Maternal mortality, a silent canker

Maternal mortality the world over has witnessed an insignificant reduction since the inception and end of the United Nations’ Millennium Development Goals (MDGs). The proportion of these deaths varies across regions, worldwide. With low- and middle-income countries being the major sufferers. Available data has proven that, globally, maternal mortality is unacceptably high. About 295 000 women died during and following pregnancy and childbirth in 2017.

The vast majority of these deaths (94%) occurred in low-resource settings, and most could have been prevented. (World Health Organization, Fact-sheets 2019).

In Ghana, with the influx of the MDGs, the maternal mortality was 760 deaths per 100,000 live births in 1990 and was expected to decline to 190 deaths per 100,000 live births by 2015 as per the expected outcome of the MDGs. Unfortunately, the country was unsuccessful in achieving this mandate, despite a reduction to 319 deaths per 100,000 live births in 2015. This means from 1990 to 2015, Ghana achieved a 42% reduction in maternal mortality instead of the expected 75% reduction. Regardless of this decline in the mortality ratio, much reduction was anticipated to juxtapose with the several death-reducing interventions and policies the country has invested in.

Historically, maternal health care has come of age. It was not until the late 20th century that maternal mortality began to be recognized as a public health concern. Until then, most interventions, be it governmental or non-governmental were vested on child health to the neglect of maternal health. For instance, interventions for children such as growth monitoring, universal immunization, nutritional supplementation, and oral rehydration therapy proved an increasing success in clamping down the rates of infant and child mortality and morbidity.

Interventions for pregnant women lagged far behind with little to no attention to women suffering injury or dying in childbirth and/or from pregnancy-related causes. Thanks to the International Safe Motherhood Initiative, launched in 1987, which gave a huge impetus to interventions, programs, and advocacy aimed at reducing maternal mortality worldwide.

The maternal mortality situation in developing countries of which Ghana is a part is very worrying and has denied many women of their right to life. It is always the joy of every family to receive a bouncing baby after nine months of a positive pregnancy experience and successful delivery. Ironically this joy is becoming a mirage. Most women of late see pregnancy and the birthing process as high risk or a near-miss and may do everything possible to avoid going through this ordeal. Millions of women die in silence from pregnancy and childbirth-related complications. Even those who successfully deliver and survive may either develop a birth complication or lose a baby.

According to the UN International Conference on Population and Development (ICPD), every woman has the right to go through pregnancy and childbirth safely, hence it is highly unacceptable for any woman in the process of giving birth to live, loses her life. It is no news that the death of a woman is a colossal loss to the family, community, and the nation as a whole. Woe betides the children of the deceased mother, most of them go through tyrannous treatment in the hands of stepmothers. The newborn baby of the deceased goes through formula feeding, instead of the recommended exclusive breastfeeding and this leads to death from neonatal infections. Again, the baby is denied the tender motherly care and love and this hampers the baby’s developmental milestone. These are just a few visible looming dangers associated with losing a mother, yet little or no attention is given to women during pregnancy and delivery.

The question is, who is culpable for these deaths? Is it the woman, is it society, is it the health system, or perhaps all the aforementioned? None the less, the purpose of this write up is not to identify culprits and apportion blame, but to distinguish the gaps leading to maternal deaths and to address them.

The causes of maternal death are a complex mixture of myriad factors ranging from individual, household, accessibility, health facility and provider-related factors, socioeconomic status, etc. That notwithstanding, most causes of maternal deaths are due to direct obstetric causes such as; hemorrhage, sepsis, unsafe abortion, obstructed labor, and hypertensive disorders.

The good news is that most of these deaths are highly avoidable if pregnant women have access to qualified birth attendants (Midwife, Nurse, or a Doctor) who are well equipped with the necessary resources, equipment, and technical skills to conduct the delivery.

Maternal death audits and reviews when conducted well, prove to be successful in reducing further maternal deaths. Unfortunately, maternal mortality audits and reviews are poorly done and fail to achieve their intended purposes. For instance, audit recommendations are not implemented.

Early referral of pregnancy complications for further management at higher-level health facilities could be of help. The majority of maternal deaths are largely due to late referrals. Periodic and regular outreach and home visits services for pregnant and postnatal women are very rewarding.

Agulu Gilbert Gangtaba Regional Health Directorate, Bolgatanga