2 February 2013

Uganda: Re-Evaluate Strategies to Reduce Maternal Mortality

"Tarehe Sita" celebrations which are held in remembrance of the first armed attack launched by the National Resistance Army guerrillas on February 6, 1981 usually involve various activities.

These include cleaning of hospitals and health centres, schools, wells and community outreach programmes in which people receive free medication, health services and mosquito nets. Thank God, gone are the days when the sight of a soldier in combat sent shivers down one's spine.

Involvement in the promotion of better health is central to development; my focus is on women's health. This week, a piece of news worth celebrating was the construction of a sh180m health facility by the Child Fund Uganda in Mayuge district to reduce the number of maternal deaths. Women were advised to use the facility rather than visit traditional birth attendants.

It was noted that mothers in that area have been going to Iganga Hospital which is 20km away to give birth and many have been dying.

Related to this, I remembered a story told by one Member of Parliament, who is also a medical doctor, on how his mother gave birth to him in a banana plantation. When I heard the story, I shuddered. I then realised that this story may not have been strange a few decades ago but it should not be the case today. In fact, several children were named after such events; some are known as Kanyarutokye meaning "of a banana plantation".

Many questions come to my mind -how did the mother and baby survive in such unhygienic conditions? What if the birth had been complicated?

This situation was highly risky! It is reported that every minute, one woman dies somewhere in the world due to preventable complications in pregnancy or chilbirth. That is a total of 1,000 women dying every day, or 365,000 a year from pregnancy-related causes.

Despite research that shows an overall decrease in worldwide maternal mortality since 1980, millions of women and girls still face a staggering risk of death or disability during pregnancy and childbirth. In sub-Saharan Africa, where Uganda is located, women have a one in 16 chance of dying during pregnancy or childbirth.

The World Health Organization, defines maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes".

Other definitions include accidental and incidental causes and extend the time period of observation to one year after the end of the gestation.

According to research, major causes of maternal deaths are: severe bleeding (25%), infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labour (8%), other direct causes (8%), and indirect causes (20%).

Indirect causes are malaria, anaemia, HIV/AIDS, and cardiovascular disease, all of which complicate pregnancy or are aggravated by it. In some cases, high rates of maternal deaths occur in the same countries that have high rates of infant mortality, reflecting generally poor nutrition and medical care.

Another issue that is associated with maternal mortality is the lack of access to skilled medical care during childbirth and the distance of traveling to the nearest clinic to receive proper care.

In developing countries and rural areas traveling to and back from the clinic is very difficult and costly, especially to poor families when time could have been used for working and providing incomes. Even so, the nearest clinic may not provide decent care because of lack of qualified staff and equipment.

Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need is access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth.

It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death.

To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. Researchers conclude that improving maternal health depends on key factors, which include:

lreviewing all maternal health-related policies frequently to ensure that they are internally coherent;

lenforcing standards on providers of maternal health services;

llocal solutions to problems discovered should be promoted, not discouraged;

lenforcement of the right to health which includes entitlements to goods and services, including sexual and reproductive health care and information;

laction to break down political, economic, social and cultural barriers that women face in accessing the interventions that can prevent maternal mortality;

lparticipation by stakeholders in policy and service development; and

lprovision of adequate funding and accountability for maternal mortality.

The key word is vision. In signing up for MDG-5, countries have indicated their vision. But it is meaningless unless it is translated into a clear strategy for achieving it. If maternal mortality is the agreed priority, then what are we waiting for?

A recent directive by the President to fully equip Health Centre IIIs to handle all health complications including maternal health services should be given priority.

Creation of awareness on maternal health, equipped health Centre IIIs staffed with well-facilitated skilled personnel will no doubt reduce maternal mortality drastically. No woman should die while giving life.

This years' Tarehe Sita theme -"Lessons from our history: NRM's commitment to create a better future for Uganda" is fitting. Let us launch an armed attack against maternal mortality TODAY.

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