Saturday, July 31, 2010

Why maternal deaths have persisted

After a decade of disappointing progress to cut maternal and child deaths, African leaders this week resolved to try again. Concluding the African Union Summit in Kampala on Tuesday, heads of state adopted new resolutions and declared that maternal and child health will remain a standing agenda item for the Union over the next five years-to 2015, which is the deadline to achieve the Millennium Development goals.

More than 500,000 women still die every year in childbirth across the globe, with majority of the deaths occurring in developing countries in Africa-where health systems are weak or non functional and health workers are scarce.

Another 12,000 children-about eight children every minute, including two newborns die on the African continent everyday mainly from treatable conditions like malaria, pneumonia, diarrhea and respiratory tract infections.

Gloomy picture
The grim statistics have persisted despite endless declarations and promises made by governments in the past to tackle the problem-one of the declarations made 16 years ago in Cairo, Egypt agreed to reduce maternal, child and infant mortality in Africa and also increase access to sexual and reproductive health services including family planning.
The picture is not any better in Uganda where maternal mortality stands at 435 for every 100,000 births while under five mortality rate is 76 per 1,000 births.

But to date, efforts to reduce both maternal and child deaths have been slow or off-target-a situation Malawian president and chair of the AU, Mr Bingu Wa Mutharika described as a shameful crisis.

In Africa, one in every 16 women dies in child delivery compared with about one in 8,000 women in the developed world. “Let this not be another song that we are going to sing and forget when we leave this hall. The crisis of maternal mortality is real and we must all take action,” Mr Wa Mutharika said.

He said it was a shame to see African mothers still dying of easily preventable causes.
“Africa’s progress in reducing maternal and child deaths is still slow and today we see more children and women dying needlessly of preventable causes than of conflicts,”said Mr Jean Ping, the chairperson of the AU Commission.

For every woman who dies because of pregnancy related complications, at least 20 others suffer injuries and disabilities, like obstetric fistula. In Africa, complications during pregnancy and childbirth are the leading cause of death for women of childbearing age.

Family Planning
According to Dr Hassan Mohtashami, the deputy representative of the UN Population Fund (UNFPA) in Uganda, women continue to die of simple causes that have been resolved easily elsewhere using cost effective interventions. “Ensuring access to family planning services is one way we can reduce maternal deaths. It’s a simple calculation; the less number of pregnancies, the less chances for death,” he says.
According to him, family planning alone can reduce by a third, the number of women who die every year because of pregnancy related complications.

Cheap intervention
Another cheap intervention, he says, is having a midwife present during delivery. “If you have a skilled health worker with a mother during delivery, it will help her to detect if there is any complication and immediately do something to save the life of the baby and mother.”

This, intervention, he said, has the potential of saving another one-third of the deaths, meaning that the two interventions have the potential of saving up to two-thirds of women who would otherwise have died.

“The remaining can be saved by Emergency Obstetric Care. If a mother needs specialised and sophisticated care by a doctor like caesarean and blood transfusion, then there should be a centre equipped with these facilities where mothers can be referred,” said Dr Mohtashami.
This strategy, he says, was used by Sri Lanka which has the same economic status with many sub Saharan African countries but has now managed to reduce its maternal mortality to 27 per 100,000 live births.

Prohibitive factor
But challenges still abound in most African countries including Uganda. One of the biggest obstacles to reducing maternal deaths here is the shortage of health workers and poor health infrastructure.

To meet the MDG target, Uganda needs to reduce its maternal mortality rate to 132 per every 100,000 live births by 2015- a target that already looks far from being achieved. One of the resolutions made by the heads of state is to strengthen health systems and make childbirth health care services free for women and children under the age of five. Women advocacy groups had argued that cost was a prohibitive factor for many women and had resulted into a number of them giving birth at home without a skilled attendant.

Ms Bience Gawanas, the commissioner for social affairs at the AU said that she hoped that with the heads of state taking a lead on reducing maternal mortality, much more progress will be made in the run up to the 2015 deadline

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