Answers needed why health system fails mothers, babies

IN FEBRUARY, four-year old Charlotte Mmowa instituted a negligence claim against the Limpopo department of health with the help of a curator.

Charlotte ’ s mother, Matlou Mmowa, died just hours after giving birth to Charlotte in St Rita’s Hospital in Limpopo. She died after failure to remove the placenta, which caused excessive bleeding. It is alleged that this was due to the negligence of the health workers involved.

Charlotte ’ s and Matlou’s story is that of far too many South African women and the children who have to grow up without mothers.

As we mark World Population Day today, it is important to note that South Africa is an uppermiddle-income country that is achieving low-income country success in maternal health.

According to World Health Organisation statistics, SA shares the position in the top 40 worst maternal health countries in the world with Ethiopia, Haiti, Liberia and Niger. Far too many mothers are dying before or after giving birth.

On this UN World Population Day it is worth pausing to consider why the health of South African mothers and their young children deserves more attention. The welfare of a country’s mothers has profound development impacts.

The Millennium Development Goals (MDGs) include a goal on the reduction in maternal mortality. A reduction in the deaths of mothers contributes to the achievement of almost all other six MDGs, including the eradication of poverty and hunger, achieving universal primary education and reducing child mortality.

Healthy mothers allow a country to maximise its human capital. In the longer term, they help in reducing poverty. Maternal health is also an indicator of the strength of a country’s health system and provides early signals of wider health system problems.

Maternal mortality in SA almost doubled between 1990 and 2008 – 1990 is used as the baseline year to measure progress with the MDGs. Data on births in hospitals indicate that the turning point might have been reached in 2010 with maternal deaths in hospitals starting to decline in 2011.

This improvement follows the implementation of the policy on providing ARV-treatment to HIV-positive pregnant women with a CD4-count of 350 or lower in 2009/10.

While just more than 40% of maternal deaths in SA are caused by non-pregnancy-related infections, mainly HIV/Aids and tuberculosis (TB), 28% of maternal deaths are due to bleeding and high blood pressure.

Data collected in hospitals indicate that 40% of the causes of maternal deaths are preventable, with the majority of deaths due to bleeding and high blood pressure being preventable.

The deaths of all mothers are an equal loss to society. But it is deaths due to preventable causes that we should be worrying about because they signal the strength of the health system.

SA is a country where pregnant women have free access to healthcare and well-developed health policies and protocols form the backbone of the system. The maternal mortality rate is the outcome of both the supply and demand for healthcare services.

Common explanations for poor health outcomes tend to focus on the supply of health services, but perspectives and experiences of the users also matter.

Some women are not accessing the health system or not accessing it early enough and it is important to understand whether this is because they cannot or choose not to. If they are choosing not to, the underlying reasons have to be found and dealt with.

Some of the factors influencing women’s access to services may be the quality or acceptability of services provided. Unfortunately the available data in SA does not yet allow us to fully answer these questions.

Poor performance in maternal health asks of policy makers and the researchers who advise them to take a step back and identify why health services may not be of a sufficient quality or quantity or why the users are not accessing the system.

It is our task to keep digging until we have a more comprehensive understanding of what is wrong in the system. And then find the answers.

Otherwise we are failing our mothers and their children … miserably.