Published34 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Tulip MazumdarGlobal health correspondentWorking in extreme heat can double the risk of stillbirth and miscarriage for pregnant women, according to new research from India. The study found that the risks to mothers-to-be are significantly higher than previously thought. Researchers say hotter summers can affect not only women in tropical climates, but also in countries such as the UK.They want specific health advice for working pregnant women globally.Eight hundred pregnant women in the southern Indian state of Tamil Nadu took part in the study, which was started in 2017 by the Sri Ramachandra Institute of Higher Education and Research (SRIHER) in Chennai. About half of those who took part worked in jobs where they were exposed to high levels of heat, such as agriculture, brick kilns and salt flats. The others worked in cooler environments, such as schools and hospitals, although some workers were also exposed to very high levels of heat in those jobs too.There is no universal threshold for what level of heat is considered to be too hot for the human body.”[The impact of heat] is relative to what you’re used to and what your body’s used to,” says Prof Jane Hirst, one of the scientists who contributed to the study.In the lush green fields of Tiruvannamalai, I meet Sumathy, one of the pregnant women who took part.She removes her thick gloves and stretches out her fingers. She has been picking cucumbers for the past two hours.”My hands burn in this heat,” she tells me, gently caressing her fingertips.Summer hasn’t even started yet, but already it is about 30 degrees here today and feeling hotter with the humidity.Sumathy has to protect her hands from the constant stabbing of the tiny spikes on the cucumbers, but the gloves make her sweat profusely.”My face burns too,” she says.She comes to the cucumber farm before and after her main job, working as a cook in a school, and is paid about 200 rupees or just under £2 for her efforts.India’s Mothers: Bearing the HeatThe BBC’s global health correspondent Tulip Mazumdar reports from southern India on new research suggesting heat can double the risk of stillbirth and miscarriage.Watch on BBC iPlayer (UK only)Sumathy was one of the first recruits. Her baby was also one of the first in the study to die.”I used to feel so exhausted being pregnant and working in the heat,” she says.One day, as Sumathy was dropping off her husband’s lunch, she suddenly started feeling very unwell. That evening, she went to see a doctor who told her she had suffered a miscarriage 12 weeks into her pregnancy. “My husband would lay me down on his lap and console me. I don’t know what I would have done without him,” she says.Sumathy talks about her husband with so much love but has had to learn to live without him. He recently died, and she is now the main breadwinner for the family.Sumathy will never know for sure if working in the heat during her pregnancy had anything to do with her losing her first child. But overall, the study found that women who worked in similar conditions as her were twice as likely to suffer a stillbirth or miscarriage than those working in cooler environments.Important for women all over the worldThe pregnant women in the study in India really are “at the forefront of experiencing climate change,” says Prof Hirst, who is a UK-based consultant obstetrician, and Professor of Global Women’s Health at medical research organisation The George Institute.Earth’s average temperature is projected to rise by nearly three degrees by the end of the century, compared with pre-industrial times, and the World Health Organization (WHO) is warning of “an existential threat to all of us” with pregnant women facing “some of the gravest consequences”.Previous studies have shown about a 15% rise in the risk of premature birth and stillbirth during heatwaves, but these have generally been conducted in high-income countries such as the US and Australia. The latest findings from India are particularly stark and worrying, says Prof Hirst, and have wider implications. “The UK is getting hotter summers, and while it’s not as hot as India, these adverse effects [on pregnancies] can be seen at much lower temperatures in more temperate climates, such as the UK.” However, she adds, they do need to be “kept in perspective”. Even with a doubling of risk, experiencing baby loss is still going to be a “rare event for most women”.There is currently no official international advice for pregnant working women in the heat. The main guidance that does exist for hot-weather working, is based on studies involving a man in the US military in the 1960s and 70s, weighing 70-75kg and with 20% body fat. Prof Hirst hopes this study, and further research, will change that. In the meantime, she says pregnant women working in the heat can protect themselves by:Avoiding prolonged periods in the heatTaking regular shade breaks if working outdoors on hot daysAvoiding exercising or sunbathing for long periods in the hottest part of the dayKeeping hydrated with waterFor the study in India, the researchers used what is called the wet-bulb-globe-temperature (WBGT), which measures the effects of temperature, humidity, wind speed and radiant heat on human bodies.WBGT readings are often lower than the temperatures you might see forecast on the TV or a weather app.The safe heat threshold for people doing heavy work is 27.5C WBGT, according to the US Occupational Safety and Health Administration. ‘No choice but to work out in the sun’ India is predicted to become one of the first countries in the world where temperatures will top the safe limit for healthy people who are simply resting in the shade, according to a recent study from the University of Cambridge.The number of hot days and hot nights (when the body struggles to recover from daytime heat) is also projected to double or even quadruple in India by 2050.In the sugarcane fields of Tiruvannamalai, Rekha Shanmugam, a former nurse and the SRIHER study’s lead researcher, is measuring the daytime heat.Around us, a couple of dozen workers – about half of them women – hack down thick stems of cane with small machetes. “These women often have no choice but to work out in the sun – they need the money,” says Ms Shanmugam.She pours water into a gauge and presses various buttons. It shows a WBGT temperature of 29.5C – that’s above the safe threshold for doing this type of physically demanding work in the heat.”If the workers continue for prolonged periods in this level of heat, they are more prone to heat-related illnesses, and it’s especially concerning for pregnant women,” she tells me. Sandhiya, 28, tells me she has no choice but to do this type of back-breaking work for which she gets paid about 600 rupees, just under £6 a day. She has two young children and an extended family to feed. Sandhiya also took part in the study – and lost her first child six months into her pregnancy.She had to take several months off work to recover and says she is still paying off the debts she racked up during that time.”All my desires centre around my children,” Sandhiya tells me. “I want them to study well and get good jobs. They shouldn’t end up toiling here in the fields like me.”The problem of peeingThe mechanisms around how and why heat impacts pregnant women and their growing babies in this troubling way are not well understood.A previous study in The Gambia found high temperatures could raise foetal heart rate and slow blood flow through the umbilical cord.One theory is that when the mother gets too hot, blood could be diverted away from the foetus, to help cool the mother down.Ms Shanmugam thinks a lack of toilets may also be playing a part.She says a previous study found many women didn’t want to squat in an open field to relieve themselves and so would avoid drinking water, developing urinary problems as a result. “They worry about insects and snakes in the bushes, or men peeping to look at them,” she says.”They often don’t feel safe, so they’ll just hold it in for the whole day and then finally go to the toilet when they get home.”Finding solutions The findings of the study in Tamil Nadu are being taken very seriously, says Dr TS Selbavinayagam, the state’s director for public health.”We already offer financial compensation to pregnant women, but maybe we need to look at options for giving alternative employment too,” he says. The state government offers poorer women 18,000 rupees (£170) when they reach 12 weeks of pregnancy, to try to ease some of their financial pressures. However, much of the power to protect these low-paid workers rests with workplace bosses.On the outskirts of Chennai, Thillai Bhasker – a brick-kiln owner – has erected giant steel roofs with special heat-protective coatings on them, to provide his workers with much-needed shade. “Business owners should be smart enough to know how to retain the employees,” he says. “If you take care of them, they will take care of you.”He also told us he was planning to build women-only toilets. Some organisations are also offering education sessions on the simple steps women can take to better protect themselves in the heat. Insulated bottles are also being made available to keep drinking water cool.Sumathy had no choice but to continue to work in extreme heat when she became pregnant again within a couple of years of her miscarriage. But she got specific advice from doctors and the SRIHER researchers on how to better protect herself. Sumathy gave birth to a healthy daughter and son. Tonight – after her long shift – she will return home to them. Exhausted, anxious, but so grateful they are there.Follow @TulipMazumdar on XIf you are affected by any of the issues raised in this story, support and advice isavailable via the BBC Action Line.

Published10 hours agoShareclose panelShare pageCopy linkAbout sharingBy Tulip MazumdarGlobal health correspondentBrain surgery using artificial intelligence could be possible within two years, making it safer and more effective, a leading neurosurgeon says.Trainee surgeons are working with the new AI technology, to learn more precise keyhole brain surgery. Developed at University College London, it highlights small tumours and critical structures such as blood vessels at the centre of the brain.The government says it could be “a real game-changer” for healthcare in the UK. Critical structuresBrain surgery is precise and painstaking – straying a millimetre the wrong way could kill a patient instantly. Avoiding damaging the pituitary gland, the size of a grape, at the centre of the brain, is critical. It controls all the body’s hormones – and any problems with it can cause blindness. “If you go too small with your approach, then you risk not removing enough of the tumour,” National Hospital for Neurology and Neurosurgery consultant neurosurgeon Hani Marcus says.”If you go too large, you risk damaging these really critical structures.” The AI system has analysed more than 200 videos of this type of pituitary surgery, reaching, in 10 months, a level of experience it would take a surgeon 10 years to gain.Image source, BBC “Surgeons like myself – even if you’re very experienced – can, with the help of AI, do a better job to find that boundary than without it,” Mr Marcus says.”You could, in a few years, have an AI system that has seen more operations than any human has ever or could ever see.” Trainee Dr Nicola Newell also finds it “very helpful”. “It helps me orientate myself during mock surgery and helps identify what steps and what stages are coming up next,” she says.’Marvel superhero’AI government minister Viscount Camrose says: “AI makes everybody massively more productive whatever it is you do.”It kind of almost makes you the Marvel superhero version of yourself.”He said this type of technology could be a game-changer for healthcare, improving outcomes for everyone and offering a “very promising” future.University College London (UCL) is one of 22 universities recently given government money to help revolutionise healthcare in the UK.Engineers, clinicians and scientists are working together on the project at the Wellcome / Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences.Follow @tulipmazumdar on X, formerly known as Twitter.More on this storyWoman’s bowel cancer spotted by AIPublished21 AprilAI cuts treatment time for cancer radiotherapyPublished27 JuneRelated Internet LinksUniversity College LondonThe BBC is not responsible for the content of external sites.

