Approximately half a million women die worldwide each year as a result of pregnancy or childbirth, 99% in developing countries 1. A woman in Niger has a one in seven chance of dying during pregnancy or delivery, whereas in Ireland, the risk of death for a pregnant woman is one in 100,000.
The major causes of maternal death are bleeding, infections, unsafe abortions, eclampsia, obstructed labour and indirect causes, such as malaria and HIV/AIDS. Research shows that almost half of the births in developing countries take place without a skilled birth attendant.
Poverty and attitudes towards women negatively impact maternal mortality rates. Cultural or traditional practices often prevent women from seeking delivery or post-partum care.
Education and information on sexual and reproductive health are pivotal to improving maternal health. According to UNESCO, educating girls for six years or more drastically improves their prenatal/postnatal care and childbirth survival rates. Educated girls have higher self-esteem, are more likely to avoid HIV infection, violence and exploitation, and to spread good health and sanitation practices to their families and throughout their communities.
Literate women tend to marry later and are more likely to use family planning methods, which can limit maternal death rates of adolescents and deaths caused by unsafe abortions.
The Millennium Development Goal 5 calls for maternal mortality to be reduced by three quarters by 2015. Since the MDGs were adopted in 2000, the global maternal mortality ratio has barely changed and the probability of reaching this goal is quite low. India and China have made some progress while maternal death rates in Africa vary widely.
There is an urgent need to address maternal mortality. The right to health is a basic human right that should not be undermined.
Is maternal death a problem in your country? What is your government doing to improve the situation? Is your NFA involved in any educational projects to decrease maternal mortality?
Maternal death is a problem in Rwanda and is one of the two MDGs that we may not be able to reach by 2015. The major bottlenecks seem to be:
• The major share of the budget is used for specific programs rather than donors providing sector wide budget support
• A considerable number of women still give birth at home without the assistance of a qualified health care professional
• Up-take of modern contraception remains low and well below the Government’s target
• Shortages of specialist health staff including medical specialists
• Infrastructure still needs to be improved especially for geographical access with an emphasis on referral transport and strengthening the community health workers initiative
• Long procurement procedures affecting the availability of drugs
• Problems in communication between the centre and decentralized units.
The Rwanda Government’s Ministry of Health is working hard to improve the situation. It needs support to
• Provide a maternity care service that ensures that no women gives birth at home
• Provide more support for family planning and antenatal care.
Examples of good practice espoused by MOH are
• Emergency maternal and neonatal care
• Maternal deaths audits and evaluation the causes of the deaths
• Advisory to visit and deliver at health centers.
RAUW is working with Soroptomists Australia and MOH to introduce birthing kits and distributing them to all heath facilities. This educational/health project will train midwives in the use of the kit.
Shirley