Childbirth in Iraq

Childbirth in Iraq is marked by a fertility rate of 4.0 births per woman, a contested but high maternal mortality rate and a moderately high infant mortality rate.

El Tahril el Aam (General Liberation Hospital), Basrah

Fertility rate

In 2015 Iraq's fertility rate was reported by the World Health Organization at 4.0 births per woman.[1]

Mortality

Maternal mortality

Maternal mortality is a much debated figure in Iraq. In 2010 the CIA World Factbook reported maternal mortality at 63 deaths/100,000 births.[2] Iraq's Ministry of Health and the WHO reported in 2011 the maternal mortality rate at 84 death per 100,000 births. That would categorize Iraq as one of the 68 countries that account for 97% of the maternal and child deaths globally.[3] In 2013 the two organizations were divided on the issue with the WHO reporting maternal mortality at 64 deaths per 100,000 and Ministry of Health reporting 25.[4]

Infant mortality

In 2014 total infant mortality in Iraq was reported 37.53 deaths/1,000 live births: male: 41.57 deaths/1,000 live births and female: 33.28 deaths/1,000 live births.[5]

Contraceptive use

In 2013, the World Health Organization reported the contraception use rate at 53% for the population of Iraq, up from 32.9% in 2010.[6]

Abortion

In 2009, the United Nations reported that in Iraq abortion was only permitted to preserve a women’s life. It was not allowed in the case of rape or incest, to preserve a women’s physical or mental health, for economic or social reasons, or on request.[7]

Pregnancy care providers

There are three types of pregnancy care providers in Iraq; midwives, obstetricians, and traditional birth attendants.[8] Midwives practice in hospitals and in their home or the home of their client.[9] They are educated in hospital based programs, but there is interest in expanding midwifery education to the university level.[10] Once licensed, a midwife receives a plaque with her license number that she displays outside the door of her home.[11] This lets potential clients know that she has the appropriate credentials.[12] Midwives do not have prescribing privileges but may obtain certain medications from a physician if they are working outside of a hospital.[13] Obstetricians are university educated and work in hospitals.[14] Traditional birth attendants work only in clients homes [15]

Prenatal care

In 2006: 84% of women had at least one prenatal visit with skilled personnel. Of the women who received antenatal care: 63% had a urine sample, 66% had a blood test, and 76% had their blood pressure taken. A client's weight was taken less than the other measurements.[16]

Labor and birth

Location

In 2011, 74% of recorded births in Iraq took place in a hospital or birth center, 79% of urban births and 67% of rural births.[17]

Attendants and support persons

In 2011, 89% of births in Iraq were attended by a skilled birth attendant.[18] Sixty percent were attended by a public or private doctor and 28% were attended by a nurse-midwife or certified midwife.[19] Traditional birth attendants, called jiddas, attended 10% of the births.[20] For hospital births, no family members are allowed to accompany the women into the hospital.[21] For a home birth, a women's mother or sister is often present [22]

Pain and pain management

Women in Iraq generally expect that there will be pain with labor and delivery. An absence of pain is often interpreted as a poor progress in labor. Epidurals are not commonly used in public hospitals in Iraq.[23]

Caesarean rate

In 2006, 20% of recorded births in Iraq were via Caesarean section.[24] The rate was higher in private hospitals and the likelihood increased with a woman's age and education level [25]

Post-birth care

Breastfeeding

A recent report found that only 20% of newborns in Iraq are exclusively fed breast milk for the first six months.[26] There is often pressures to switch to formula feeding, though this can be unsafe in a country such as Iraq where clean drinking water is not always available.[27]

Female circumcision

Female circumcision is controversial in Iraq. While it is not widespread throughout the country, it is still common practice in Iraqi Kurdistan.[28] The decision to perform female circumcision is often made by the mother or grandmother on religious, social, or purity grounds.[29] Negative consequences to the child's health include bleeding, sepsis, shock, psychological disorders, obstetrical complications, and urogenital problems.[30] In 2010 the United Nations released a report that placed the prevalence of female genital mutilation at 78% of women in Kurdistan.[31] A more recent survey of 1,508 women in Kurdistan recorded a prevalence of 23% of women, with the mean age at which it performed being 4.6 years old.[32] Traditionally the procedure is performed at home by a midwife, traditional birth attendant, or relative. In 2011 a law was passed which made female circumcision illegal in Iraqi Kurdistan[33]

