NAME: TEMITOPE ABAYOMI FADIYA
PROGRAM: MPH
MATERNAL MORTALITY: A SCOURGE OF HUMANITY!
Every year over half a million women continue to loose their own lives to the hope of creating life (1). Maternal mortality is one of the basic health indicators of a country, since it reflects or assesses the strength of basic health care services of a nation. The figure portrays how well or not a society is rated in terms of basic health care facilities.
By definition, maternal mortality is the annual number of death of women from pregnancy-related causes, when pregnant or within 42 days of termination of pregnancy, per 100,000 live births (1).
This definition is used in its broad sense because pregnancy itself is a physiological process and not pathologic! Pregnancy and pregnancy outcomes are important indices of assessing the obstetric care or access to obstetric care which is one of the rights of every pregnant woman in a society!
For example, “women who have their children at a birthing center where midwives and obstetricians team up have more natural deliveries with fewer interventions than women who gave birth at a hospital – and their infants are just as healthy, new findings show” (2).
In inference, this shows that most cases of pregnancy proceed well where there is access to basic obstetric care. On the other hand, complications of pregnancy and child birth are the leading cause of death and disability among women of reproductive age in developing countries. About “515,000 women die each year from maternal causes and “nearly all maternal deaths (99%) occur in the developing world – making maternal mortality the health statistics with the largest disparity between developing and developed counties” (3), 50% of this occur in the sub-Saharan Africa. One woman die every minute from complications related to pregnancy and child birth which translates to about 1600 deaths/day. “For every woman who dies 30 more suffer injuries, infections and disabilities (1). “15 million women incur such injury each year and a total of about 300 million are affected. This is a quarter of adult women in developing world. Since about 50% of all maternal deaths occurs in the sub-Saharan Africa, it is important to note that “1 in 13 die from such pregnancy related causes which is a sharp contrast to 1 in 4085 in women in the industrialized world” (1), where sophistication in antenatal and obstetric care had reduced the scourge drastically.
It is equally important to note that the incidence of maternal mortality is still alarmingly high in about 20 countries in the developing world, where the incidence account for 65% of all cases. These countries, for example, India, Nigeria, Ethiopia, Indonesia, Bangladesh, Democratic Republic of Congo, China, Kenya, etc
‘One would say that these countries constitute the maternal mortality belt of the world.’ As a consequence, since more than 65% of the cases of maternal deaths occur in this region, this means that the maternal mortality ratio is high. And, by maternal mortality ratio one means “a measure of the risk of death once a woman has become pregnant”, which means by becoming pregnant in these regions the number of precious lives loss invariably increases. Thus, more women loose their lives in the bid to create life!
However, the question remains, why such an alarming rate of maternal deaths and what could possibly account for such deaths.
Studies have shown that more than a quarter of maternal deaths are due to post-partum hemorrhage. “Post-partum hemorrhage is blood loss after child birth in excess of 50%, because it is often difficult to estimate blood loss, the true incidence of PPH may be underestimated by up to 50%.
Maternal mortality due to PPH is highest where there is poor access to skilled providers, transport systems and emergency services. This is not surprising considering that a woman will die within two hours, on average, after onset of PPH if she does not receive proper treatment ( e.g appropriate drugs, blood transfusion or surgical intervention)” (4).
It is important to note that, “130,000 women will bleed to death each year while giving birth and about 25% of such deaths will occur in sub-Saharan Africa, 27% in West Africa and 45% in Indonesia” (4). This negative picture shows that post-partum hemorrhage should be prevented, at least, to save the lives of mothers.
The second cause of maternal mortality is sepsis, which if simply defined, entails all forms of infection due to poor management of pregnancy and labor. “Modern improvements in the maternal services and the general advance of medicine have resulted in a dramatic reduction in deaths of women due to pregnancy and child birth. But deaths due to sepsis still occur, which are worth examining in great details and provide lessons for all engaged in the practice of obstetrics” (5)
Thus, sepsis or infection contributes to maternal mortality in the developing countries, where it accounts for 15% of all cases.
The third cause of maternal mortality is complication of unsafe abortion. For instance, “the practice of abortion is by no means a new phenomenon in Nigeria (6) and “each year an estimated 610,000 abortions, at a rate of 25 abortions per1000 women aged 15-44 are obtained in Nigeria. In addition, an estimated 40% of abortions are performed by physicians in established health institutions while the rest are performed by non-physician providers, for example, auxiliary nurses, and traditional birth attendants. Of all hospitals and clinics that provide abortion, 87% are privately owned, and abortions are provided by non-specialist general practitioners” (7).
As a consequence, complications of unsafe abortion accounts for 13% of all cases of maternal deaths.
