Preventing Maternal Death In Africa

Across Africa, the challenge of preventing maternal deaths is enormous. While progress has been made in some countries, the 23 countries in the world with the worst mortality rates in 2006 were all in sub-Saharan Africa. While a pregnant woman in Sweden has only 1 in 30,000 chances of dying, in Sierra Leone the risk is 1 in 7. in 2002, the WHO warned that if nothing is done to improve access to maternal care in Africa, 2.5 million women would die before the end of the decade, and 49 million would be living with disabilities.

Dr. Luc De Bernis, UNFPA'S senior on maternal health in Africa, says the problem is the poor state of Africa's health systems. “What is needed is an effective system” by which woman can be assisted during the birth, he told Africa Renewal. “We know that 15 percent of pregnant women develop complications that obstetric care, and up to 5 percent will require some type of surgery. We have to invest in the infrastructure necessary to do it.”

Dr. Grace Kodindo, a former head of maternity at the main hospital in Ndjamena, the capital of Chad, agrees. “In Africa we have shortage of qualified staff,” she says. “In most of the continent, the ratio is 1 doctor for every 60-80,000 people. We lack equipment and drugs, and there is inadequate coverage in the rural areas.”

WHO estimates that three quarters of maternal fatalities and disabilities could be prevented if deliveries were to take place at well-equipped health centres, with suitably trained and skilled staff.
According to Dr. Yves Bergevin, a senior adviser on reproductive health at UNFPA, every woman needs to be near a health centre so she get advice about nutrition. Such centres should also have trained personnel who can recognize complications and either manage them or quickly refer the woman to a larger hospital. Facilities for emergency surgery or lifesaving blood transfusions must be available. “Even if it is three in the morning an obstetric emergency is something for which you can tell the mother to come back tomorrow,” he told Africa Renewal, “If that woman needs but doesn't get a caesarean, then it's very simple she will die.”

The international community has agreed that binging down maternal mortality is a priority. The Millennium Development Goals (MDGS). Agreed to by world leaders in September 2000, include a specific target of reducing the number of women dying during pregnancy and childbirth by three quarters by 2015.

Achieving the MDG goals of reducing child and maternal mortality “is one of the most urgent tasks ahead of us,” UN Deputy Secretary-General Rose Migiro said in New York in September 2007, at the launch of Deliver Now, a campaign by 80 governments. Donor agencies and non-governmental organizations (NGOS) aimed at rising the commitment and funds to improve delivery of and access to maternal services.

African leaders have also committed themselves to improving health services. At meeting in Abuja, Nigeria, in 2001, they pledge to put aside 15 percent of their annual budgets to improve health access. Buy 2004, only Botswana and Gambia had met that target.
Dr. Kodindo questions African governments' commitment. “Yes they are poor,” she told Africa Renewal. “But they have some money. For example, Chad is producing oil, but the money is used to buy arms. Meanwhile mortality is not on the agenda…. We have seen other countries like Honduras and Sri Lanka. Which despite poverty have been able to lot. Our countries could do it if they really wanted. Maternal mortality is simply not a priority. If it were a priority, they could have put it in the governments' annual budgets.

A related problem, says Dr. De Bernis, is that governments and donor agencies tend to focus on specific themes. Such as HIV infection, malaria and tuberculosis, while failing to address the general state of Africa's health care systems. Strengthening health services to address maternal mortality would be very important for all these programmes, he says.

A surgery room, “he adds, will not only serve the mothers. It will serve the needs of the community. A road which goes to a health centre will serve the community in other ways, this is a development issue and economists should recognize this. We have never seen any country developing without a mineral health system. What we need is long-term investment, which is not what is being done at present.

Courtesy  of the Africa Renewal