Improving maternal health- the health of women during pregnancy, childbirth, and the postpartum period, is undoubtedly crucial in saving lives and decreasing complications that tend to result from pregnancy and childbirth. However, challenges to achieve this fully are still present in Rwanda and the world over. The global maternal mortality ratio in 2020 was 152 deaths per 100,000 live births, up from 151 deaths per 100,000 live births in 2019, according to Gates Foundation data. In Rwanda however, maternal mortality decreased from 1,071 per 100,000 live births in 2000 to 203 per 100,000 live births in 2020. This improvement is as a result of, among other things, efforts to encourage women to give birth at hospitals and improved access to antenatal services. The New Times’ Davis Higiro had an interview with Rwanda Biomedical Centre’s Director of Health Facility Unit, Dr Regis Francois Cyiza on the special interventions that have led to the enhanced maternal and infant care, and what more can be done to further this development. How would you describe the status of maternal health in Rwanda? Based on recent data from the Rwanda Demographic Health Survey, over the last 20 years, maternal health in Rwanda has improved significantly as shown by the data; maternal mortality has decreased from 1,071per 100,000 live births in 2000 up to 203 per 100,000 live births. Another thing is that most women are delivering from health facilities from 27 percent in 2000 up to 93 percent in 2020. Those who deliver from health facilities (hospitals and health centres), 94 percent of those deliveries were assisted by a skilled health care provider in 2020, while in 2000, they were only 31 percent. Also, around 98 percent of pregnant women were followed in Antenatal care in 2020 (DHS 2019/2020). The use of family planning has also increased, where the overall contraception rate is 64 percent, and this also contributes to the decrease of maternal mortality and overall maternal health. What special interventions have been made to improve maternal health in Rwanda? Because there has been strong political commitment, there has been increased awareness and social behaviour change, especially health care-seeking behaviours for pregnant women. There has been improvement in the quality of antenatal care services- close follow-up and accompaniment of pregnant women by community health workers and health care providers. Addressing accessibility barriers (geographical and financial) by increasing and decentralising health facilities in which currently, each sector has at least one health centre, and the removal of financial barriers by introducing community based health insurance (Mutuelle de Santé) have also been vital. Increasing the number of health care providers in health facilities (nurses, midwives and medical doctors), continuous capacity building of health care providers through training, onsite training through mentorships, and increasing equipment and commodities in health facilities, have all been a game changer. Are there challenges you were facing before that are no longer present? Health care services need continuous improvement, therefore I would say that there are no more financial barriers, and geographical barriers have been addressed significantly, but some mountainous regions may be an obstacle to access some health facilities. However, this will be solved by the increasing number of health posts in each village as it is the target of the Ministry of Health. In brief, many challenges have been addressed but sustainability and continuous improvement is needed, since you cant say you are at 100 percent in health care services or systems. What about the status of prenatal and postpartum depression? How are you dealing with it? Generally, cases of prenatal and postnatal depression are not many, based on my experience in clinical services, although there are some cases. About numbers you may check if any, with the mental Health department. What is the rate of infant mortality in Rwanda? The rate of infant mortality in Rwanda was 33 deaths per 1,000 live births in 2020 (DHS 2019/2020 reports), and this was at 107 deaths per 1,000 live births in 2000. What interventions were made to minimise infant mortality? There are interventions like the treatment of diseases which are the main causes of infant and under-five mortalities such as diarrhoea, malaria and pneumonia. This has been done with the help of community health workers. The overall improvement of quality of health care services in facilities, increasing and decentralising health facilities and putting them closer to the population has been helpful too. Also, improving the structure of the referral health system, increasing awareness and significant timely health-seeking behaviour of parents for their children has also helped reduce infant mortalities. The increase of antenatal care and increase of deliveries assisted by skilled health care providers which decrease neonatal mortality, has also been helpful. Any recommendations to further improve maternal health? Pregnant women should attend antenatal care services as soon as they know they are pregnant, especially in the first three months (1st trimester) and follow the guidance of health care providers. This helps women to be followed-up for any problem they may have, but also to receive treatment to prevent problems the baby may have prior delivery. This also includes counselling on nutrition, disease prevention and preparing women to avoid any problems that may arise and affect the child during pregnancy, delivery or after. All pregnant women should deliver from health facilities and seek medical attention earlier, for any problem that their children may have, instead of consulting traditional healers or applying traditional practices, or delaying at home until the mother or infant is severely weak, to the extent that they cant be saved. Good nutrition and hygiene of infants, mothers, and family is also important. Together, ensure living a healthy lifestyle; physical exercise, doing regular screening of some diseases like cancers, high blood pressure, and diabetes. Family planning is also very important to mothers and infants, as well as to the family. The use of insecticides treated bed nets in families should also be considered to avoid malaria. Malaria is one of the main killers of s under-five. Families should also have health insurance to avoid any financial barrier that may limit their access to services as required.
