Reducing maternal mortality is a concern for all

Article: Salome Donkor
When families lose their relations through maternal and neonatal death, the joy that motherhood brings to families and relatives turn into agony, suffering, pain and distress.
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.
This is in view of the fact that the Ghana Demographic Health Survey, 1993 puts the maternal mortality rate in Ghana at 214 per 100,000 live births with a life time risk of one in 35, and health experts say the situation may not change by 2015 if no drastic measures are taken to reverse the situation.
According to the World Health Organisation (WHO), 2006, while women in northern Europe have a one in 4000 likelihood of dying from pregnancy-related causes, for those in sub-Saharan Africa, the chance is one in 16.
Available evidence shows that 75 per cent of these deaths are preventable and that the timely provision of blood transfusion, caesarian section, oxytocin and antibiotic therapy, and the timely management of pre-eclampsia/eclampsia are sufficient to reduce maternal mortality rates by 50 per 100,000 without the need for advanced technology and safe support mechanisms.
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.
Maternal mortality is defined by health experts as the death of a pregnant woman during her pregnancy or within 42 days of pregnancy termination. According to the experts, an obstetric emergency is not a situation where the expectant mother involved could be asked to come back the next day, since that can result in her death.
The Millennium Development Goals (MDGs), agreed to by world leaders in September 2000, included a specific target of reducing the number of women dying during pregnancy and childbirth by three-quarters by 2015 but health experts say the situation may not change by 2015 if no drastic measures are taken to reverse the situation.
An obstetric gynaecologist, formally at the Koforidua Regional Hospital, Dr J.E Taylor, once remarked that, “when a woman is pregnant, one of her legs is in the grave and depending on the care and treatment she receives, both legs can enter the grave or the other leg would come out of the grave”.
That is why the MDGs give a central place to maternal health and gender equality. MGD 5, improving maternal health, is often called “the heart of the MDGs” because if it fails, the other goals will also fail.
Evidence from 20 years of research and pilot interventions has identified five primary causes of deaths of pregnant women. Pregnancy-related conditions, also known as obstetric complications, include post-partum haemorrhage, (bleeding), eclampsia (high blood pressure in pregnancy), sepsis (infection), 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.
Maternal mortality is a global issue and the concern for reducing maternal mortality stems from the fact that at least 583,000 women die each year from the complications of pregnancy and childbirth. The alarming situation is that, almost 90 per cent of these deaths occur in sub-Saharan Africa and Asia.
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 2008, the then Minister of Health, the late Major Courage Quashigah (rtd) revealed that the country was not winning the war against maternal deaths (Daily Graphic, April 5, 2008). That statement might have touched the hearts of many people, including women in the reproductive age, as well as the relatives of people who have lost their dear ones through maternal and neonatal deaths.
Recently, a couple, Mr Thomas Vaah and his wife Mrs Elizabeth Vaah, came out into the open to complain about the mistreatment Mrs Vaah endured when she was admitted at the Lister Hospital for delivery (Daily Graphic, Saturday, April 10, 2010).
The essence of their story was that Mrs Vaah was admitted at the Lister Hospital for delivery. However, the hospital authorities did not approach their work with diligence and dedication leading to the unfortunate but avoidable death of the baby boy.
The traumatised couple has set up a foundation called “Vaah Junior Foundation for Better Maternal and Child Health” to serve as : A mouthpiece platform for families affected by such negligence, Create awareness on the prevalence of professional negligence in maternal and child health care delivery in Ghana, help provide legal backing for families affected by negligent and incompetent maternal and child health care service delivery, as well as institute an award scheme to reward and recognise exemplary service by maternal and child health personnel and service providers.
Barely two weeks after that incident, another pathetic story had been reported involving the death of the wife of a Deputy Minister of Energy, Alhaji Inusah Fuseini, Mrs Fuseini, at the Police Hospital on April 21, during child birth at the Police Hospital in Accra (Daily Graphic, April 23, 2010).
A report quoted the Director-General of Police Intelligence and Professional Standards Bureau (PIPS), Deputy Commissioner of Police (DCOP) Timothy Ashiley as saying that the news came as a surprise, especially, when a research published recently indicated that the Police Hospital had the best maternal health standards in the country.
In an article written by Yaw Boadu-Ayeboafoh, titled “Solidarity with the Vaahs”, published in the April 15, 2010 edition of the Daily Graphic, the author who said he had been a victim of the negligence of medical staff at the Komfo Anokye Teaching Hospital, said he had been paying for that since December, 1999.
He explained that his daughter who has a permanent brain impairment, could not speak and has problems with speech, and had since 2000 been on medication, which is usually imported specially for her.
It is obvious that husbands who have lost either their wives or children or both through child birth, due to various reasons, have stories to share, but most of such incidents or reports are not reported to draw public’s attention. They include stories involving expectant mothers who are carried in hammock to hospitals that are miles away, due to bad roads and lack of transport and health facilities that do not have the requisite drugs and equipment to make the process of child delivery smooth.
There are also cases of institutional delays at the health facility and the attitude of health professionals that contribute to maternal and neonatal deaths.
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.
In October 2007, the 62nd general Assembly of the United Nations approved a new target on universal access to reproductive health. The indicators of measuring progress towards the target included providing access to family planning to reduce unintended pregnancies of adolescents; and providing antenatal care to address health risks to mothers and children.
Reproductive health problems remain the leading cause of ill health and death for women of childbearing age world-wide. The impact of reproductive health intiatives is to make motherhood safer by; improving access to family planning in order to reduce unintended pregnancy and achieve preferred spacing between intended pregnancies; achieving skilled care for all births; and providing timely obstetric care for all women who develop complications during childbirth.
The 2008 Ghana Demographic and Health Survey (GDHS) said almost all Ghanaian women (95 per cent) received some antenatal care from a skilled provider, most commonly from a nurse or midwife (63 per cent) and a doctor (24 per cent), adding that more than three-quarters of women had the recommended four or more antenatal visits, and 55 per cent of women had an antenatal care visit by their fourth month of pregnancy, as recommended.
Accessing antenatal and postnatal care enabled more women to take iron tablets or syrup and intestinal parasite drugs during their last pregnancy before the survey. Women who received antenatal care during their most recent births were informed of the signs of the complications of pregnancy, and were also protected against neonatal tetanus.
This year’s State of the World’s Children Report for 2009 prepared by the United Nations Children’s Fund (UNICEF), 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.
A woman’s health is critical to the well-being of her family and to the economy of her community and her country. The health of a pregnant woman is even more special because she needs access to essential health services to save her life from death resulting from obstetric complications that cannot be predicted and are difficult to prevent.
The voices of persons whose lives have been lost due to maternal and neonatal deaths, such as Mrs Fuseini, Vaah Jnr and many others that are not known, are criying for immediate action at all levels to address the problem of maternal, neonatal and infant deaths, and the time to act is now.