The fourth cause of maternal mortality is prolong or obstructed labor, this accounts for 8%. Complications of Prolong or obstructed labor are largely the result of bad obstetric practice or where the health providers are not skilled in recognizing such conditions.
Also, certain conditions could actually predispose to obstructed labor. For example, a woman whose growth has been staunted by chronic malnutrition and also women who undergo the brutal and debilitating female genital mutilation are also prone to obstructed labor and invariably maternal death.
Hypertensive disorder in pregnancy especially eclampsia, which accounts for 12% of maternal deaths is equally worth mentioning!
The overall picture of maternal mortality seems so gloomy and this is especially for the developing counties of the world, particularly the sub-Saharan Africa. A number of global initiatives have been launched aimed at tackling this menace. And, since most developing countries are members of the World Health organization, invariably most of these initiates have been ratified by the problem of implementation still persist!
For instance, “the 1990 world summit for children, was aimed at halving the high 1990 levels of maternal mortality by year 2000” (1).
And more recently, the millennium Declaration of September 2000, where the “making pregnancy safer initiative” was launched aimed at reducing the women dying during child birth by 75% by year 2015 (8). In order to achieve the objectives of the millennium Declaration a number of principles were adopted for this initiative which will benefit, for example, Nigeria where maternal mortality remains the highest in the sub-Saharan Africa!
First, the provision of skilled attendant who is a health professional trained and educated in the necessary skills of management of normal and uncomplicated labor and who could recognize cases of abnormality and refer such for specialist care.
Second, the strengthening of the health care system. It’s important to note that health system must be functional for it to discharge its full responsibility to humanity. This implies that the necessary policy framework must be implemented which enable equitable distribution of health care services which is accessible, affordable, and safe for all. One of the ways of ensuring the functioning of the health system is to adequately remunerate the health care providers. Standard and protocols for practice should be well spelt out and workers trained on its interpretations.
Infrastructure must be adequate for the smooth discharge of duties. There should also be good roads and transport network from various parts of the country to the nearest available health care facility to transport women in labor or those in need of urgent specialist care.
The question of ignorance and poverty must be tackled by policy makers. Ignorance and superstitions about the use medical health facilities and the patronage of the amateurish traditional birth attendants where health facilities are in place.
Also the link between poverty and health can not be ignored and this is an area for policy makers and international organizations should look into! However, “failure on the part of governments and the international community to strengthen systems that promote health would condemn low income families to continuing poverty and social disadvantage” (9)
Lastly, the entire community also needs to be involved and adequate education on the menace of maternal mortality and on the channels available to pregnant women and on how to obtain help.
Maternal mortality is preventable but all stakeholders must exercise the will to prevent this condition!
REFERENCE
- UNICEF. World Summit for Children. Reduction of maternal mortality by half. Available in www-form at: << 10.12.04
- Reuter Health. Birth Center delivery safe, less surgery: study.
Am Jour Pub Health 2003; 93. Available in www-form at: <http://www.phoebeputney.com/HealthNews/Reuters/NewsStory0529200310.htm< 10.12.04 - Safe motherhood.org. The partnership for safe motherhood and New born Health. Available in www-form at: << 10.12.04
- Maternal and Neonatal Health. Best Practices, preventing postpartum hemorrhage: Active management of third stage of labor. Available in www-form at: <http://www.mnh.jhpiego.org/best/pphactmng.asp <10.12.04
- Lopez JA, Deshmukh KK, Iyer KS. Maternal mortality due to sepsis. Jour Obst & Gyn of India. 1986 Jun; 36(3) : 4113-3. available in www-form at: <http://medind.nic.in/imvw/imvw22404.html
- Stanley K.H et al. The Incidence of Induced Abortion in Nigeria. International Family Planning Perspectives, 1998, 24(4); 156-164. Available at: http://www.guttmacher.org/pubs/journals/2415698.html
- Archibong EI, Illegal induced abortion–a continuing problem in Nigeria, International Journal of Gynecology and Obstetrics, 1991, 34(3):261–265; Kinoti SN et al., Monograph of Complications of Unsafe Abortion in Africa, Baltimore, MD, USA: Johns Hopkins Program for International Education in Reproductive Health, 1995. Available at:
- WHO. Maternal and Newborn Health. The Making Pregnancy Safer Initiative. Available in www-form at: <http.www.who.int/reproductive-health/MNBH/index.htm <10.12.04
- Sachs, J. (2001). Macroeconomics and health: investing in health for economic development, Report of the commission in macroeconomics and health. Available in www-form at: <http://www.who.int/reproductive-health/mpr/poverty.html
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