A lot has been written about the causes of maternal deaths with the main cause attributed to the high costs of maternity fees. What is being overlooked are the reasons women want to get pregnant in the first place. Do they want to get pregnant out of choice or are they forced to get pregnant due to other pressing forces which are beyond their control?
In the discussions that I have had with women, the overriding factor is the desire to bear children when the woman is married. Then, it follows that this should be a planned pregnancy in which the man and the woman agree to mate and have offspring.
At three months into the pregnancy, the mother to be should register with the clinic to receive periodical monitoring of her pregnancy until the time of delivery. It is this initial fee that keeps many pregnant women away from health centres.
The husband, in many cases, does not take the responsibility to find money to make sure that his wife is well looked after.
Another scenario is where a woman becomes pregnant through carelessness by not using protection obtained through family planning clinics.
Family planning clinics offer these preventive methods free of charge but some women never take advantage of these services for reasons only known to themselves.
The unmarried women then face a daunting task of fending for themselves to get money to register their pregnancies at clinics. Unless the single mother-to-be is employed or has her own financial means, she will not be able to access health care during her pregnancy.
What is at stake here is the lack of knowledge if one wants to become a mother to a child. Those women who are married are required to visit either the clinic or a doctor for a medical check-up to see whether they do not have any underlining disease that could affect them if they became pregnant.
These days, HIV and STI tests are mandatory. Furthermore, a medical examination is necessary and any history of ill health has to be communicated to the health centre. Once all these precautions are taken, the husband and wife can go ahead and start a family.
Complications in pregnancy which may lead to the death of the mother or the child at birth can be avoided if the woman has access to health facilities before and during her pregnancy.
One can understand about the waiving of maternity fees for expectant mothers if the initial registration fee is done away with. Pregnant women must not be deterred from accessing a health facility due to poverty. But, the question still arises: Who is to meet the costs of allowing pregnant women to visit health centres for free?
The Ministry of Health and Child Welfare is not getting enough money to fund its activities at health centres, such as clinics, district, provincial and referral hospitals.
The Ministry of Health is failing to recruit more health cadres due to budget constraints from the national fiscus. What could be the solution? The Government introduced the Aids levy as well as the national pension insurance (NSSA). What is puzzling is why the Government did not do the same by introducing a national health fund?
If maternity fees are abolished, then the Government should levy, maybe one U.S. dollar for every purchase made, to start the health fund to support maternal health care. As for health care costs in the cities and towns, the local government authorities could levy two U.S.dollars from every resident who pays water and rates.
The previous colonial governments used to levy residents in affluent suburbs to subsidise the costs of bus companies operating in the cities and towns. The health levies could go a long way to meet the costs of allowing expectant mothers access to health facilities free of charge.
But the major issue may not lie with just maternity fees to prevent or reduce maternal deaths. Poverty is so pervasive in Africa that free health care may not be the only answer to this major problem.
The policy of empowering women with education and resources such as land and pursuit of informal or formal business activities would go a long way in reducing maternal deaths even eliminating the scourge of poverty completely.
When the Government's policy on indigenisation and empowerment is dismissed by some, especially NGOs, our own people do not realise that the health of the people could be taken care of by the people themselves if they were given the capacity to earn income and not to rely on handouts from foreign organisations. The country must get away from a culture of getting services for free.
There should be a system where the health centres are paid from a fund to offer free service. Sometimes a means test could be applied where those that can afford can be charged for the service.
Those that cannot pay for the service due to poverty can carry welfare cards that will enable them to seek free health.
Any death that can be avoided should not be allowed to occur due to poverty. But, any health policy must be accompanied by education on health care of the individual. Maybe, the education on health care for women must start at primary school level and spread right to the community at large.