The New Times (Kigali)

17 February 2009

Rwanda: Maternal Mortality - the Unfortunate Price of Life

opinion

Kigali — Child bearing is one of the biggest health risks for women worldwide and the women in the world's least developed countries are 300 times more likely to die in childbirth than those in developed countries.

These facts are highlighted in UNICEF's State of the World's Children report on maternal and newborn health, launched last January in Johannesburg.

And according to United Nations Population Fund (UNFPA) every minute a woman loses her life giving life, adding up to 10 million women over a generation.

And according to the latest report (June 2008) by the Department of International Development (DFID) 536,000 women continue to die needlessly each year.

Worse still, the world's health organisation (WHO) estimates that 1,500 women die every day while giving birth. That is approximately half a million mothers every year.

There is no mystery about why so many women are dying while giving birth. They are dying because they have no access or limited access to health care, or because the quality of care is poor.

According to WHO, women die due to haemorrhage, sepsis, hypertensive disorders, unsafe abortion and prolonged or obstructed labour - complications that can often be effectively treated in a health system that provides skilled personnel facilities to handle emergencies when they occur and post-partum care. This underscores the importance of having a skilled attendance at delivery.

Associated risks

A woman's health and nutritional status, including HIV and anaemia, underlie these causes. Maternal mortality is also viewed as the accumulation of a number of risks that girls and women face (malnutrition, female genital mutilation, premature marriage and pregnancy, lack of family planning mechanisms for child spacing) that reflect the relative lack of status and worth accorded to them.

Ironically despite a reasonable amount of funding available for maternal mortality, so many challenges remain to adequately address the problem.

According to Mubarak Mabuya, a gender expert co-ordinating a UNFPA Gender project in Uganda, despite funding challenges in addressing maternal mortality, there are major gaps in intervention programmes that tend to ignore the indirect causes of maternal mortality.

Most of the funding and intervention programmes stress direct causes of maternal mortality yet indirect causes also have implications.

"The question is where is the money being put? It is not enough to just put money into the health care service but also the indirect causes because they also impact on maternal mortality," Mabuya asserts.

Preventable maternal deaths are caused by the deprivation of basic rights of women, because "issues like domestic violence that most women experience when they are pregnant have not been given adequate attention yet they also have an impact on maternal mortality," he concludes.

This coupled with the inability to control their income, lack of knowledge about family planning, inability to negotiate for safe sex; all have implications on maternal mortality.

Addressing maternal mortality is not only an issue of increasing access to health care services (supply) but also demand.

For instance the issue of community mobilisation, that is to appreciate the importance of delivering in a well established health centre, information about the different methods of family planning available, ability to determine which family planning method is convenient for them, and also consider factors that influence mothers to deliver in their homes or any other areas than hospital. These are critical factors for should be considered to address maternal mortality.

DFID also indicates that in the poorest parts of the world, the risk of a woman dying as a result of pregnancy or childbirth is about 1 in 6.

In Northern Europe the risk is about 1 in 30,000. This is because most women in the developed world have access to skilled birth attendants in addition to essential maternity and basic health care services.

This also attests that medical interventions are important in reducing maternal mortality. Especially important is competent emergency obstetrical care.

According to the development agency, ensuring access to reproductive health and family planning services for all could help avert up to 35 percent of maternal deaths.

This fact may be because many of the life-threatening complications that accompany pregnancy and delivery cannot be predicted for individual women.

Also important is the provision of family planning services, which operate to lower the number of births and thus reduce the risk of maternal death.

Overall maternal mortality is much lower in societies in which women have higher educational levels and higher social status.

Though, there is no direct one-to-one relationship between improvements in women's social conditions and reductions in maternal mortality.

Nevertheless, access to legal abortion is equally important in reducing deaths because legal abortions are more likely to be performed in a clean environment by trained medical personnel.

UNFPA estimates that about one-half of abortions lead to maternal death in countries where abortion is illegal; this translates to the deaths of nearly 1 million women per year.

The situation is worse in Africa, where provision of safe and legal abortion is bound up with cultural views about gender roles, and is intimately related to women's position in society.

Population control

In Rwanda, one major challenge in addressing maternal mortality is the continued rapid growth of the population which is estimated at 8.3 million and is set to double to 16 m by 2020 with the current growth at 3.2 percent per year.

High rates of population growth are largely the result of frequent childbearing or high fertility often corresponding with a large unmet need for family planning.

In 2008, 37percent of the population took measures to adopt family planning methods as compared to 27 percent and 10 percent in 2007 and 2006 respectively.

The Ministry of Health's target is to have at least 70 percent of the population practicing family planning by 2012.

According to the health statistics, the fertility rate is currently 5.5 children per woman, which is supposed to be reduced to 3 children by the end of 2012.

Meeting the unmet need for family planning not only allows families to space and limit their births when desired; and directly contribute to the reduction of maternal and child mortality.

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