Making pregnancy safer - Ghana’s initiatives (Daily Graphic, 04/04/09)

Article: Salome Donkor
Pregnancy and childbirth are generally times of happiness and much cherished by families due to the emotional and social joy that it brings to families.
In some cultural settings in the country, elaborate ceremonies are held to ‘outdoor’ new-born children and thank God for seeing the pregnant women through nine months of pregnancy.
Unfortunately, there are occasions that the period of pregnancy and childbirth pose great risk to the health and survival of women and new-borns and these result in maternal and neonatal mortality and mobidity.
When families lose their relations through maternal and neonatal mortality, the joy that motherhood brings to families and relatives turns into agony, suffering, pain and distress.
Pregnancy-related conditions, also known as obstetric complications, include post-partum haemorrhage, infections, eclampsia and prolonged or obstructed labour, as well as complications of abortion, and these are the leading causes of death among women of reproductive age in many developing countries.
Stories of causes of maternal mortality and neonatal (new-born) mortality in Ghana and other developing countries with high rates of maternal mortality, paint a gloomy picture and portray a state of despair as a result of the slow progress being made in saving women’s lives quickly.
The problems cause more anxiety and uneasiness considering the fact that the factors that jeopardise maternal and new-born survival are preventable or treatable with essential services, and the most effective, affordable public health interventions.
One of the Millennium Development Goals is to reduce maternal mortality by three-quarters by 2015 and it is necessary to assess the progress towards the achievement of the goal.
An online report by the World Health Organisation and the United Nations Children’s Fund (WHO/UNICEF, 1999) estimates that there are 585,000 maternal deaths globally each year, resulting from complications of pregnancy and childbirth. The situation in Ghana is equally gloomy with institutional maternal mortality rate of 250 per 100,000 live births.
In 1987, the World Health Organisation (WHO) and other United Nations agencies like UNICEF launched the Safe Motherhood Initiative (SMI). Since then, efforts have been made to raise awareness about safe motherhood, set goals an priorities for the global Safe Motherhood Initiative and also support national safe motherhood programmes through the stimulation of research, mobilisation of resources, provision of technical assistance, and sharing of information to make childbirth and pregnancy safer.
These efforts have rallied interest and commitment from donors, programme planners, researchers and practitioners to reduce the maternal mortality rate, the indicator with the greatest disparity between developed and developing countries.
Ghana adopted the SMI and that led to the initiation and implementation of Safe Motherhood programmes in the country.
In 1998, the government introduced free antenatal care for all pregnant women and in September 2003, a policy of exempting all users from delivery fees in health facilities was introduced.
The exemption policy was given a further boost in 2008 when the British government provided the Ghana Government with £42.5 million to provide free medical care for pregnant women under the National Health Insurance Scheme.
These were done to remove financial barriers to using antenatal and delivery care in public and private health facilities, in order to complement the role of dedicated and skilful health professionals to achieve a reduction in the maternal mortality rate.
This year’s State of the World’s Children Report for 2009 prepared by the UNICEF, which was launched in Accra last Wednesday, called on political leaders, governmental and non-governmental organisations (NGOs) to generate action at all levels to address the problem of maternal and neonatal deaths.
Produced annually, the report is UNICEF’s flagship publication and closely examines a key issue affecting children. The 2009 edition of the report focuses on maternal and new-born health and identifies the intervention and actions that must be scaled up to save millions of lives.
It outlines the direct causes and underlying factors that undermine the health and survival of mothers and new-borns and mentions the causes of obstetric complications, which include post-partum haemorrhage, infections, eclampsia and prolonged or obstructed labour.
It also talks about complications of abortion, which account for most maternal deaths, and anaemia, exacerbated by malaria, HIV and other conditions which heighten the risk of maternal death from haemorrhage (bleeding).
It said for these reasons, around 1,500 women died from complications related to pregnancy and childbirth, adding that since 1990 the estimated annual number of maternal deaths world-wide had exceeded 500,000, amounting to almost 10 million maternal deaths during the past 19 years.
The launch of the report, attended by policy makers, health workers and members of civil society organisations, included an interactive panel discussion, during which members of the panel and the audience deliberated on the issue of maternal mortality in Ghana and the need for stakeholders to implement effective measures for reducing maternal mortality and improving neonatal survival.
The panellists were Dr Opoku Fofie, Gynaecologist at the Wa Hospital; Dr Elias Sory, Director-General of the Ghana Health Service (GHS), and Dr Nelson Damali, Obstetric Gynaecologist at the Korle-Bu Teaching Hospital. The rest were,: Dr Gloria Quansah Asare, Head of Family Health, GHS and Nana Oye Lithur, Africa Regional Co-ordinator of the Commonwealth Human Rights Initiative.
Dr Quansah Asare said Ghana, like other developing countries, does not have the full complement of health care at health facilities to tackle the problem effectively.
She said there was the need to make sure that equipment was available and steps needed to be taken to address the problem of delay in getting to the health facility, adding that the road map to efficient maternal and new-born care was to equip adolescents with knowledge about reproductive health care.
Dr Sory said socio-cultural difficulties encountered by expectant mothers, such as crossing a river to the health facility, and with some perceptions in some traditional setups where women who deliver their babies at the hospitals are laughed at, the problem will still persist.
He also said there was the need to train more midwives to offer comprehensive, emergency obstetric care at the various levels of service delivery.
Nana Oye, who is also a member of the Steering Committee of the Safe Motherhood Initiative, stressed the need for doctors and health service providers to counsel and explain issues to patients and expectant mothers, who must also be given the opportunity to ask questions to know more about pregnancy and the risks associated with it.
She said that was necessary to empower women with knowledge on maternal health and reproductive rights for them to make informed choices on their reproductive health needs.
Dr Fofie spoke about the constraint and challenges confronting health personnel in the rural areas and suggested an incentive package to boost the morale of staff in those areas, as well as encourage others to accept posting to those areas.
Dr Damali called for the provision of basic materials and equipment and the expansion of infrastructure to meet the demands on health facilities, the result of increased hospital attendance due to the provision of free, medical care for pregnant women. He also said non-governmental organisations and individuals and related agencies and organisations should help strengthen the health care system.
The Majority Leader and the Member of Parliament (MP) for Nadowli West, who identified poverty and education as major constraints to maternal health care, called on all stakeholders to come on board to invest in sectors that support essential maternity and basic health-care services to strengthen health systems and improve maternal and new-born care.
He said in addition to enhancing information systems, it was also imperative to expand human resource, foster social mobilisation, establish equitable financing and develop infrastructure, transportation and the referral process.
The UNICEF Ghana Representative, Dr Yasmin A. Haque, asserted that maternal mortality and neonatal deaths were not about statistics, since the loss of the life of one woman through maternal death was painful. For that reason, she said the launch of the report provided an opportunity to count and investigate every life lost as a result of pregnancy and childbirth.
In doing so, we will all recognise the roles we have to play to complement efforts of health professionals, who also need to put in their best including the right attitudes to offer quality care to mothers and enhance safe motherhood in Ghana.