SharecloseShare pageCopy linkAbout sharingSitting at the kitchen table, sometimes with their heads in their hands, Laura and Lawrence recount the “hell” that unfolded the day they lost their baby.It culminated in them doing something unfathomable.”I took a tupperware box containing my baby’s remains home from hospital in a taxi, cleared up some space in our fridge and put the box in there,” says Lawrence. The couple had gone to University Hospital Lewisham’s A&E department after Laura had a late miscarriage at home. But they were advised there was nowhere safe to store the baby’s remains, and they felt their only option was to take their baby home. Greenwich and Lewisham NHS Trust says a full investigation is under way. But the case has raised wider concerns about miscarriage care in the UK. ‘I. Am. So. Sorry’: Talking about my pregnancy lossesThe impact of miscarriage on families around the worldMiscarriage: Tens of thousands have PTSD symptomsMiscarriage: The Search for AnswersLaura and Lawrence knew there was something very wrong when Laura started bleeding profusely almost four months into their pregnancy. They went to the early pregnancy unit at University Hospital Lewisham and were advised their baby still had a heartbeat and that all was well. But days later, after another scan, doctors confirmed their baby had died. The couple were sent home and were told to wait for a bed to become available for Laura to give birth to their dead baby. Two days later, Laura woke up in severe pain. She ran to the bathroom, and that’s where she delivered her baby. She said at first she hadn’t understood what had happened. But as she removed what had fallen into the toilet, she realised it was the remains of her baby. “And it was then,” she said, “I saw it was a boy.”She screamed, and in utter panic ran out of the bathroom, closed the door and told her partner: “Don’t go in there.”Total chaosThe couple dialled 999 but were told it was not an emergency. So they wrapped their tiny son’s remains in a wet cloth, placed him in the box, and made their way to A&E. They say when they arrived, it was total chaos. “We were put in the general waiting room and told to sit at the back,” said Laura.”I was there holding my baby in a tupperware box, crying, with 20 or 30 other people in that waiting room.”Eventually they were taken into a bay where Laura was told she would need surgery to remove the placenta. All this time, the couple say, their baby remained in the box in the hot and stuffy A&E department, with staff saying there was nowhere safe to store him.”Nobody would even open the box and look at our baby,” said Laura.”It was almost as though no-one wanted to acknowledge it. Because if they did, then they would have to deal with the problem,” added Lawrence.It got to midnight, and they decided they had no option but to take their baby’s remains home.”There was no-one at the hospital willing to take charge of our baby. No-one seemed to know what was going on,” said Lawrence.”Our baby had been in a hot room for nearly five hours now. So we decided together that I would take him home.”He describes going home in a taxi with the box on his lap.”It was a lonely, surreal moment clearing space in my fridge.” “It just felt so grotesque,” added Laura.In a statement, Lewisham and Greenwich NHS Trust said: “We are deeply sorry and offer our sincerest condolences to Ms Brody and her partner for the tragic loss of their baby and these traumatic experiences.” “A full investigation is under way to understand where failings in care may have occurred so that any necessary changes and improvements can be made.” ‘Tipped into hell’Laura and Lawrence got in touch with the BBC after seeing some of our special reports on miscarriage care around the world. They say they are speaking out to try to ensure this doesn’t happen to anyone else.”It feels like there’s no safety net when things go wrong with pregnancy,” said Laura.”And even with all the staff and experts working really hard, the processes are so flawed, that it just felt like we’d been tipped into hell.”There are national guidelines for all four nations in the UK, on how best to care for women who experience miscarriages.But there are concerns staff are not being given enough time and training to understand them and put them into practice.The Department of Health says new guidelines are due to help hospitals deliver more personalised miscarriage care.Prof Dame Lesley Regan, consultant gynaecologist and spokesperson for the Royal College of Obstetricians and Gynaecologists, said because late miscarriage was rare – it happens in around one in every 100 pregnancies – many A&E staff might not know how to respond.She said: “I think late losses are much less understood, and some healthcare professionals find it very frightening.”Best practice for managing late miscarriage: Communication should be empathic, sensitive, non-judgementalThe labour ward should have a special bereavement room People coming to A&E with baby’s remains should be transferred to the gynaecology or maternity departmentBaby’s remains should be transferred with them, with facilities for sensitive storage Information should be made available on issues such as post-mortems, sensitive disposal of remains and funeral optionsSource: Miscarriage Association and National Bereavement Care PathwayRuth Bender Atik, head of The Miscarriage Association, described Laura and Lawrence’s case as “unbearable”, but warned against assuming all care was “awful”.”There simply should be an available cold place in A&E where these pregnancy remains or tiny little babies can be safely, respectfully and carefully stored with clear labelling,” she said.However, Zoe Clark-Coates, of the charity Saying Goodbye, and co-chair of the government’s Pregnancy Loss Review, said similar problems were not rare, and that some couples had been told to store their baby’s remains over a weekend until hospitals could accept them.Women are often advised to bring in their baby or pregnancy remains so that tests may be carried out to try to understand why the pregnancy ended.If you are affected by pregnancy loss, there are links to help.Follow Tulip on Twitter.