Women s deaths: it doesn’t have to be this way

Two recent reports have brought to the fore the shocking number of women who are dying of preventable causes in SA. They set out the terrible price women are paying for the failings of the public health system.

First there is the Saving Mothers Report 2020-22, which investigated deaths during pregnancy, childbirth and in the six weeks that followed. Even before the pandemic struck, SA’s institutional maternal mortality rate was far too high, at 98.8 per 100,000 live births in 2019. The disruption to routine health services during the pandemic, combined with the direct risks Covid-19 posed to pregnant women, sent SA’s maternal mortality rate soaring to 148.4 in 2021, before falling to 109.7 in 2022. Put another way, there were a staggering 3,763 maternal deaths in the three-year period covered by the report.

Every single one of these deaths is a tragedy. It is even more appalling that the vast majority could have been prevented with better care. Many died from high blood pressure during pregnancy or from severe bleeding and infections after childbirth, which can be managed if promptly identified.

In a similar vein, the World Health Organisation’s latest cancer report is a damning indictment of SA’s public health system. In a notable departure from global trends, cervical cancer is the leading cause of cancer deaths among SA women. Globally, the leading cause of cancer mortality in women is breast cancer, followed by lung and colorectal cancer.

The fact that cancer deaths among SA women are skewed towards a preventable disease is not only a reflection of the government ’ s inability to provide women with cervical cancer services but also highlights its failure to bring the HIV epidemic under control. Women living with undiagnosed or poorly controlled HIV are not only at greater risk of contracting HPV (human papillomavirus), the virus that causes cervical cancer, but also at greater risk of complications that make their cancers harder to treat. While the government did the right thing in launching an HPV vaccination programme for girls in 2014, it will still be several years before it makes a dent.

Neither of these reports provides personal accounts of the women who were failed in their darkest hour. But we know from investigations by the health ombudsman that far too many patients are subjected to inhumane, humiliating and inadequate treatment at public hospitals and clinics. The ombud’s reports have revealed facilities rotten to the core run by managers indifferent to the plight of the patients they were appointed to serve.

Fixing this is not just a question of money. The far bigger issue is management. If fewer cadres were deployed to key health positions, and those in charge were held accountable for their actions, many more women would be alive today.