In South Africa about 4 300 women die due to complications related to pregnancy and child birth. About 20 000 infants are still-born and a further 23 000 die in the first month of life. In addition 75 000 children never live to reach the age of five. What are the causes for this?
The high levels of maternal and child mortality in South Africa could prevent the country from achieving Millennium Development Goals 4 and 5, which relate to improving health outcomes for pregnant women and children. Maternal and child mortality have been alarmingly high in recent years.
"Instead of seeing a progressive decrease, which is what we should have seen over the last few years as a country, what had happened is, in fact, we've seen a reversal of gains. We've actually seen maternal mortality increasing and we've seen infant mortality and under-five mortality increasing", says Professor Helen Rees, Executive Director of the Wits Reproductive Health and HIV Research Institute.
Director of Maternal and Child Health in the Gauteng Heath Department, Dr Sikhonjiwe Masilela, concurs that the lives of many pregnant women and babies are at risk. He says in Gauteng, as in the rest of the country, mortality levels are still high.
"We are moving, but very slow Moving very slow in the sense that the Gauteng report that has come out now, the triennial report 2008 - 2010, the maternal deaths is now at 150 per 100 000 live births from 167 per 100 000 live births. The major challenge will be still trying to reduce the child mortality rate. If we look at the statistics of 1990, we were at 45, and we are moving a little bit, going up", Dr Masilela says.
He says there are a number of factors responsible for these mortality rates.
"Our challenge is the health care professionals. We still have a challenge with skills knowledge following of protocols. We have a problem with the health systems. We have a problem with communities. One of our indicators is that we would like women to come to antenatal care at 12 weeks (of pregnancy) with the new protocol. That is still a challenge that we seem to be having".
Professor Helen Rees cautions that many complications occur because South Africa does not have effective emergency obstetric care.
"The entire pregnancy process is a risk period. But, clearly, when things can go acutely wrong where you can either have a live baby or a dead baby or a damaged baby and a dead mother is actually during the actual delivery process and the birth process. That's really the biggest thing that drives maternal mortality. What we're failing to do in this country at the moment is to have effective emergency obstetric care. A lot of things that are eminently treatable in the mother, such as hypertension or even haemorrhage, are simply not being managed properly. And the outcome there is not only potentially fatal for the mother or has long term consequences, but can often damage or result in a dead baby.
If we were going to look at that point of vulnerability If we put a lot of energy into that, that certainly would make a difference to both maternal outcome and infant outcome", she says.
Rees also singled out the attitudes of health care personnel as something that needs to change to prevent maternal and child deaths in the country's health facilities.
"It is alienating patients from the health system. It is giving a very negative experience of the health system. It is ultimately scaring people away from access to services", she says.
She adds that HIV is one of the primary drivers for both maternal and child deaths.
"If we are going to tackle maternal mortality seriously and infant mortality, we have to tackle the HIV epidemic and, particularly, in this case, around women and around the whole pregnancy time when there is transmission of HIV to infants. We really need to start looking very hard at how we reduce HIV in young women. We're still sitting in our antenatal clinics with about 30% of young women being infected with HIV, and that's still driving maternal mortality. And that's very complex because that can be anything from tackling gender-based violence, tackling gender relationships, to developing new products that women can use to protect themselves against HIV".
Professor Alex van den Heever, chairperson of Old Mutual's Social Security Programme, says the poor performance of the country's health system is of grave concern given the relatively high health budget that the country has in comparison to other developing countries.
"The public health system in South Africa is extremely well-funded in comparison to many other developing countries, but its performance is considerably below that of many other developing countries. So, that's the first question that has to be examined in terms of performance, including maternal mortality ratios. There are serious problems in health care delivery in South Africa in the public sector and the causes of that are not actually being addressed", Professor van den Heever points out.