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesWomen who experience bleeding in early pregnancy and have had at least one miscarriage should be treated with the hormone progesterone.The new guidance, from the health watchdog NICE, is based on research suggesting the treatment could lead to 8,450 more births each year in the UK. The more miscarriages a woman had, the more effective progesterone was, the trial found.The naturally occurring hormone helps prepare the womb for the growing baby. After five miscarriages, Josie is now 15 weeks into her sixth pregnancy.It is her longest so far – and while it is impossible to know for sure whether her progesterone treatment is the reason, it makes a big difference to how she feels.”If this is what is going to make it OK for us… it’s just miraculous,” she says.”All we’ve ever wanted is to become parents. “So to actually get this far and to have the opportunity and have the progesterone, it gives us incredible hope.” Bleeding continuesAbout one in five women experience bleeding, or spotting as it is sometimes called, in the first 12 weeks of pregnancy. It often causes no problems but they are advised to have it checked out with their doctor or midwife to be sure. Some may experience a “threatened miscarriage”, where bleeding continues along with the pregnancy. Most are told to go home and wait and see what happens next.The new National Institute for Health and Care Excellence (NICE) guidance recommends inserting progesterone pessaries into the vagina twice a day. Doctors at the Birmingham Women’s Hospital prescribed it for Josie. A trial carried out by researchers at the Tommy’s National Centre for Miscarriage Research which the new guidance is based on, found that progesterone didn’t make much of a difference for women who just had bleeding and no previous miscarriages. But the more miscarriages a woman had suffered, the more effective progesterone was. Best treatmentsOne of those behind the Tommy’s National Centre for Miscarriage Research research, Prof Arri Coomarasamy, from the University of Birmingham, said: “This is a very significant moment. “We have an intervention that works that can stop a miscarriage. “This gives hope to thousands of couples throughout UK.”But it’s really important to appreciate that only some miscarriages can be prevented by progesterone. “There are other causes for miscarriages. “We still need to study them.”We need to find other effective treatment.”About one in four pregnancies ends in miscarriage – the vast majority in the first few months or trimester.Royal College of Obstetricians and Gynaecologists president Dr Edward Morris said: “It is positive that NICE has acknowledged the latest evidence. “We do, however, still have a way to go before understanding the best treatments for women experiencing unexplained pregnancy loss and would welcome further research in this area.”Professor Gillian Leng, NICE’s chief executive, said the research evidence “is clear that progesterone will not be able to prevent every miscarriage”.But she said it would be “of benefit to some women, and as an inexpensive treatment option, can be made available to women on the NHS from today”.Follow Tulip on Twitter.NICEThe Miscarriage AssociationTommy’sThe BBC is not responsible for the content of external sites.

SharecloseShare pageCopy linkAbout sharingThe BBC’s Tulip Mazumdar has reported on maternal health and the issues women face across the world. Here she reflects on her own experiences of pregnancy and baby loss.You never think it will happen to you. But then you’re sitting in scan room 9, you’re staring at your bright blue socks as you wriggle your toes against the white hospital sheets, waiting for the sonographer to say something.But they don’t. Instead they call someone else in. And in the split second before she speaks, you realise that your world is about to go into freefall.I. Am. So. Sorry.I have had four miscarriages in the last two years. Two losses in the first trimester, known as an early miscarriage, and two late losses in the second trimester.It’s estimated that at least one in four pregnancies end in miscarriage in the UK. Around 50% of the time it’s down to a chromosomal abnormality, where the baby would never have been able to survive, and most women do go on to have a healthy pregnancy.But like me, 1 in 100 women will experience recurrent miscarriage, which is defined in the UK as three miscarriages in a row, and the more losses we experience, the less likely a successful pregnancy becomes.Around half of these losses are attributed to known causes, such as problems with clotting or the lining of the womb. But for many couples, the reasons remain unknown, simply because the research hasn’t been funded and undertaken yet. Women’s health issues are notoriously under-researched.My losses went from bad to worse. The first was an early pregnancy test, followed by a late and long period, that’s known as a chemical pregnancy. The second was what’s called a “blighted ovum” where a gestational sac was found, but no embryo was developing. I lost that pregnancy while on an assignment for work, reporting on maternal health in a Greek refugee camp.As I popped in and out of the camp’s filthy portable loos, I just had to focus on the task at hand. I was acutely aware that – with thousands of women packed into the camp – I wouldn’t be the only one in the process of losing a pregnancy. But – unlike the other women – I would get to fly home and be properly cared for.Then there was Rivah. My tiny little boy. He was born without a heartbeat. Born sleeping as some people prefer to describe it.Rivah arrived in a perfect amniotic bubble, after a strangely beautiful labour. I’ve felt so bizarre admitting I “enjoyed” the birth. But it was the only thing we were able to do together. My husband holding my hand, and my baby being born.The next few weeks are a blur. I have snippets of memories: agonising over whether to have a post-mortem, dressing my toddler son up as a bear for world book day, sitting in a funeral home being shown a catalogue of tiny