How to Prevent the Death Of Expectant Mothers

It is no longer news that every minute, a woman dies during childbirth. However, it is disheartening that every minute a woman dies needlessly from avoidable mistakes and errors, a family’s life is shattered because the woman’s children, husband and dependants experience a threat from survival.

From the global record of the United Nation’s Population Fund (UNFPA), for every woman who dies, 20 or more experience serious complications.

Some of the notable complications women experience from becoming pregnant range from injuries like obstetric fistula (referred to as VVF or RVF) to some other form of chronic infections.

From global data, every year, 536,000 women die from pregnancy-related causes, which translate to mean that more than one million children are left motherless and vulnerable.

In Nigeria, the overall maternal mortality ratio (i.e. pregnancy related deaths) is 800 per 100,000 while for the UK is just about nine per 100,000 women. In some parts of Nigeria, the figure gets to 1500 per 100,000, which means in perspective, a woman dies approximately every 10 minutes from childbirth.

According tom the UNFPA, working for the survival of mothers is human rights imperative which has enormous socio-economic ramifications – and is a crucial international development priority.

Both the International Conference on Population and Development and Millennium Development Goals call for a 75 per cent reduction in maternal mortality between 1990 and 2015. This three-pronged strategy is key to the accomplishment of the goal:

*All women have access to contraception to avoid unintended pregnancies

*All pregnant women have access to skilled care at the time of birth

*All those with complications have timely access to quality emergency obstetric care

In countries such as China, Cuba, Egypt, Jamaica, Malaysia, Sri Lanka, Thailand and Tunisia, significant declines in maternal mortality have occurred as more women have gained access to family planning and skilled birth attendance with backup emergency obstetric care. Many of these countries have halved their maternal deaths in the space of a decade. Cadres of professionally trained midwives have been critical to these successes. Severe shortages of trained health providers with midwifery skills are holding back progress in many countries.

In 2005, UNFPA was part of the launch of the Partnership for Maternal, Newborn and Child Health. In 2007, UNFPA established a Thematic Fund for Maternal Health that will help developing countries increase access and use of quality maternal health care and empower women to exercise the right to maternal health. The thematic fund will focus on supporting 75 countries with the greatest need. The goal is to raise $465 million during 2008-2011, and encourage developed countries and private sponsors to contribute more to saving women’s lives.

In Lagos State for instance, government’s efforts to scale up activities to save mothers’ lives has included the upgrading of existing maternity centres at the local government and general hospitals across the city as well as the construction and equipping of five hundred units Maternal and Child Centres which are meant to address the two MDG goals on Maternal and Child Health in one package.

According to Dr. Jide Idris, Commissioner for Health, "these centres are health facilities for pregnant women and their children which incorporate preventive and first contact care (Primary Health Care) and intermediate level curative or hospital care (i.e. secondary health care) under one roof."

The centres, which are to be commissioned by December are located in Ikorodu, Ifako-Ijaye, Isolo, Gbaja-Surulere, Amuwo-Odofin, Ajeromia nd Ibeju-Lekki.

Women by this development can attend these centres from the time when they get pregnant until delivery and during the post-delivery period and continue to attend after their children are delivered till they become adults.

Some of the proposed facilities expected within the newly constructed maternities and paediatric wards include all encompassing antenatal care, labour and delivery care, treatment of babies, post-natal care, immunisation for children, nutrition clinic for malnourished children, health education for mothers, emergency obstetric care, emergency neonatal and general pediatric care HIV prevention and treatment for children and pregnant women and family planning.

In readiness for the scaled- up agenda, advanced trainings on Emergency Obstetric Care (EMOC) and Good Labour Practice Courses are being organised for the various cadre of midwives and nurses in the state.

EMOC has been found to be one of the most important strategies with the capacity to reduce maternal mortality (deaths) and morbidity (injuries) significantly.

*An estimated 200 million women want to delay or avoid pregnancies but are not using family planning.

*Researchers project that the demand for contraception will grow by 40 per cent during the next 15 years.

*One in three deaths related to pregnancy and childbirth could be avoided if women who wanted effective contraception had access to it.

*An estimated 19 million unsafe abortions are carried out each year in developing countries.

*Every year, an estimated 68,000 women die as a result of unsafe abortions and millions more suffer complications.

*Worldwide use of modern contraceptive methods, including voluntary sterilisation, has increased from 10 per cent to 65 per cent over the past 45 years.

*Lack Of Access To Skilled Assistance And Emergency Obstetric Care

*Four out of five maternal deaths are the direct result of obstetric complications; most of which could be averted through delivery with a skilled birth attendant and access to emergency obstetric care.

*Up to 15 per cent of pregnant women in ALL population groups experience potentially fatal complications during birth-20 million women each year.

*A study of 2.7 million deliveries across seven developing countries found that only one-third of women who needed life-saving care for a complication received it.

*Majority of women die due to severe bleeding. This complication can kill a woman in less than two hours, so control of bleeding, replacement of blood or fast emergency evacuation is needed to save their lives.

*Approximately five per cent of women – six million women – will need surgery, most often a Caesarean section, and many are without access to emergency obstetric care. This unmet need may result in death or painful disabilities, such as obstetric fistula.

*Worldwide, 62 per cent of births were attended by a skilled health worker. Although almost all births in developed countries were attended by skilled health personnel, this proportion is 57 per cent in less developed countries and only 34 per cent in the least developed countries.

*An estimated 35 per cent of pregnant women in developing countries do not have access or contact to health personnel prior to delivery.

*In sub-Saharan Africa where maternal deaths are highest, fewer than 40 per cent of women receive skilled assistance during childbirth.

*Maternal mortality is highest during labour and the two days just following birth.

*Women who undergo infibulation – a radical form of female genital mutilation/cutting that involves stitching of the external genitalia – are at higher risk of complications during childbirth.

*Young People’s Lack Of Knowledge And Opportunities

*Girls aged 15 – 20 are twice as likely to die in childbirth as those in their twenties. Girls under the age of 15 are five times as likely to die.

*Girls aged 15 -19 account for one in four unsafe abortions – an estimated 5 million each year.

*Complications of pregnancy or childbearing represent the leading cause of mortality for girls aged 15-19 in developing countries.

*Less than 20 per cent of all sexually active young people in Africa use contraception.

*In societies where men traditionally control household finances, women’s health expenses are often not a priority.

*Women are often not in a position to decide if, when and with whom to become pregnant or to determine the number, spacing and timing of their children.

*In countries with similar levels of economic development, maternal mortality is inversely proportional to women’s status.

*The poorer the household the greater the risk of maternal death

*Early marriages, female genital mutilation/cutting, too many childbirths and violence signal the violation of a woman’s right to make decisions about her own body.

*Poverty And Health Care Delivery

*Maternal mortality rates mirror the huge discrepancies between the haves and the have-nots both within society and between countries.

*Poor women are far more likely to die as a result of pregnancy or childbirth.

*Poor families and individuals have less money and tend to live further away from healthcare facilities.

*Tackling the problem of maternal death and disability will constitute a significant step towards poverty alleviation.

*Strategies to reduce maternal death and disability will strengthen health systems in such a way as to benefit all.

*Indeed, maternal health indicators are used to gauge health system performance in terms of access, gender equity and institutional efficiency. Investing in maternal health therefore holds the promise of improving overall health service delivery.