Government needs to ensure women have adequate health care
OUR health system women.
Every year Parliament debates violence against women and children to initiate what is known as a period of 16 days of activism. Every year we listen to promises, not to mention the sequential pontification of most MPs, about making a real and meaningful difference to the lives of women and children.
But what has been the practical effect of government measures on our lives?
We say “our” because as fathers to daughters we have the greatest desire, like other fathers surely would, for them to be part of a world where women live safe, secure and prosperous lives. Too often the issue is framed as anti-male (Parliament’s website has it that men abuse children as if women don’t) and the pain of their situation only understood by themselves.
For all the talk, Parliament does not exercise its powers of executive oversight when it comes to the welfare of women.
We see women being let down on a daily basis – at police stations, in the courts and in our hospitals and clinics, with little positive intervention from those in charge. Of serious concern, for example, is the failure of the government’s department of women to implement its vision of serving women. Minister Susan Shabangu and her department have failed dismally to reach their targets – not least failing to interact with other departments and provinces – and to integrate its well-intended but never implemented policies.
In just one area, health, and we find numerous examples of how women are suffering daily in our health system:
Katherine Childs wrote about Betty Mabuza of Welkom who went “back and forth to a clinic in the last few months of her pregnancy. When she finally got help in a hospital, a doctor told her she had been carrying a dead child for more than a month”.
The Free State has some of the worst hospitals and clinics in the country, so her experience may not be atypical. Inadequate obstetrics care contributes significantly to our high maternal death rate.
According to the World Health Organisation, South Africa’s maternal mortality rates, (as measured by pregnant women who die per 100 000 live births), was 138 in 2015.
Brazil’s is 44, Russia’s is 25, China’s is 22 and Israel’s is five.
Provincially, the Free State has the highest maternal deaths at 202 per 100 000 live births, and the Western Cape the lowest at 54.4.
In 2014, a total of 140 mothers 18 years or younger died, of whom 37 were from Kwazulu-Natal, 28 from the Eastern Cape, 22 from Gauteng, 20 from Limpopo, 14 from Mpumalanga, 13 from the Free State, four from North West and two from in the Northern Cape. There were none in the Western Cape.
Our figure of 138 is far higher than the 38 we set out to achieve with the Millennium Development Goals (MDG).
According to the department of health’s Confidential Committee of Inquiry into Maternal Deaths, the three most important causes are:
● HIV/Aids, which accounts for half the deaths. The department adopted a policy stipulating all HIV- positive pregnant and breastfeeding women must be placed on lifelong antiretroviral medication for the prevention of mother-to-child transmission regardless of their CD4 counts. This would make a consider- able difference, but much depends on women’s access to clinics, and their personal diligence in using their medication;
● Hypertension in pregnancy: Hypertension in pregnancy accounts for about 15 percent of maternal deaths. Severe hypertension in pregnancy is a serious condition that can result in a range of complications for both mother and the unborn baby. Pre-eclampsia is hypertension in pregnancy with organ damage, commonly to the kidneys (which causes an increased amount of protein in the urine). Eclampsia, a condition characterised by fits (seizures), greatly increases the chance of death in pregnancy; and
● Pre-birth and post-birth haemorrhage (bleeding) is also a major cause of maternal mortality, causing about 16 percent of these deaths. Obstetric haemorrhage is one of the leading causes of preventable maternal death, with contributing factors being a lack of adequately trained health care staff – and ambulances arriving too late, or often not at all, to take patients to hospital.
The government cannot dictate the lifestyle habits of individuals. But it is responsible for the quality and staffing levels of obstetricians at public hospitals and the adequacy of emergency services.
Firstly, there is a need to address the shortage of midwives and obstetricians, especially in public health establishments.
Greater numbers of graduates from nursing colleges and medical schools are urgently needed. The use of innovative training approaches should be explored, such as offering specialist obstetric training posts in rural areas, supported by satellite teaching units and telemedicine.
Secondly, South Africa has a national 112 emergency number, but it is supported only by cellular networks and therefore has limited reach. Numerous meetings between the departments of health and communications since 2001 and a trial 112 Western Cape centre have delivered nothing. It is not rocket science. It is a travesty that there is no single number like the US’s 911 via which an ambulance, fire brigade or the police can be reached.
The cost (in 2012) for setting up a single number emergency service was R24 million in capital and R124m in recurrent costs, not a huge sum of money given the compelling importance of the service.
Thirdly, emergency response times vary greatly. The norm for priority calls involving the critically ill or injured patients is 40 minutes in rural areas and 15 in urban. But in Kwazulu-Natal three of 19 districts meet the norm 50 percent to 75 percent of the time, and only one district 75 percent to 100 percent of the time.
In the Eastern Cape six of 14 districts met it 50 percent to 75 percent and none 75 percent to 100 percent. In Mpumalanga all five districts met the norm 0 percent to 25 percent of the time, the worst in the country. By contrast, five of the 12 Western Cape districts meet the norm 50 percent to 75 percent and seven districts 75 percent to 100 percent of the time.
There are currently 234 obstetrics ambulances in the country. There is a need for more ambulances in these provinces – but the resources are not there to buy them.
A failure to address the most basic of health needs can lead to the most violent suffering of women. The government should take heed.
‘We see women being
● Dr James, MP and Dr Volmink MP are DA spokesman and deputy spokesman on health, respectively.