coffins, meeting my beautiful nephew for the first time.I know how intense it might feel to read this. Horrific even. But so many women and families have had similar experiences, and so few feel able to talk about it openly. I’ve ended up apologising to others for my sad news making them feel bad, when I see their faces inevitably drop. It’s hard for either of us to know what to say. Like me, millions of women do not get answers to why their baby died. But I consider myself one of the “lucky” ones with the excellent care I received here in the UK. I have reported on maternal health from many parts of the world, and I’ve seen first hand how so many women – particularly in some developing countries – don’t see a medical professional before, during or after losing their babies. I remember meeting 17-year-old Sulaina in central Uganda. She was in labour on the floor of her small hut for two days before she was able to get to the nearest hospital two hours away. Her baby girl was stillborn. Sulaina told me she didn’t even get to hold her, and when she returned home, she was shunned by her community. Second trimester losses are described as rare, also around 1 in 100 pregnancies. If a baby is born after 24 weeks in the UK (or after 20 in the US), it’s described as a stillbirth and the baby is officially recognised in a stillbirth register. If a baby is born before that, it’s called a miscarriage and it is not officially recognised – and in many countries, including the UK, it isn’t even officially counted. So, I was just “unlucky” I was told. All my investigative tests came back normal and we were advised to simply try again.So we did, and we got pregnant again the same year. I was terrified, depressed, and exhausted with grief. But I was fast approaching 40, and waiting didn’t feel like a good option.I did what you’re strongly advised not to do, and listened to my baby’s heartbeat from home regularly. It was beautiful and precious and fragile. I had a number of reassurance scans, supported by Sarah, the amazing bereavement midwife at my local hospital. I returned to work and tried to get through the days, weeks and months.Then, again well into my second trimester, I was back in scanning room 9. I’d had a scan just four days earlier – my baby’s heartbeat was strong. Everything was normal. Everything was going to be ok, despite the tears streaming down my face as they applied the cold gel. This reaction had been pretty standard for all of my scans since losing Rivah.There was silence as she moved the device across my belly.I.Am.So.Sorry.Rae was born four days later. The birth was traumatic. I lost a lot of blood and ended up having to go into theatre.Like I had done with Rivah, I spent the night with Rae. He lay beside me, wrapped in a tiny yellow gown and placed in a special cot that’s kept cold. I had brought leaves from the myrtle tree we had planted for Rivah, and rose petals which I placed beneath him.I had experience this time, and knew how to try and make our brief time together special. I bought LED candles, a book to read him, and decorated the little white box they placed him in, with metallic felt-tip pens. I lay the little knitted blue teddy we were given in our memory box by his side.I know how terribly sad all of this sounds, and it was. But it was also beautiful and loving and important for me to do. I know many women, and their partners, can’t or don’t want to do this. My husband chose not to. But I mention it here to try and remove some of the horror from this situation, and replace it with love. The love a mother has for the baby she carried.If you have lost a pregnancy, I am so sorry.If you know someone who has experienced the loss of a much wanted pregnancy, consider asking them about it.It’s so hard to know what to say, and everyone is different. When Rivah was born, all I wanted to do for months afterwards was tell everyone every single detail about him. With Rae, it was the opposite. I was stunned into silence.But for me, it’s feeling like I can talk about my losses if I need or want to, and that it doesn’t need to be this dark sad secret that can only be discussed in hushed, soft tones.It is acknowledgement of the cherished lives that have been lost. If you or someone you know has been affected by issues with pregnancy, you can find advice and support at bbc.co.uk/actionline.Follow @TulipMazumdar on Twitter.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesHealth and care workers are being “left behind” in efforts to vaccinate the world against Covid-19, nursing leaders say.There were promises they would be among the first to be jabbed.But the International Council of Nurses (ICN), which represents 27 million professionals, says tens of millions have not even had one dose. The World Health Organization (WHO) estimates around 200 have died each day since the pandemic began. Howard Catton, chief executive of the ICN, says: “If this was an airline going down every day with 200 people on board, there’d be immediate investigations.”You’ve got nurses and healthcare workers knowing that they are at higher risk, knowing that there is a way to protect them… and that people who are far less vulnerable in other countries are getting that protection. But they are being left behind.”It feels that despite all of the warm words of support, nurses and healthcare workers are in some way are dispensable or disposable. Mandy Malambo, a nurse in Lusaka, Zambia, has had one dose of a Covid vaccine and is eagerly awaiting her second. “Things have been very, very difficult during the pandemic,” she says. “We have been short-staffed, and the number of cases we are receiving each and every single day is overwhelming.”The staff are not able to take care of these Covid patients. so work has been very, very stressful, especially when you think, what if today is the day that I contract coronavirus?”It’s really scary. We’re just hoping for the best.”Reporting of infections and deaths among healthcare workers is patchy and the true figure is thought to be far higher than the 6,643 officially reported to the WHO. Many countries are not officially reporting the number