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References
  1. Iraq: WHO Statistical Profile. (January, 2015). Global Health Observatory. Retrieved on March 21st, 2015 at http://www.who.int/gho/countries/irq.pdf?ua=1
  2. Middle East: Iraq. (2014, June 22). CIA World Factbook. Retrieved March 24, 2015, from https://www.cia.gov/library/publications/the-world-factbook/geos/iz.html
  3. Webster, P. C. (2013). Roots of Iraq's maternal and child health crisis run deep. The Lancet, 381(9870), 891-894.DOI: 10.1016/S0140-6736(13)60658-3
  4. Al Hilfi, T. K., Lafta, R., & Burnham, G. (2013). Health services in Iraq. The Lancet, 381(9870), 939-948. DOI: 10.1016/S0140-6736(13)60320-7
  5. Middle East: Iraq. (2014, June 22). CIA World Factbook. Retrieved March 24, 2015, from https://www.cia.gov/library/publications/the-world-factbook/geos/iz.html
  6. Iraq: Country statistics summary. (2013). World Health Organization. Retrieved on March 24, 2015 at http://rho.emro.who.int/rhodata/node.country.country-IRQ-stats?lang=en
  7. World Abortion Policies 2011. (March, 2011). United Nations, Department of Economic and Social Affairs. Retrieved on March 24, 2015 at http://www.un.org/esa/population/publications/2011abortion/2011wallchart.pdf
  8. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  9. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  10. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  11. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  12. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  13. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  14. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  15. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  16. Iraq: Multiple Indicator Cluster Survey 2006. (2007). Central Organization for Statistics & Information Technology. Kurdistan Regional Statistics Office. Iraq Ministry of Health. Retrieved at http://www.childinfo.org/files/MICS3_Iraq_FinalReport_2006_eng.pdf
  17. Iraq Multiple Indicator Cluster Survey 2011 (2012) Retrieved at http://www.childinfo.org/files/MICS4_Iraq_PreliminaryReport_Eng.pdf
  18. Iraq Multiple Indicator Cluster Survey 2011 (2012) Retrieved at http://www.childinfo.org/files/MICS4_Iraq_PreliminaryReport_Eng.pdf
  19. Iraq Multiple Indicator Cluster Survey 2011 (2012) Retrieved at http://www.childinfo.org/files/MICS4_Iraq_PreliminaryReport_Eng.pdf
  20. Iraq Multiple Indicator Cluster Survey 2011 (2012) Retrieved at http://www.childinfo.org/files/MICS4_Iraq_PreliminaryReport_Eng.pdf
  21. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  22. Reed, L. (2007). Midwifery, Freedom to Practice?. Churchill Livingston, Elsevier
  23. Reid, L. (2007). Freedom to Practise?: An International Exploration and Examination of Midwifery Practice. Philadelphia, PA. Elsevier Health Sciences
  24. Iraq: Multiple Indicator Cluster Survey 2006. (2007). Central Organization for Statistics. Iraq Ministry of Health. Retrieved at http://www.childinfo.org/files/MICS3_Iraq_FinalReport_2006_eng.pdf
  25. Iraq: Multiple Indicator Cluster Survey 2006. (2007). Central Organization for Statistics. Iraq Ministry of Health. Retrieved at http://www.childinfo.org/files/MICS3_Iraq_FinalReport_2006_eng.pdf
  26. Webster, P. C. (2013). Roots of Iraq's maternal and child health crisis run deep. The Lancet, 381(9870), 891-894.DOI: 10.1016/S0140-6736(13)60658-3
  27. Webster, P. C. (2013). Roots of Iraq's maternal and child health crisis run deep. The Lancet, 381(9870), 891-894.DOI: 10
  28. Rozhgar A. Saleem MBChB MSc , Nasih Othman MBChB PhD , Fattah H. Fattah MBChB MSc , Luma Hazim BSc MSc & Berivan Adnan MBChB MSc (2013) Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors, Women & Health, 53:6, 537-551, DOI: 10.1080/03630242.2013.815681
  29. Rozhgar A. Saleem MBChB MSc , Nasih Othman MBChB PhD , Fattah H. Fattah MBChB MSc , Luma Hazim BSc MSc & Berivan Adnan MBChB MSc (2013) Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors, Women & Health, 53:6, 537-551, DOI: 10.1080/03630242.2013.815681
  30. Rozhgar A. Saleem MBChB MSc , Nasih Othman MBChB PhD , Fattah H. Fattah MBChB MSc , Luma Hazim BSc MSc & Berivan Adnan MBChB MSc (2013) Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors, Women & Health, 53:6, 537-551, DOI: 10.1080/03630242.2013.815681
  31. Rozhgar A. Saleem MBChB MSc , Nasih Othman MBChB PhD , Fattah H. Fattah MBChB MSc , Luma Hazim BSc MSc & Berivan Adnan MBChB MSc (2013) Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors, Women & Health, 53:6, 537-551, DOI: 10.1080/03630242.2013.815681
  32. Rozhgar A. Saleem MBChB MSc , Nasih Othman MBChB PhD , Fattah H. Fattah MBChB MSc , Luma Hazim BSc MSc & Berivan Adnan MBChB MSc (2013) Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors, Women & Health, 53:6, 537-551, DOI: 10.1080/03630242.2013.815681
  33. Rozhgar A. Saleem MBChB MSc , Nasih Othman MBChB PhD , Fattah H. Fattah MBChB MSc , Luma Hazim BSc MSc & Berivan Adnan MBChB MSc (2013) Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors, Women & Health, 53:6, 537-551, DOI: 10.1080/03630242.2013.815681
  • Al Hilfi, T. K., Lafta, R., & Burnham, G. (2013). Health services in Iraq. The Lancet, 381(9870), 939-948. DOI: 10.1016/S0140-6736(13)60320-7
  • Webster, P. C. (2013). Roots of Iraq's maternal and child health crisis run deep. The Lancet, 381(9870), 891-894.DOI: 10.1016/S0140-6736(13)60658-3
  • Iraq: WHO Statistical Profile. (January, 2015). Global Health Observatory. Retrieved on March 21st, 2015 at http://www.who.int/gho/countries/irq.pdf?ua=1
  • Rozhgar A. Saleem MBChB MSc, Nasih Othman MBChB PhD, Fattah H. Fattah MBChB MSc, Luma Hazim BSc MSc & Berivan Adnan MBChB MSc (2013) Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors, Women & Health, 53:6, 537-551, DOI: 10.1080/03630242.2013.815681
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