Im­prov­ing ma­ter­nal health in Africa

De­spite progress in some coun­tries, many women and ba­bies still die dur­ing child­birth in Africa

Africa Renewal - - Front Page - By Kings­ley Igho­bor

On 27 Fe­bru­ary 2013, four-year-old Char­lotte Mmowa sued Lim­popo Prov­ince health au­thor­i­ties in South Africa for 1.1 mil­lion rand (about $100,000) for mis­han­dling her own birth, dur­ing which her mother died. Months later the court agreed that the nurses and doc­tors who treated her mother had been neg­li­gent, and awarded Char­lotte 547,000 rand ($50,000) com­pen­sa­tion.

In 2009, 24-year-old Matlou Mmowa de­liv­ered Char­lotte with­out also de­liv­er­ing the pla­centa, which is ab­nor­mal. The pla­centa con­nects a foe­tus to the uter­ine wall and al­lows a baby in utero to feed off its mother. Ms. Mmowa bled pro­fusely as doc­tors un­suc­cess­fully tried to man­u­ally re­move her pla­centa. The Lim­popo court heard that health per­son­nel or­dered blood at 4 p.m. and that by 9 p.m., when she died, the blood had not ar­rived. She was badly treated, claimed Char­lotte’s cus­to­dian.

The bungling of Ms. Mmowa’s child­birth, and the nov­elty of the court case, drew at­ten­tion and out­rage from many South Africans. The Lim­popo per­son­nel claimed they had done their best with avail­able re­sources — hint­ing that they might have saved the woman’s life if it hadn’t been nec­es­sary to drive a long dis­tance for blood.

Poverty fu­elling deaths

Africa ac­counts for a big chunk of global ma­ter­nal deaths. In 2013 about 289,000 women world­wide died dur­ing preg­nancy or child­birth, and of those deaths 62% oc­curred in sub-Sa­ha­ran Africa, states the World Health Or­ga­ni­za­tion ( WHO), the UN Pop­u­la­tion Fund (UNFPA), the World Bank, and the UN Pop­u­la­tion Di­vi­sion in their 2014 re­port, “Trends in Ma­ter­nal Mor­tal­ity: 1990 to 2013.” The re­port adds that in 2013, the ma­ter­nal mor­tal­ity ra­tio in de­vel­op­ing coun­tries was 230 women per 100,000 births, ver­sus 16 women per 100,000 in de­vel­oped coun­tries. Glob­ally, 3 mil­lion new­borns die each year and there are 2.6 mil­lion still­births, with Africa ac­count­ing for more than half of both num­bers.

Poverty fu­els ma­ter­nal mor­tal­ity, ex­perts say, which ex­plains why death rates are higher in poor coun­tries than in rich ones. “For moth­ers as well as for their in­fants, the risk of dy­ing dur­ing or shortly after birth is 20% to 50% higher for the poor­est…than for the rich­est quin­tile,” states a re­port by UNICEF, the UN Chil­dren’s Fund. To put this into per­spec­tive, in Chad, just 1% of the poor­est preg­nant women get an­te­na­tal care, com­pared with 48% of wealthy women.

Ado­les­cent girls (ages 15–19) are at high risk of child­birth- and preg­nancy-re­lated com­pli­ca­tions, says WHO. “The prob­a­bil­ity that a 15-year-old woman will even­tu­ally die from a ma­ter­nal cause is 1 in 3,700 in de­vel­oped coun­tries ver­sus 1 in 160 in de­vel­op­ing coun­tries.” For many women in many coun­tries, no nurses and doc­tors are avail­able to as­sist in child­birth.

A woman’s pain

Ellen David, 17, of Mon­rovia, Liberia, did not have money for ma­ter­nity bills last Oc­to­ber when she went into labour late in the night; the clin­ics are not open at night, and the cur­few im­posed in the wake of the out­break of the Ebola virus meant she could not have gone to any hos­pi­tal even if she’d had the money. As a re­sult, un­skilled neigh­bours helped her to de­liver in a bed­room very early in the morn­ing. But her joy turned to sor­row when the child died hours later. By noon fam­ily mem­bers were by its grave, of­fer­ing silent prayers as Ms. David sobbed un­con­trol­lably.

“It was a har­row­ing ex­pe­ri­ence,” said Ded­deh Howard, one of Ms. David’s neigh­bours, in an in­ter­view with Africa Re­newal. “I can only imag­ine how many ba­bies and moth­ers we lose in this man­ner.” Ms. Howard her­self lost her baby just after giv­ing birth in 2011. “It’s an aw­ful pain. You look to cud­dle your bun­dle of joy and it dies. You want the ground to swal­low you up.” Ms. Howard is the cor­po­rate so­cial re­spon­si­bil­ity man­ager for Chevron Cor­po­ra­tion in Liberia, which is as­sist­ing Hope for Women, a lo­cal health non­govern­men­tal or­ga­ni­za­tion, to pro­vide an­te­na­tal care for ado­les­cent girls.

The med­i­cal di­rec­tor of Hope for Women, Dr. Wil­helmina Jal­lah, says that

Chevron’s support is sig­nif­i­cant but hardly enough. “Many, many young girls try to de­liver at home; some of them may re­quire Cae­sarean op­er­a­tions and it gets re­ally com­pli­cated for them,” she told Africa Re­newal in an in­ter­view.