of health and care workers who have died of Covid, and the WHO estimates the real figure is at least 115,000 – and potentially much higher. ‘A moral responsibility’The organisation’s Dr Jim Campbell says: “It’s a moral responsibility that we should all be concerned about.” There are around 135 million health and care workers around the world, according to the International Labour Organization.image copyrightGetty ImagesThe latest data reported to the WHO from 140 countries suggests just one in eight is fully vaccinated, the vast majority in richer nations. Dr Phionah Atuhebwe, from the WHO’s Regional Office for Africa, says 2.4 million health workers across 38 countries have had at least one dose of a vaccine – but another 66.2 million doses are needed to ensure all health and care workers in the region are double-jabbed.”We are concerned about the availability of vaccines to healthcare workers and (about) vaccine acceptance among healthcare workers,” she said,In Nigeria, for example, health workers have a range of concerns around safety and supply, but research also found they were unable to take time off work for vaccination.The ICN says it’s essential there is a better record of how many healthcare workers fall ill and die from Covid.”The data will raise some difficult and uncomfortable questions about the level of risk, and whether there could have been more effective policy responses to protect those people,” says Mr Catton. “But I say, don’t be fearful of bringing this data forward because you’re worried about the accountability. Think about how bringing this data forward can better protect healthcare workers and save their lives.”Covid vaccines are scarce internationally, particularly in lower-income countries.It’s also these countries that tend to have precious few health and care workers. The wider concern is that if they are not protected, the communities they serve are also left more vulnerable. Follow @TulipMazumdar on Twitter.You might also be interested in:

SharecloseShare pageCopy linkAbout sharingimage copyrightReutersThere are fresh calls for the UK to show “historic leadership” and start sharing its vaccine doses with the world right now. The country is hosting this year’s G7 summit, where seven of the world’s most powerful countries will come together in Cornwall next week. The Covid pandemic will be high on the agenda.In an open letter to UK Prime Minister Boris Johnson, the heads of the Wellcome Trust and Unicef in the UK are warning that hard earned freedoms in the country will be “short lived” if enough people in other countries are not vaccinated too. The letter says decisions at the summit “will define the 21st Century”, and calls on Mr Johnson and other G7 leaders to “rise to this challenge and end this crisis for good”.The UK says it has no surplus supplies to share at the moment, but will donate doses when it does. But Unicef says the UK and the other G7 countries could share 20% of their supplies in the next three months without impacting their own domestic rollouts.World on brink of catastrophic moral failure – WHOEU approves Pfizer jab for 12-15 year oldsI’m under 30 – which vaccine will I get?Ever since India stopped exporting Covid vaccines because of the crisis there, countries in Africa have been counting down their last doses. “It is deeply unfair,” says Dr Phionah Atuhebwe, who is in charge of new vaccine introductions for the World Health Organization (WHO) in Africa. “Of the almost two billion doses that have been administered globally, sub-Saharan Africa has received about 1% of all these vaccines.” She says 18 African countries have either already run out of doses or are about to, including: Completely run out:Morocco Rwanda eSwatiniWill run out in next few weeks: Kenya Ghana Malawi Hoarding vaccine suppliesIt’s a massive blow to many low and middle income countries. In Ghana, there’s been a very successful rollout of the first dose of vaccines for the most at risk groups, including health workers. Their second doses are now due – but officials are unclear on when they will arrive. Meanwhile, richer countries have bought up the lion’s share of global supplies and are pushing full steam ahead with their vaccination programmes, now administering doses to much lower-risk groups including teenagers. The UK, US and Canada have vaccinated more than half of their populations, while in Germany, Italy and France the numbers are over 30%. Japan’s uptake has been much slower, but not because they’re short on supplies.Whereas some countries in Africa have yet to vaccinate a single person, including health workers looking after Covid patients on the front line. The international vaccine equality scheme Covax, which is providing vaccines to some of the world’s poorest countries, is currently 190 million doses short. In the open letter, Wellcome’s Prof Sir Jeremy Farrar and Unicef UK’s Steven Waugh said that because high income countries – including the UK and G7 – have most of the world’s Covid vaccine supplies, they “are the only ones who can makes doses available right now”. Deadlier mutations warningWellcome and Unicef UK are calling for G7 countries to donate 20% of their doses in June, July and August to help plug the massive gap. For the month of June that works out as:US – 26.9 million doses UK – 4.1 million doses Germany – 3.3 million doses France – 2.7 million doses Italy – 2.4 million doses Japan – 2.3 million doses SOURCE: Airfinity/ Unicef “If we do not get… doses, we get back to the virus circulating and possibly mutating yet again, coming up with new variants that affect the world and take us all back to square zero,” says Dr Atuhebwe. So far France and New Zealand are the only nations to have already started diverting some of their own supplies to poorer countries. Boris Johnson promised to donate the UK’s surplus doses three months ago.In the open letter, the authors called on the prime minister to “make that pledge a reality”.But speaking at the G7 health ministers meeting in Oxford this week, Health Secretary Matt Hancock said there were no plans to do that, yet. “The UK vaccination programme has very much been based on delivering vaccines as soon as they’re delivered to us,” he said. “So we don’t have excess doses at the moment. But absolutely we want to lean in to this global effort, when there is spare capacity.” In the latest round of pledges this week, countries have promised another $2.4bn (£1.7bn) to the Covax scheme to help get vaccines into poorer countries. But with manufacturing unable to keep up with demand, and a few rich countries hoarding current supplies – it’s the world’s poorest who remain last in line. That in turn could mean deadlier versions of a mutated version of Covid-19 ending up back on the shores of wealthier nations.Follow @tulipmazumdar on Twitter

