2005, Natalia G. doesn’t feel stigma and discrimination, which always come together with her HIV positive status. She is just a happy mother of her daughter.

Had she had a baby a year ago, she would have been in a very different situation.

When Maternal and Infant Health Project staff arrived in Maternity #2, the maternity where all HIV positive women from entire Crimean Republic have to deliver, they found a lot of stigma-related issues both in the maternities and women’s clinics.  They discovered “special” conditions created for HIV+ women in the maternity: isolated delivery/operation rooms in the basement premises, isolated postpartum rooms for no one to attend.  Infants born to HIV positive women were separated from time to time from their mothers to be fed with formula by health care staff. The feeding methods were not quite followed as nurses didn’t provide correct feeding pattern to infants born to HIV+ mothers, which included unclear quantity and consistency of formula given, and not-on-demand feeding.

But moreover they also discovered a brick WALL constructed to separate HIV + women from the rest of the maternity, so that women wouldn’t mix and communicate.

For lees then a year, the project succeeded in linking HIV Prevention and treatment services (AIDS centers) with women’s clinics and maternities to optimize care and support to HIV-positive pregnant and postpartum women.  Extended innovative trainings “Effective Prevention of HIV from Mother to Child in Perinatal Facilities” and workshops with health care providers of various institutions (Maternity, AIDS center, women clinic) and representatives of Network of People Living With HIV in maternity N2  focused on such issues as: delivery methods, C-section, treatment, optimum support and counseling of HIV+ women and infant in postpartum period, family-oriented support to HIV+ women and infants, referral mechanisms for HIV+ women in case of emergencies.

The results turned to be truly amazing. Now HIV+ women now can deliver in nice, privacy oriented delivery rooms of the maternity. Their relatives are welcomed and are free to attend new mothers, help them to feed their babies and support women after C-section (C-section the only delivery method now in the maternity, which helps to reduce HIV transmission to newborns).  

And last, but not the least: the WALL separating HIV+ women from the rest of the department was removed.

“All the changes in the maternity became possible due to the enthusiastic spirit and professionalism of all trainers and participants of various categories working in the field of HIV/AIDS that influenced maternity N2 medical staff’s attitudes to HIV+ women,” says Dr. Illya Glazkov, the Chief Doctor and Chief OB/GYN of Simferopol Maternity N2. “All this led to learning basic aspects of care and treatment and solving everyday difficulties in fighting with HIV/AIDS epidemic in Crimean Republic and Ukraine. Now we see happy women and their newborns, as well as a tendency in reduction of abundant infants born to HIV+ mothers compared to the last year and before.”

Husband Casts Tradition Aside and Helps Deliver Son

Sakhi - It wasn't easy getting Nikolai Yarmakov to take part in the birth of his son.  Within much of Ukrainian society a lingering attitude exists that a man does not do "female tasks" like making the bed, doing the cooking or, heaven forbid, taking part in the birth of his child.  More customarily, while his spouse is giving birth, the husband gathers with his friends to await news of the birth and then toast the newborn.

Nikolai, 34, finally agreed to be present and help in the birth if his first child only after much cajoling from his wife, Maria, and doctors at the Sakhi Rayon Maternity Hospital in the Crimea .  Sakhi Maternity is part of the Maternal and Infant Health Project (MIHP), a program supported by the U.S.   Agency for International Development and implemented by John Snow, Inc.  The MIHP purpose is to improve reproductive and infant health in Ukraine by fostering quality perinatal services.  It is part of a general commitment by USAID in partnership with the Ukrainian government to improve the overall health of the Ukrainian population.  MIHP has been working in Ukraine since 2003.

It was common to see a long line of fathers-to-be begging medical staff to spend time with their wives in their maternity rooms at Donetsk Maternity # 3 before we began our work. Changing non-evidence based practices like this one – where fathers/relatives are not allowed to be with mothers-to-be in an attempt to control infection – has been the focus of our work in Donetsk .

During a series of trainings in August 2003, local ob/gyns, midwives and neonatologists, worked with our trainers around the clock to learn evidence-based perinatal technologies and international best practices. This was a challenge for our trainers because they not only had to share information, but to change the longstanding perception of the local staff regarding traditional/outdated protocols. Gradually though, the majority of the local staff adopted the international perinatal practices. These include:

• A family-oriented delivery
• Skin-to-skin contact
• Complete rooming-in
• Exclusive breastfeeding

At the end of our trainings we were confident that Donetsk Maternity # 3 would take over the ‘evidence-based baton'. Today, you will not see any lines of people waiting to see their wives and daughters, sisters or mothers through the maternity windows – all relatives are free to come in!

Furthermore, during a follow-up visit in May 2004 (eight months after the first training) we were astonished by the positive change in their indicators. The following are just a snapshot of their formidable results since August 2003.

• Hypothermia cases reduced from 63% in Oct. 2003 to no cases
• Episiotomies dropped from 37.1% in Oct. 2003 to 7.8%
• C-sections performed reduced to 24.4% compared to Oct. 2003's 33%

If you enter a maternity room now, you will see happy mother with her newborn on her chest and her husband and relatives smiling at the sometimes awkward yet adorable movements of the new baby!

Inspired Maternity personnel at Donetsk are receiving numerous delegations from other districts and city Maternities who come to learn how to create happy babies, parents, relatives and health care workers at their maternities.