Ba­bies giv­ing birth to ba­bies

With 225 ado­les­cents in ev­ery 1,000 cases of preg­nancy, the Demo­cratic Repub­lic of the Congo has the world’s high­est rate, fol­lowed by Liberia (221) and Niger (204). In fact, 75% of girls in Niger are mar­ried be­fore the age of 18, the world’s high­est per­cent­age. Dr. Geeta Rao Gupta, UNICEF’s deputy ex­ec­u­tive di­rec­tor, warned that, “A 15-yearold girl liv­ing in sub-Sa­ha­ran Africa faces about a 1 in 40 risk of dy­ing dur­ing preg­nancy and child­birth dur­ing her lifetime,” whereas in Europe the ra­tio is 1 in 3,300. “Ba­bies giv­ing birth to ba­bies,” was how Ms. Howard de­scribed the ado­les­cent preg­nancy phe­nom­e­non in Liberia.

Also, younger girls are at high risk of de­vel­op­ing ob­stet­ric fis­tula, a po­ten­tially se­ri­ous med­i­cal con­di­tion in which a hole de­vel­ops be­tween the vag­ina and rec­tum or the uri­nary blad­der. Tens of young fis­tula pa­tients are hos­pi­talised in Liberia.

Ac­cord­ing to WHO, the main causes of ma­ter­nal deaths are se­vere bleed­ing after birth, post-child­birth in­fec­tions, high blood pres­sure dur­ing preg­nancy, un­safe abor­tion and dis­eases such as malaria and HIV/ AIDS. “Many hos­pi­tals in my coun­try don’t even have in­cu­ba­tors for pre­ma­ture ba­bies or doses of oxy­tocin to stop bleed­ing,” says Ms. Howard. In 2013, of the 7,500 AIDSre­lated ma­ter­nal deaths world­wide, 6,800 (91%) were in sub-Sa­ha­ran Africa. South Africa alone ac­counted for 41.4% of global HIV-re­lated ma­ter­nal deaths, states WHO.

It gets com­pli­cated when women can­not even make de­ci­sions about their own health. In Mali, Burk­ina Faso and Nige­ria, 70% of women sur­veyed by UNICEF said they had no in­flu­ence over such de­ci­sions. In gen­eral, adds a re­port by the UN Pop­u­la­tion Fund (UNFPA), 95% of mar­ried girls un­der the age of 19 in sub-Sa­ha­ran Africa “have no say over whether to ac­cess or use con­tra­cep­tives.”

Progress is be­ing made

Pre­vent­ing ma­ter­nal deaths is not com­pli­cated, some ex­perts say. “All women need ac­cess to an­te­na­tal care dur­ing preg­nancy, skilled care dur­ing child­birth, and care and support after child­birth,” states UNICEF. That may sound sim­ple, but it’s not. For ex­am­ple, due to dis­tance, poverty and a lack of in­for­ma­tion, women in re­mote parts of Africa have no ac­cess to health care. A study by Jose Luis Al­varez, Ruth Gil, Valen­tine Her­nan­dez and An­gel Gil for BMC Pub­lic Health, an on­line health jour­nal, found that il­lit­er­acy, poverty and weak health care sys­tems ham­per progress in ma­ter­nal health.

To be fair, African lead­ers have placed ma­ter­nal health on the front burner. They are com­mit­ted to Mil­len­nium De­vel­op­ment Goal (MDG) 5, which en­vi­sions a 75% re­duc­tion in ma­ter­nal mor­tal­ity by 2015. A re­cent re­port by UNFPA shows some progress, though hardly enough for a vic­tory lap. Equa­to­rial Guinea has achieved MDG 5, hav­ing re­duced ma­ter­nal deaths by 81%. With an an­nual av­er­age re­duc­tion of 6.2%, Eritrea has met the goal with a 77% re­duc­tion in ma­ter­nal deaths. Ethiopia has achieved 69% re­duc­tion, Rwanda 76%, An­gola 68%, Mozam­bique 64% and Cape Verde 77%. Twenty-six of the 46 sub­Sa­ha­ran African coun­tries are at the 40% mark, and that in­cludes Nige­ria, which ac­counts for 14% of global ma­ter­nal deaths.

African First Ladies are spear­head­ing ad­vo­cacy ef­forts on ma­ter­nal pol­icy and in­vest­ments in the sec­tor. At the UN Gen­eral Assem­bly de­bate last Septem­ber, the First Ladies said they were “alarmed” at child wives, early preg­nancy, un­safe abor­tions and the risk of HIV. “The cur­rent sit­u­a­tion [of Ebola] in West Africa shows that we can­not short­hand progress on health,” ad­mon­ished Ban Soon­taek, wife of UN Sec­re­tary-Gen­eral Ban Ki-moon, at a fo­rum at­tended by the First Ladies. “We have a long way to go post2015, so we need each other…[to] de­liver for women and girls in Africa,” added Ro­man Tes­faye, Ethiopia’s First Lady. In other words, women needn’t die or lose their ba­bies in child­birth. The hard work is to make this dream a re­al­ity.

UNFPA/Eve­lyn Ki­api As­fs­dfs­dfs­dfs­fsd

df­s­gfdgdfgdfgfers. Trainee mid­wives demon­strat­ing the child­birth process us­ing a birth sim­u­la­tor in Kampala, Uganda.

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