Countries in Africa have among the highest maternal mortality rates in the world.
In some nations on the continent it is near 2,000 deaths per 100,000 live births. In Japan, by contrast, the figure is four deaths per 100,000. In Malawi, a woman has a one-in-18 lifetime risk of dying in childbirth, according to the British charity Oxfam.
Dorothy Ngoma, Oxfam ambassador and executive director of the National Organization of Nurses and Midwives of Malawi, attributes the high number of maternal deaths partly to the phenomenon of nurses seeking better paying jobs abroad.
Malawi is short of maternity clinics in rural areas, she says, and when they do exist they do not have enough skilled midwives. "You have one midwife sometimes delivering 10 or 20 babies in one night. She will be too exhausted to even identify problems early and save those lives."
Some maternity units have no midwife at all, she adds, and mothers have to deliver to traditional birth attendants who lack skills. There are 600 registered nurse midwives in Malawi and most of them are in management. "This just leaves nurse technicians. They are not really experts when the difficulties set in."
Malawi has an average of one nurse for 3,500 people, compared to one for 1,000 in Africa as a whole, Oxfam says. In Germany the ratio is one nurse for 102 people.
Complications
Another reason for the high rate of maternal mortality in Africa is the continent's changing disease burden. Tuberculosis, HIV/Aids and malaria complicate pregnancy even more, says Ngoma: "The pregnant women with these diseases cannot cope."
Oxfam says the maternal mortality rate in Malawi almost doubled between 1990 and 2000, rising to 1,200 deaths per 100,000 live births.
Not only are there complicating illnesses, but there is also a dire lack of resources. Ngoma saw a stark contrast first-hand when she recently visited Britain to raise awareness in the lead-up to the World Health Assembly and the G-8 summit about the lack of adequate medical care in developing countries. She was taken aback to see the abundance of baby cots in British hospitals. In Malawi, three or four babies will sometimes share space intended for one. There is also a lack of basic drugs, such as pitocin, which is widely used to help slow bleeding during labor.
Other problems contributing to high maternal mortality are a lack of transportation or proper roads so women in labor can get to clinics on time.
International Commitment
Ngoma says while African governments had to take responsibility for failing to devote adequate resources to health care, or for misusing resources, developed countries had a responsibility as well. She called on those who live in wealthy countries to make their voices heard to support a campaign for adequate, universal health care.
Thirty years ago, international leaders made a commitment in the Declaration of Alma-Ata (in present-day Kazakhstan) to achieving health care for all by 2000. However, Ngoma believes there has been too little effort to follow through.
"There has to be a commitment by all, by the whole world, that there should be health and education for all, that as a world society we have a social and moral responsibility to save lives and provide support," she says. "It is a crisis now, so the commitment must be there to shift the resources to these poor countries. We need more drugs, equipment, incentives that will make nurses and doctors stay home. It cannot happen if the concentration of resources are within the richest countries."
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Ted Alemayhu, founder and CEO of U.S. Doctors for Africa, agrees that the health care crisis in Africa is a global problem: "More focus needs to be done to really come up with a win-win solution, and therefore to have happy medical personnel, fairly compensated medical personnel, in Africa who are going to remain and help their own people."
Alemayhu's non-profit organization is launching the "African Diaspora Medical Professionals Mission" to encourage African professionals to return to their countries of origin for three to six months at a time.
The organization is also planning to launch its first mobile clinic, in Ghana or Ethiopia, to help provide medical services in rural areas. At the same time, it will provide training for local health care personnel.
