27 November 2010

Mali: Prenatal Care Key to Reducing Maternal Mortality

Bamako — Despite successive awareness campaigns, many Malian women see no need to attend pre-natal check-ups. Health workers say this results in an elevated rate of maternal and infant mortality.

"I was present at the death of a young woman of 18 in October," says Fatoumata Fané, "who lost a lot of blood during labour."

Fané is a midwife at a birthing centre in the Hamdallaye neighbourhood of the Malian capital, Bamako. The baby was born healthy, she says, but the mother needed a blood transfusion urgently.

"Unfortunately, she had not made it to her medical appointments during the pregnancy which would have allowed us to know what her blood group was. So it was too late to identify her group."

Adiaratou Doumbia, a young woman visiting the Hamdallaye maternity clinic told IPS, "I'm four months pregnant. But if I had not fallen ill, I wouldn't have come here. I didn't know that one had to come to a health centre to avoid problems during childbirth."

Mali has some progress to show in caring for maternal and infant health, but the mortality rates remain high. The country's second MDG report - published by the United Nations Development Programme in March 2010 - says the rate of infant mortality has fallen from 113 to 96 per 1,000 births between 2001 and 2006. For the same period, the maternal mortality rate has also dropped, from 582 to 464 deaths per 100,000 live births.

Dr Mariam Diarra, a gynecologist at the Sissmed Clinic in Bamako, says that millions of women who survive childbirth, go on to suffer adverse after-effects, infections, illness and disabilities. And despite the increasing numbers of public and private health facilities, the number of deaths following childbirth remains a concern for health workers.

"So many women die in hospitals following complications because their health was compromised during the pregnancy. The truth is, a significant number of women don't know the risk that they run by not coming in for check-ups," said Diarra.

Dr Moussa Diakité, from Bamako's Acti-Santé Cinic, says that pre-natal consultations allow a doctor to predict 90 percent of future complications that can cause the death of a mother or child.

Up to 80 percent of pregnancy-related deaths and illness could be avoided if women had better access to maternal and primary health care, according to a 2009 report from the Malian Ministry of Health.

"Prenatal consultations allow one to make an initial assessment with the aim of detecting infections or illnesses which may impeded the smooth progression of pregnancy," said Diakité.

"During my first pregnancy, I started coming to the health centre late, when I got ill. But the midwife advised me to come to the health centre from the start - from the earliest days after conception - to avoid complications in the pregnancy," said Kadia Sylla, 23, five months pregnant in Bamako.

Awareness campaigns have borne fruit, and one finds a growing number of women who do understand the importance of regular monitoring by medical people of pregnancy for their survival and that of their children.

"[Prenatal visits] allow one to plan childbirth," says Assan Koné, a 20-year-old mother of a two-month-old infant. "For example, if a pregnant women is less than 1.5 metres tall, she cannot give birth (vaginally); she will need a caesarean. These are the sorts of things that prenatal consultations allow you to see."

Diakité confirms Koné's view, saying that a shorter woman's pelvis is likely to be narrower, presenting an elevated risk to mother and child during childbirth.

"One can fight against maternal mortality if pregnant women follow the advice of health workers," says the midwife Fané. "We have to encourage pregnant women to give birth in medical facilities because the leading cause of maternal deaths is bleeding that occurs from the start of contractions until 24 hours after the placenta is passed."

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