According to the 2016 “Midwives' Voices, Midwives’

Realities” report, 20% of midwives have to look for other

means of income on top of their full-time midwifery jobs, 37%
of midwives have experienced harassment, and 30% working in
Africa deal with poor management due to insufficient staffing.
“A lot of it comes down to gender,” said Cadée. “We’re women,
working with women, doing women's things, so it's like a
triple whammy.” Twenty to thirty percent of midwives believe
they are treated poorly because of their gender. Pay
inequality is one such example. “For all women in the global
health workforce, even beyond nursing and midwifery, we’re
seeing extreme challenges in terms of gender equity. There are
differences in terms of the wage gaps,” said Joy Marini,
global director of insights at Johnson & Johnson Global
Community Impact, in a Facebook Live with Devex.

Strong leadership, not just among organizations but as

individuals within the health community, is one way to tackle
these topline issues, Cadée said. “Stand with midwives, say
that midwifery matters, walk the talk.” But midwives also have
their own power and need to realize that leadership is not
just leading an organization, she added. “It works well when
midwives come together and know that when they're together
they're strong — get midwives at the table so that they're
part of the discussion. ”Having people outside the profession
speaking up for midwives, as well as midwives themselves
advocating for their causes, has a big impact in addressing
some of the issues, added Cadée. “Midwives have plenty of
power, just don’t take it away from them and let them speak
up. Sometimes they might say things you don’t like and that’s
how it is, that’s what power means. But we also need others to
speak for us.”

1. How many midwives have experienced harassment? Par I

2. According to Joy Marini what is the extreme challenges for
women beyond nursing and midwifery?
3. Why midwives in Africa deal with poor management.
4. How many percent of midwives treated poorly because of
their gender?
5. According to Cadée how to tackle these topline issues? Par
II

6. It works well when midwives come together and know that

when they're together they're strong.
What does it refer to?

7. What should we do to get impact in addressing some of the

issues?
ANSWER: B
Text II.
Nutrition for women in pre-pregnancy, pregnancy, and over
the first two years of the child’s life is of utmost
importance for the survival, health and development of mothers
and their children. In pregnancy, requirements of energy,
protein, and essential micronutrients (vitamins and minerals)
are increased not only to maintain the mother’s own health,
but to also support optimal physical and brain development in
the foetus. Furthermore, nutrition reserves are built over
pregnancy to produce breastmilk for the post-child birth
phase. Deficiencies of energy, protein, iron, calcium, iodine,
vitamin A and folic acid during pregnancy predispose mothers
to maternal complications and even mortality. These also
contribute to foetal birth defects, low birth weight,
restricted physical and mental potential, and foetal or
newborn mortality.
Exclusive breastfeeding is recommended for infants 0-6
months of age to meet all their nutrition needs for optimal
growth, and to protect them from infection. This should be
followed by continued breastfeeding alongside appropriate
complementary feeding until the child reaches 2 years of age.
To sustain the production of adequate quantity and nutritional
quality of breastmilk, lactating women have higher
requirements of energy, protein, and other micronutrients.
Poor maternal nutrition over this period risks depletion of
the mother’s own nutrient stores and health, and harms the
nutrition and health of the growing child . Addressing
nutritional needs of pregnant and lactating women is now
entrenched within the Sustainable Development Goals. By
scaling up efforts to achieve this target, progress will also
be accelerated on the targets on maternal and child mortality
and health.

The impact of poor nutrition on maternal health and

survival is indisputable. Anaemia, which results from
deficiencies of nutrients such as iron and folic acid is an
important risk factor for haemorrhage; a leading cause of
maternal mortality. Calcium deficiency during pregnancy also
increases the risk of pre-eclampsia, another cause of maternal
mortality . Improving nutrition alongside good antenatal care
can reduce these numbers significantly. Globally 52% of
maternal deaths are attributable to haemorrhage, sepsis, and
hypertensive disorders; 28% to non-obstetric causes; 8% to
unsafe abortion . Infection during pregnancy can deteriorate a
mother’s nutritional and health status, and impact foetal
development. Maternal infections before or during childbirth
are known to be associated with around 1 million new-born
deaths each year, and contribute to about 10% of the global
burden of maternal mortality. Malnutrition, is one of the main
factors increasing the risk of such life-threatening
infections through its role in decreasing immunity and
delaying recovery .

Maternal and child undernutrition contributes greatly to

mortality and morbidity of women and children in Pakistan, and
is also one of the most important contributing factors to
inter-generational poverty. Around 51% of Pakistani women of
reproductive age are anaemic. A recent health survey
acknowledges deficiencies of iron and vitamin A among pregnant
and lactating women as a common public health challenge.
Despite this, only 22% of women are found to be taking the
full 90-day course of iron supplements in pregnancy whilst
around 55% took none. The proportion of pregnant women
receiving antenatal care from a skilled health provider has
increased from 26% in 1990 to 73% in 2012-13. However, 3 in 5
pregnant women in Pakistan still do not receive 4 or more
antenatal care visits as recommended by the World Health
Organisation. These visits are extremely important to prevent
and detect health complications, and to reduce the risk of
adverse pregnancy outcomes for both the mother and child. In
addition, 2 out of 5 pregnant women in Pakistan do not receive
the two recommended doses of tetanus toxoid vaccination which
protect against maternal and neonatal tetanus. Furthermore,
huge disparities in health and nutrition outcomes exist based
on maternal age, education, economic status, and location.