SharecloseShare pageCopy linkAbout sharingimage copyrightUnicef/KokorokoThe international scheme to ensure equal access to Covid-19 vaccines is 140 million doses short because of India’s continuing Covid crisis. The Serum Institute of India (SII), the largest single supplier to the Covax scheme, has made none of its planned shipments since exports were suspended in March. The UN children’s agency Unicef buys and distributes vaccines for Covax. It is urging leaders of G7 nations and EU states to share their doses.They are due to meet in the UK next month. How India’s vaccine drive went horribly wrongExtra $45bn needed for Covax plan to vaccinate poorTracking vaccine progress around the worldUnicef says data it has commissioned suggests that together this group of countries could donate around 153 million doses, while still meeting their commitments to vaccinate their own populations.’A huge concern’The SII was due to supply around half of the two billion vaccines for Covax this year but there were no shipments for March, April or May. The shortfall is expected to rise to 190 million doses by the end of June.”Unfortunately, we’re in a situation where we just don’t know when the next set of doses will materialise,” said Gian Ghandi, Unicef’s Covax co-ordinator for supply.image copyrightUnicef/Panday”Our hope is, things will get back on track, but the situation in India is uncertain… and a huge concern.”Unicef is calling on the G7 countries – Canada, France, Germany, Italy, Japan, the UK and the US, as well as the EU, to donate their surplus supplies urgently. Some countries have ordered enough to vaccinate their population many times over, including the UK, US and Canada.In February British Prime Minister Boris Johnson promised to donate most of the UK’s surplus supply to poorer countries but he has so far given no specific timescale. It is a similar story for the US. So far France is the only G7 country to donate doses in view of the crisis in India. Unicef said the rich and powerful G7 countries could make a huge dent in the vaccine deficit for poorer countries by donating 20% of their supplies in June, July and August, which would release around 153 million doses for the Covax scheme. France has pledged half a million doses by mid-June while Belgium has promised 100,000 from its domestic supply in the coming weeks. Spain, Sweden and the United Arab Emirates are some of the very few others pledging to share their supplies now. There are grave concerns that events in India could play out in other countries too – both near and far from the region. “Cases are exploding and health systems are struggling in countries like Nepal, Sri Lanka and Maldives… and also in Argentina and Brazil,” said Unicef director Henrietta Fore. “The cost for children and families will be incalculable.”Booster jab dilemmaCountries in Africa are some of the most reliant on doses through the Covax scheme. But, like in many parts of the world, there has also been hesitancy around receiving the vaccine among some communities. Another major challenge is physically getting the doses into people’s arms – all that requires health workers to be specially trained and the vials to be transported to far-flung parts of countries where infrastructure can be limited. Some nations are now facing the prospect of deciding whether to give second doses to the most vulnerable who have already been given one jab or continue vaccinating more people as planned in the hope that the next shipments turn up soon. “We’re in a situation now where healthcare workers and frontline workers in many countries in Africa are yet to be vaccinated,” said Gian Ghandi. “And yet higher-income countries are vaccinating lower-risk populations, such as teenagers.” Nations including Rwanda, Senegal and Ghana are already using some of their last remaining doses, according to the World Health Organization (WHO).Covax doses in AfricaSeven countries in Africa have used almost 100% of their Covax doses including Botswana, Ghana, Rwanda and Senegal Kenya and Malawi have used nearly 90% of their Covax doses Cabo Verde and the Gambia have used 60% of their Covax doses1.3 million doses have been redistributed from Democratic Republic of Congo to other parts of Africa because the country will not be able to use them all before their expiry date in June source: WHO”We really do sympathise with the situation in India,” said Dr Richard Mihigo, who heads up the immunisation and vaccine development programme for the WHO in Africa.”Most of our [18 million] Covax doses so far have come from India. “I think it’s very important [to keep] the global promise of solidarity for those countries that have enough vaccines – to distribute and share them because unless we stop the transmission everywhere, it will be very difficult to end this pandemic, even in places where people have been fully vaccinated.”What is Covax?Aim is to distribute two billion Covid-19 vaccine doses by the end of 2021No country to receive vaccines for more than 20% of their population before all countries have vaccinated at least 20% of the populationScheme has so far shipped around 60 million doses to 122 participants Co-led by the WHO and the vaccine alliance – Gavi and the Coalition for Epidemic Preparedness Innovations (Cepi)Unicef is the key delivery partner New deals with different vaccine suppliers and manufacturers are under way to try to get the Covax scheme back on track but none of those deals will help fill the shortfall from India in the coming weeks. The only way to fill the gaping hole for poorer countries right now is for richer countries to donate some of their supplies. “We have issued repeated warnings of the risks of letting down our guard and leaving low- and middle-income countries without equitable access to vaccines, diagnostics and therapeutics,” said Ms Fore.”We are concerned that the deadly spike in India is a precursor to what will happen if those warnings remain unheeded. The longer the virus continues to spread unchecked, the higher the risk of more deadly or contagious variants emerging.” More on fair access to vaccines: ‘Some countries can’t afford the Covid vaccine’Africa’s long wait for the Covid-19 vaccineWill countries be left behind in the vaccine race?Follow @tulipmazumdar on Twitter

