Medilinks Africa

Reducing Maternal Deaths in Africa

By John Kiwanuka Ssemakula , March 13 2003

Women have been producing children from the beginning of time. Childbirth is one of the natural miracles of the world. But in Africa too often the birth of a child becomes an occasion for grief due to the death of the mother and /or baby. Over 250,000 African women die from pregnancy related complications every year.

There has been almost no change in maternal mortality in Africa over the past five decades, and there are signs things maybe getting worse. Of those women who survive childbirth, many are at risk of disability, injury or infection.

“More girls and women die from the complications of childbirth in developing countries than from any other cause, UNICEF said, calling the figures "a shameful record of discrimination and apathy toward women and their rights."

Africa has the highest maternal mortality in the world at 1000 deaths per 100,000 live births.

In Sub Saharan Africa, the lifetime risk of a woman dying of pregnancy related complication is 1:14 compared to 1:4000 or even 1:10,000 in developed countries.

Without improved delivery of health services it is estimated that over the next 10 years, more than 2.5 million women will die during pregnancy, childbirth or the six weeks following delivery.

Over the next decade nearly 49 million women in the WHO Africa region will endure pregnancy associated disability.

Productivity losses will be $45 billion dollars - $22 billion due to maternal deaths and $23 billion due to disabilities

75% of maternal deaths are preventable

WHO/UNICEF/UNFPA estimates of maternal mortality ratios, maternal deaths and lifetime risk for 1995

UNICEF region

Maternal mortality ratio
(maternal deaths per 100,000 live births)

Number of maternal deaths

Lifetime risk of maternal death,
1 in:

Sub-Saharan Africa	1,100	252,000l	13l
Eastern/Southern Africa	(1,200)	(133,000)l	(12)l
Western/Central Africa	(1,000)l	(119,000)	(14)l
Middle East/North Africa	360l	33,000l	55
South Asia	430l	155,000	54l
East Asia/Pacific	140	49,000l	283l
Latin America/Caribbean	190l	22,000l	157l
CEE/CIS and Baltic States	55l	3,500l	797l
Developing countries	440l	511,000l	61l
Least developed countries	1,000l	230,000l	16l
Industrialized countries	12l	1,200l	4,085l
World	400	515,000	75
Source: Maternal mortality in 1995: Estimates developed by WHO, UNICEF and UNFPA, Geneva, 2001.

The high rates of teenage pregnancies contributes greatly to this risk. In the majority of countries in the African region, 50% of first births are to teenagers. Women who start childbearing early, will have more children over their lifespan, thereby increasing their lifetime risk of dying from pregnancy related complications.

Associated with this high maternal mortality rate is a high neonatal mortality rate, the highest in the world 45 deaths per 1000 live births.

Causes of Maternal Deaths

Indirect causes include malaria, anemia and HIV/AIDS.

For each women who dies as result of pregnancy, 20 or more will suffer short or long term disability.

- Chronic anemia

- Infertility

- Stress incontinence

- Fistulae

- Chronic pelvic pain

- Emotional depression

- Maternal exhaustion and/or physical weakness

Obstacles to Safe Motherhood

Deaths can be prevented if pregnant women receive timely and appropriate care.

THREE MAJOR DELAYS are the cause of most of the deaths:

Delay in deciding to seek care

Failure to recognize danger signs
Lack of birth preparedness by family and community

Delay in reaching a health facility

Poor roads
Poor communication networks
Lack of transport

Delay in receiving appropriate care after reaching the health facility

Inadequate skilled attendants
Lack of equipment, drugs, supplies
Poor referral system.

Health System challenge

The WHO and UN have started a program to strengthen the health system component of Safe Motherhood to ensure pregnant women and their babies receive the care they need and deserve through the Making Pregnancy Safer Initiative. UNFPA also has a program promoting safe motherhood - Caring for Mothers in their time of Need.

In most countries of Africa health systems remain weak and cannot adequately respond to the health needs of mother and newborn due to:

Inadequate skilled attendants
Lack of needed equipment, medications and supplies
Poor referral system

Available data shows that overall skilled attendants are present for only 42% of the deliveries in the Africa region. Studies have also shown that the higher the proportion of deliveries with a skilled attendant in a country, the lower the maternal mortality rate.

Interventions:

The WHO target is to reduce maternal mortality by 50% over the next 10 years, but this requires immediate action. Countries will need to strengthen their health systems to ensure the availability of

Health professionals trained in midwifery skills
Basic emergency obstetric care at primary health care level

Normal delivery
Manual removal of the placenta and retained products
Intravenous (IV) sedatives, antibiotics and oxcytocin

Comprehensive emergency obstetric care at the referral level

Basic obstetric care as well as
Surgical procedures, including caeserian section under anaesthesia
Safe blood transfusions.

For every 500,000 people there should be at least 4 basic Emergency Obstetric Care facilities and one Comprehensive Emergency Obstetric Care facility

Navrongo: A community nurse, with her backpack loaded with medicines and notebooks, setting off on her rounds to village homes. The motorbike she uses is provided by the local health authorities. The community build and maintain her house. The service she provides is free but medicines must be paid for. WHO/TDR/Crump

Community participation is also critical to increasing timely and appropriate utilization of health services. Community based health providers working with community resource persons who are trained to:

Recognize life threatening complications
Know where and when to seek appropriate care if complications arise
Develop birth preparedness plans, including emergency transport.

These community health providers in turn can encourage and educate the women, their partners, and their family in recognizing these danger signs

Prompt action by governments is needed

Make maternal and newborn health high on the government agenda and development partners
Review policies, guidelines and programs and update, adapt them to ensure the availability of emergency obstetric care
Mobilise, allocate and release adequate resources for maternal and newborn health
Foster partnership with private sector, civil , religious and other community -based organizations.

Prompt action by governments will result in

· 500,000 women’s lives will be saved

· 10 million disabilities will be saved

· 1.5 million children will be saved