In many parts of Africa, the sight of a pregnant woman reminds one of death. This is based on cultural beliefs that a pregnant woman has one foot in the grave as her chances of survival or having a safe birth are very slim.
In April 2010, The Lancet published a worldwide study on maternal mortality conducted by the Institute for Health Metrics and Evaluation (IHME) of Washington University. For the first time in decades, researchers reported a significant drop in the number of women dying each year from pregnancy and childbirth.
From total maternal deaths of roughly 525,000 in 1980 to about 342,900 in 2008, the IHME analyses utilizes new and better country data and a more sophisticated statistical method that draws from birth records, national surveys, censuses and surveys of siblings deaths.
The new findings from 181 countries also show an annual decrease of 1.3% in the maternal mortality ratio (MMR), the ratio of the number of maternal deaths per 100,000 live births.
However, the situation in most Sub Saharan African countries moved in the opposite direction due largely to near collapse of health infrastructure and services.
For instance the whole of Bissau, the capital of Guinea Bissau has only one functional surgery room which attend to women in labour and the sad story from the room is that one out of every eight women that gives birth there dies while most of the babies don’t live to see the third day.
Nigeria according to the IHME study also moved in the opposite direction of this global trend, with a 1.4 per cent increase each year, from 473/100,000 in 1990 to 608/100,000 by 2008. For every woman who dies, twenty will face serious or long-lasting medical problems.
Women who survive severe, life-threatening complications often require lengthy recovery times and may face long-term physical, psychological, social and economic consequences. The chronic ill health of a mother puts at risk surviving children, who depend on their mothers for food, care and emotional support.
Ending these preventable deaths therefore was the subject of discussion during a recent meeting of International Confederation of Midwives 29th Triennial Congress that held in Durban South Africa.
Callista Mutharika, the first lady of Malawi used the occasion to charge midwifes on their responsibilities and why no woman should die giving birth.
Mutharika said that most women were afraid of giving birth in hospitals and other designated facilities due to cultural issues as well as lack of sensitivity and poor treatment of women by midwives. “A midwife is to ensure that a pregnant woman get the best care,” said Madame Mutharika.
The State of the World’s Midwifery 2011: Delivering Health, Saving Lives report says that women have cited a variety of abusive behaviours as reasons for choosing the more perilous route of home birth.
Among them were offensive and demeaning language on the part of the health care personnel, ridicule in the form of mockery concerning a woman’s clothing, smell, hygiene, cries of pain or the desire to remain clothed while giving birth.
In some cases the provider does not speak the local language and female providers may not be available when wanted.
The report says that unless an additional 120, 000 midwives are trained, deployed and retained in supportive environments, 38 of 58 countries surveyed might not meet their target to achieve 95 percent coverage of births by skilled attendants by 2015, as required by the Millennium Development Goals (MDG) 5 on maternal health.
“The report points to an urgent need to train more health workers with midwifery skills and ensure equitable access to their life saving services in communities to improve the health of women and children,” said Babatunde Osotimehin, Executive Director, United Nations Population Fund (UNFPA).
The new report also shows that adequate midwifery could save more than 3.6 million lives whose death could be avoided each year in the 58 developing countries if midwifery in 58 countries if midwifery services are upgraded by 2015.
“There has never been a report like this said Bridget Lynch International Confederation of Midwives (ICM) President noting that it had been supported by more than 30 agencies whose collective aim is to strengthen midwifery practices to prevent maternal death and disability and improve the health of newborns, families and the entire communities,”.
“The biggest challenge however remains the shortage of midwives,” said Lennie Kamwendo Chairperson, Board of Trustees, White Ribbon Alliance for Safe Motherhood in Malawi.
For a country to stop women and newborn babies from dying, one of the most important investments it can make is in human resources to ensure skilled care, particularly midwives, during labour and delivery.