Dying to Be Born

Maternal deaths remain a huge challenge on the African continent Put awareness of maternal health firmly in the mindset of Africans and it will go a long way to reduce the ongoing tragedy of maternal deaths on the continent.That’s the qualified opinion of Dr. Ngoga Eugene, head of Obstetrics and Gynecology Department at the referral Hospital in Kigali, Rwanda. “We [Africa] have a shortage of skilled personnel, and even the few who are qualified migrate for better pay to developed countries,” he said, lamenting the fact that spreading awareness is directly linked to skills on the ground. In most African countries, the ratio of doctors to patients is still very low, and qualified staff leave Africa because there is a shortage of equipment and drugs to operate effectively. Consequently, there is inadequate health coverage in the rural areas. Examining culture African culture and the mindset to have many children by traditional birth attendants at home leads to death during childbearing. Dr. Ngoga said the days of African mothers thinking that many children hold future riches and that things are still done in the same way it was in the last decade are no longer applicable. “Many mothers die because of multiple pregnancies and they writhe through the pain of home deliveries in the absence of a professional midwife,” said Dr. Ngoga. African countries need to address the problem. These include providing access to healthcare services in the remotest areas, affordable health service and educating women on family planning. It is through these services that health workers will find out the risks and complications, such as hemorrhage and high blood pressure of expectant mothers, to be handled by qualified staff for safer delivery. Information from UNFPA (the United Nations Population Fund) indicates that even where services are available, they are often inadequate or of poor quality. Studies in Benin, Ecuador, Jamaica and Rwanda show that, practitioner knowledge is often lacking with test scores between 40 and 65 percent of pre-specified norms. Standards failing In Ghana, as few as 17 percent of hospital births met the standards of good clinical practice while technical and quality of care scores were likewise woefully inadequate in health centers located in Nigeria and Cote d’Ivoire. In some cases, women gave birth in a hospital with no professional support whatsoever. In the UNFPA link, “No woman should die giving life,” women have cited a variety of abusive behaviors as reasons for choosing the more perilous route of home birth. Among them is offensive and demeaning language on the part of healthcare personnel, ridicule in the form of mockery concerning a woman’s clothing, smell, hygiene, cries of pain, or the desire to remain clothed while giving birth. The real challenge lies in countries with the highest rate of deprivation and the poorest maternal health indicators. Still, practice shows that even in the poorest countries, maternal health indicators can be substantially improved if there is enough political will. Today in Rwanda, rural health centers have been equipped with ambulances and skilled community health workers. African countries ought to act proactively, put incentives for doctors, invest in health centers and make it affordable for every expectant mother. “Every part of the world’s health infrastructure should work together, toward one goal. Governments and health services in developed and developing countries alike, international organizations, businesses and private foundations, non-governmental organizations and civil society,” said UN Secretary General Ban Ki Moon at a conference in Washington aimed at finding solutions to problems affecting women and girls worldwide. MDG aspect According to the recently released UN Millennium Development Goals (MDGs) Report 2010, only 46 percent of the deliveries in Sub-Saharan Africa were attended by skilled health personnel in 2008, a stark contrast to the average figures in the world’s developing regions and the developed regions that stand at 63 percent and 99 percent respectively. The MDGs, agreed to by world leaders in September 2000, include a specific target of reducing the number of women dying during pregnancy and childbirth by three quarters by 2015. “African countries could do it if they really wanted, because we know what we need, what is missing and what can be done; but that’s only if maternal mortality is simply prioritized,” Dr. Ngoga explained. In Rwanda, even if 99 percent of women have community health insurance scheme, statistics show that more than 48 percent of the pregnant women choose to deliver at home. However, addressing maternal mortality is not only an issue of increasing access to health care services. Other strategies to be stressed in a move to curb maternal death include education, minimizing Gender Based Violence (GBV), and economically empowering women to control their income, so that they can have the ability to negotiate for safe sex. Unsafe abortions In the recently concluded AU summit in Kampala it was said that one in 16 women and girls die giving birth in Africa.Unsafe abortion is cited as another driver of maternal death at 14 percent. Unfortunately, 60 percent of these women are under the age of 25. Unsafe abortion is a reality in Africa because it is still a taboo in some countries for women to get pregnant when unmarried. As a result, women and girls end up using other methods of forced birth hence getting infections and losing their lives. “It is a big debate but in my own opinion, abortion should be legalized because in the process, many lose lives and those who are lucky will only lose their uterus,” Dr. Ngoga said. Integration of information and communication technology into healthcare system is another tactic that would see local community health workers in touch with the rural families. Agnes Binagwaho, Permanent Secretary in the Rwandan Ministry of Health, said that African countries need to put up infrastructure and communication platforms, along with education systems that would see vulnerable groups enrolled in the whole health scheme. “This calls for strong government commitment and visionary leadership,” Binagwaho said. gmear@yahoo.com