8. In pregnancy, what requirements are increased? Par I

9. What deficiencies during pregnancy can predispose mothers
to maternal complications and even mortality?
10. These also contribute to foetal birth defects, low birth
weight, restricted physical and mental potential, and foetal
or newborn mortality.
What does the underlined word mean?
11. How long is the exclusive breastfeeding period? Par II
12. This should be followed by continued breastfeeding
alongside appropriate complementary feeding until the child
reaches 2 years of age.
What does This refer to?
13. What are the ruquirements to sustain production of
adequate quantity and nutritional quality of breast milk?

14. What will happen if you give poor maternal nutrition?

15. Addressing nutritional needs of pregnant and lactating
women is now entrenched within the Sustainable Development
Goals.
What does the underlined word mean?
16. What is the impact of poor nutrition on maternal health
and survival? Par III
17. What is the impact of calcium deficiency during pregnancy?
18.Generally how many percent of maternal deaths caused by
haemorrhage, sepsis, and hypertensive disorders?
19. How many percent of maternal deaths caused by unsafe
abortion?
20. Anaemia, which results from deficiencies of nutrients such
as iron and folic acid is an important risk factor for
haemorrhage; a leading cause of maternal mortality.
What does the underlined word mean?
21. What are the great effects maternal and child under
nutrition in Pakistan? Par IV
22.How many Pakistani women of reproductive age are free from
anaemic?
23. How many antenatal care visits recommended by WHO?
24. How many women do not take iron supplements in Pakistan?
25. How many percent of proportion increasing of pregnant
women recieving antenatal care from a skilled health provider?
26. Around 51% of Pakistani women of reproductive age are
anaemic. A recent health survey acknowledges deficiencies of
iron and vitamin A among pregnant and lactating women as a
common public health challenge.
What does the underlined word mean?

Text III.
Child and mother vaccination is one of the most effective
public health interventions that can reduce child morbidity
and mortality.  Vaccines can prevent many life-threatening
illnesses including diarrheal disease, a killer of nearly two
million children per year. Oftentimes, however, mothers are
not likely to obtain vaccines, even when available.  This is
due to many well-known barriers to care including fear, lack
of transportation, and cultural practices.  For example,
mothers may prefer to utilize traditional practices rather
than medical interventions.  One study examined the
association between mothers' use of traditional healer
services and vaccination among Haitian children. Researchers
found that children whose mothers used the services of
traditional healers were less likely to be vaccinated compared
to children whose mothers did not use the services of
traditional healers. Furthermore, mothers' use of traditional
services was negatively associated with vaccination after
controlling for maternal age, education, religion, and
distance from the nearest health care facility. Findings from
this study underscore the potential to enlist the help of
traditional healers in promoting child health by educating and
mentoring the healers in support of vaccination efforts.
Education is a powerful tool, and educating traditional
healers and mothers can have positive consequences that extend
to others in the family and the community. For example,
Indonesia Demographic and Health Surveys show that the
ownership of health educational materials, such as home-based
immunization handbooks, leads to increased rates of
immunizations. In 2002–2003, 70.9% of children whose household
had handbooks had received all vaccines by the time of the
survey, whereas only 42.9% of children who did not have
handbooks had been immunized.  Based on these findings, an
Indonesian ministerial decree in 2004 stated that the Maternal
and Child Health Handbook (MCH handbook) was to be the only
home-based record of maternal, newborn and child health. This
has increased immunization coverage through raising awareness
of immunization among children's parents and community members
and by allowing more accurate measurement of immunization
coverage. The MCH handbook implementation has several features
that promote its effective use. For example, MCH handbooks are
given to women in pregnancy and are kept at home, referred to
at any time of need and brought to health service
appointments. Health personnel give guidance to clients to
help them learn the contents of the handbook and to encourage
them to share the information with their family.
Recently, the United States Agency for International
Development invested in 1 million handbooks as the core
material to promote immunization and GAVI, the Global Alliance
for Vaccines and Immunization, approved its use to promote
immunization under its health system strengthening program.
“The MCH handbook also provides opportunities to improve other
services, such as community strategies for the integrated
management of childhood illness and birth registration, and is
a potential platform for integrating health services to ensure
a continuum of care.”  Like the Maternal and Child Handbook,
community-based health interventions are a well-established
and proven strategy to educate and reduce disease among women
and children.  A central pillar of community based
interventions is the involvement of community health workers
(CHWs).  The World Health Organization defines CHWs as members
of the communities where they work, who should be selected by
the communities, be supported by the health system but not
necessarily a part of its organization, and have shorter
training than professional workers.  Since the 1980s, CHW
programs have been a cornerstone of primary health care based
on the Alma-Ata declaration of 1978. CHWs have been considered
as agents linked to behavioral change and play a key role in
the expansion of formal health services.  For example,
interventions in several African countries have demonstrated
that community-based health workers can effectively deliver
“differential treatment for childhood illnesses based on
clinical symptoms”.   In this way, CHWs function to initiate
referral for severe illness and can help save lives of
children suffering from pneumonia, malaria, and diarrhea. 

27. What is the most effective way reduce child morbidity and
mortality? Par I.

28. How does vaccine work?

29. What did Researchers found about association between

mothers' use of traditional healer services and vaccination
among Haitian children?  
30. What is powerful tool to educate traditional healers and
mothers? Par II.

31.In Indonesia how many percent of people getting handbook in

2002-2003?
32. In Indonesia, based on ministry of health decree what is
the only handbook for maternal, newborn and child health?
33. This has increased immunization coverage through raising
awareness of immunization among children's parents and
community members and by allowing more accurate measurement of
immunization coverage.
What does the underlined word refer to?
34. How many books invested by the United States Agency for
International Development? Par III.
35. What is the central pillar of community based
interventions?
36. How does The World Health Organization define CHWs?
37. When did CHW programs established as a cornerstone of
primary health care based?
38. When was the Alma-Ata declaration?
39. What is the CHWs function?