SharecloseShare pageCopy linkAbout sharingBlack people face a significantly higher risk of having a miscarriage than white, research suggests.The Lancet analysis of data on 4.6 million pregnancies in seven countries suggests being black increases miscarriage risk by 43%.It calls for people in the UK to be given support after their first pregnancy loss.Currently, referral to specialist clinics usually occurs after three consecutive losses only. Most countries, including the UK, do not collect statistics.But researchers estimate:15% of pregnancies end in loss1% of women will experience recurrent miscarriageSome estimates of miscarriage rate are higher, but this is due to differences in how countries define pregnancy loss, which can be from a positive pregnancy test or from a scan.The report also found that women who suffered miscarriage, from all ethnic backgrounds, are more vulnerable to long-term health problems, such as blood clots, heart disease and depression.Doreen Thompson-Addo and her husband Reggie experienced seven miscarriages.”When I got pregnant the first time, I was very excited,” Doreen said.”I told my friends and family, I started thinking of names for the baby and planning my baby shower.”But within two months of her positive pregnancy test, Doreen started bleeding and lost the pregnancy.”You hear about how common miscarriage is,” she said, “but you never think it’s going to happen to you.”Doreen, who had her daughter Arielle in 2017, was simply told to “try again” after her first miscarriage. After her third, she was referred to an NHS recurrent-miscarriage clinic but never found out why she had lost multiple pregnancies. What increases miscarriage risk?being under 20 or over 40a previous miscarriagebeing very underweight or overweightlong hours and night shiftsbeing blacksmokinghigh alcohol intakeWhat help can be offered?The research published in The Lancet suggests:pre-conception support so women are in the best possible condition for pregnancyregular early scans and support from the start of the pregnancypelvic ultrasounds to check the structure of the wombhormone treatment aspirin and heparin injections to reduce blood clot risk progesterone for some of those with bleeding in early pregnancytests and treatment for a weak cervix Most of the research was carried out in Sweden, Finland and Denmark, some of the few countries that gather statistics, though data from the US, UK, Canada and Norway was also used. “We know there’s an increased risk of dying in pregnancy for black women,” Tommy’s National Centre for Miscarriage Research deputy director Prof Siobhan Quenby, from the University of Warwick, who worked on the study said. “But I was very shocked to also find an increased risk of miscarriage.”Black people are at higher risk of developing type 2 diabetes and heart disease – and both conditions increase the risk of miscarriage. But Prof Quenby said scientists were also investigating whether the risk of other health issues, such as fibroid conditions and autoimmune disorders, could help explain the higher rate.Lifestyle changesAbout 75% of those who miscarry will go on to have a healthy pregnancy, which is partly why couples are usually encouraged to try for another baby without further investigations.But Prof Quenby – who also runs a recurrent-miscarriage clinic – said: “There are things we can do to prevent miscarriage. “It’s not a condition that’s hopeless.”Lifestyle changes could help – and about 30% of people referred to her clinic smoked, had uncontrolled diabetes, a high body-mass index or blood pressure.”That means the health services missed three opportunities to get them into a better state for their next pregnancy,” Prof Quenby said.A “graded response” was needed, she added, providing:targeted advice after one miscarriageadditional tests after twofurther investigations after threeIn an editorial accompanying the research, the Lancet says: For too long, miscarriage has been minimised and often dismissed. “The lack of medical progress should be shocking. “Instead, there is a pervasive acceptance.”The era of telling women to ‘just try again’ is over.”‘Fell apart’The research also suggests significantly increased risks of suicide, depression and anxiety for those who miscarry and says the impact on partners needs further investigation.After eight losses, Charlotte was expecting twins but at a scan discovered she had also lost that pregnancy.”I just fell apart,” she said. “My husband was trying to hold me together. “And I was just wailing and screaming. “I didn’t want to live anymore.”Post-traumatic stressInitially, Charlotte was just given a leaflet.Only when she started talked about ending her life was she offered additional support and, eventually, treatment for post-traumatic stress. She went on to have a healthy boy, Ansel, last year, and now feels able to speak openly about her experiences. “It’s a great joy to have my son,” she said.”I know how lucky I am to get there. “Not everyone does.”Follow @Tulip Mazumdar on Twitter.If you, or someone you know, have been affected by the issues covered in the story, the BBC Action Line has details of organisations offering help and support.Related Internet LinksThe Miscarriage AssociationTommy’sThe BBC is not responsible for the content of external sites.