Strengthen primary health care to promote quality maternal health

Mother's Day is a celebration to honour mothers; celebrate motherhood, maternal bonds and the influence of mothers in society. Many individuals and families use the occasion to express their appreciation towards mothers and mother figures in their lives.

At this point, it is useful to reflect on the maternal health situation and the national response at improving maternal health outcomes in the country. In spite of the critical roles women play in our society, many women continue to needlessly die or suffer life threatening injuries associated with pregnancy and childbirth.

Globally, the number of women who die from causes related to pregnancy and childbirth has almost halved since 1990. The annual number of maternal deaths per 100,000 live births fell by 44% between 1990 and 2015, from approximately 385 to 216. Though commendable, the figure came far below the target set by the United Nations as part of its millennium development goals (MDGs) in 2000, which aimed to see a drop of 75% by 2015.

Ghana’s maternal mortality ratio declined from 760 per 100,000 live births in 1990 to 319 per 100,000 live births in 2015. The pace of decline in maternal mortality has been slow and this led to Ghana’s inability to achieve the MDG target of 190 per 100,000 live births in 2015.

According to Mr Isaac Nyampong, Programme Manager of the Alliance for Reproductive Health Rights (ARHR), the maternal mortality ratio remains high and requires strenuous efforts if Ghana has to achieve the sustainable development goal (SDG) target of 70 per 100,000 live births by 2030.

He said for those women who do not die, there could be short and long-term morbidities and disabilities resulting from pregnancy or from delivery and its management. Such complications of post-birth morbidities and disabilities, he explained have consequences for the continued well-being of the woman, the health and survival of her children, the cost of care to the family, and the ability of the woman to contribute productively to her family and community.

Furthermore, the noted complications, post-birth morbidity and disability add costs to the health care system more generally.

The causes of maternal mortality he described are usually classified into direct obstetric and indirect causes. Direct causes include haemorrhage (postpartum and ante partum), unsafe abortion, miscarriage, sepsis, obstructed labour, ectopic pregnancy, eclampsia and embolism. The indirect causes are mostly infectious and non-infectious diseases and other miscellaneous causes. These include mainly malaria, HIV and AIDS, hepatitis, respiratory infections, anaemia, sickle cell disease, meningitis, cerebrovascular diseases and others.

One of the key drivers of maternal mortality and morbidity is high unmet need for Family Planning (FP). Unmet need is the percentage of women who want to space their births or do not want to become pregnant but are not using contraception. Thirty per cent of currently married women have an unmet need for FP and 27 per cent of married women are currently using a contraceptive method.

Mr Nyampong noted that only 47 per cent of the potential demand for FP is being met and called on government to prioritise investments in FP to reduce preventable maternal morbidities and mortalities as well as operationalising the provision of FP services under the National Health Insurance Scheme.

Research indicates that providing free FP services and commodities as well as addressing the non-financial barriers to FP, will increase the number of unintended pregnancies averted by 17.5%, avert 22, 537 infant deaths and 2, 253 maternal deaths in Ghana.

He noted that ARHR recognises the efforts of the government and all other key stakeholders at addressing issues of maternal mortality and morbidity. However, these efforts will yield very little results if it is done outside the context of a strengthened and well-functioning primary health care system.

There is the need to build the competency of health providers, with specific focus on the midwifery shortage, and promote policies, budgets, and regulations to address the needed skill level mix, appropriate health worker deployment, retention, and motivational efforts, including task shifting.

“In line with these, ARHR welcomes government’s move to post midwives to every Community-based Health Planning and Services (CHPS) facility. It is our hope that this initiative will yield the needed outcome by addressing the quality, equity and access of care issues associated with maternal health”.

He said improved access to basic emergency obstetric care, robust referral systems, attitude of providers, availability of essential drugs and inputs and others are fundamental to the survival of pregnant women.

“We are fully aware of many CHPS compounds that are yet to be completed and many more without access to essential amenities to their operation such as electricity, potable water and toilet”, he added.

He called for stronger inter-sectoral collaborations at all levels to effectively deal with maternal health issues. The health, roads and transport, energy, local government, sanitation and the private sectors should work together to address maternal deaths.

Furthermore, measures should be put in place to eliminate out-of-pocket payments associated with the free maternal health care policy to enhance the utilization of maternal health services.

“The best gift a nation can give to all women as we celebrate and honour mother sis a strengthened and well-functioning primary health care health system to prevent maternal mortality and morbidity,” he added.