Camera men rushed ahead of the entourage. Journalists were poised with their tools. A few who had the opportunity shoved through the crowd as the Obamas stormed the La General Hospital during their historic visit to Ghana. Heads were up, hearts swelled with pride, eyes gazed in admiration as the first African- American US president and his wife made their way through the throng of people to La General Hospital in Accra –Ghana. At the hospital the Obamas interacted with several expectant mothers, touched and held babies and smiled at them sweetly. The US president remarked during his visit to the hospital that “…the rate of both infant mortality [and] Maternal Mortality is still far too high…” in Africa hence the need to address poor Maternal Health.
There is an urgent need for us to tighten our belts in our efforts to save the lives of pregnant women in Ghana and every other woman around the world like Lariba (name changed) who nearly lost her life during pregnancy. Clad in her white dress with her three month bouncing baby boy as a first time mother Lariba shares her story.
“I remember being rushed to the hospital in a hired taxi that particular evening. I had painful contractions and felt sick and weak. I was told later at the hospital that I needed to undergo a caesarean. It was expensive and my husband spent hours seeking for help from family and friends. It was very difficult and painful moments for me but I am happy that I survived and my baby is healthy too”.
As many girls and women conceive daily, some live to experience the joy of motherhood yet many more pass away during pregnancy and its related complications. But should women die in the process of giving life to others? For how long should we watch women slip through our fingers because of maternal mortality when these deaths can be avoided in the first place? Can we achieve the United Nations Millennium Development Goal (MDG) 5 of reducing maternal mortality by 75 per cent by the year 2015 as a country or a continent?
As the clock ticks every minute a girl or a woman dies due to pregnancy related complications or during childbirth. Statistics by the World Health Organisation (WHO), The United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF) suggest that about half a million women worldwide die every year during pregnancy and childbirth. Should we sit with our legs crossed watching our women die and wail after they have gone or should we act to protect and save the situation?
The World Health Organisation (WHO) defines maternal mortality as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”.
Maternal mortality knocks at the door of many pregnant girls and women in Ghana. Available statistics indicate that about 80% of these maternal deaths are caused by obstetric complications –haemorrhage, sepsis, unsafe abortions, pre-eclampsia and eclampsia and prolonged or obstructed labour due to some reproductive, socio-cultural, economic and political factors.
Although a relatively advanced health system exists in Ghana, maternal mortality is still soaring.The evidence? One, WHO and the International Journal of Gynecology & Obstetrics both estimate Ghana's maternal mortality ratio to be 560 per 100,000 live births. In 2007, the Ghana Maternal Survey estimates 451 deaths per 100,000 live births hence approximately 5,000 women die annually as a result of pregnancy related complications and childbirth.
Two, the Daily Graphic on Thursday 27th August 2009 reports that “Health institutions in Kumasi Metropolis recorded a total of 133 maternal deaths last year as against 108 in 2007”.
Three, in the Tema metropolis( which is part of Accra) 30 pregnant women died through complications out of 7,800 deliveries at the Tema General Hospital in 2007 and in 2008, there were 28 maternal deaths out of a total of 8000 births at the same hospital according to the Ghanaian Journal.
From conception to delivery the Ghanaian girl or woman is prone to death. Poor girls and women especially those living in rural communities are the most vulnerable and are at the highest risk of maternal mortality as there is a delay in accessing a medical facility and also difficulty in affording medical health from cost of transportation to cost of drugs.
Out of the maternal mortality cases world wide, 24% of women die of haemorrhage (severe bleeding), 20% as a result of indirect causes such as anaemia, malaria and heart disease, 15% because of infections, 13% because of unsafe abortions, 12% because of hypertensive disorders of pregnancy, and 8% because of obstructed labour and 8% of direct causes such as ectopic pregnancy, embolism, anaesthesia-related according to WHO.
In an interview with some women in some communities in Accra-the capital city of Ghana and in Bantima a town in the Ashanti region of Ghana, women between 20 and 45 who had between one and four children, shared their experiences from conception to delivery. Many have dreaded from the moment of conception through to the day of delivery as they wonder how to afford and access effectively quality health service during this critical periods of their lives.
Most of these mothers interviewed had at least basic education, were married and worked as house wives, traders and teachers. They feel strongly about the need for every woman who conceives to be able to access and afford medical health and also and also think that more clinics should be built in communities.
“I do not think that it is fair for a woman to die during childbirth when we can actually prevent this death as a country. We cannot justify to the child who grows up to learn that he lost his mother giving birth to him because of drugs, unskilled attendant or whatever” Gladys, a mother of two children and a teacher could not hide her feelings when interviewed.
“My sister was pregnant. There was no clinic in my community. We had to walk form our community to the next one to get a car which comes only twice a day before we could take her to the clinic. It was a painful and a sad moment for all of us as we wondered whether she would survive or not “. Another woman shared her experience.
But what could be the reasons for the high rate of maternal mortality in Ghana? There exist a myriad of root causes which encompasses biomedical, reproductive, socio-cultural, economic and political factors that contribute to the high rate of maternal mortality in Ghana.
As far as reproductive factors are concerned, the death of a woman depends largely on the number of children she gives birth to in her life time. The higher the number of children a woman has the higher her risk of a pregnancy related death. Research findings show that very young girls and older women who are above 35 years old and who have more than four children stand the greatest risk of dying during pregnancy and childbirth.
Cultural Factors such as traditional norms, beliefs and practices are contributing factors to the high rate of Maternal Mortality in Ghana. For instance in some rural communities in Ghana some people believe that a pregnant woman must drink some concoctions as a traditional practices or norm. These traditional concoctions are believed to be powerful and protective. Most of the times these concoctions are not medically tested and can affect the health of the mother or the baby. Manu, a taxi driver in a short interaction laments “I still cannot believe that at this age and time, my father in-law still believes and threatens me if I do not allow my wife to travel all the way with the pregnancy to the village for a concoction”.
Social Factors including infrastructure, lack of health facilities in some communities, inaccessibility of health centers, poor roads, transportation difficulties, lack of education or information on pregnancy, child birth, lack of skilled or professionals-midwives, birth attendants are the numerous social factors that contribute to the rocketing rate of maternal death in Ghana. In some communities there is no health facility at all, where there is health facility, the roads are too bad or there are few cars to transport pregnant women to the health centre during emergency. In some cases too, there is lack of water or electricity in some of health facilities. In other cases too there is lack of drugs for the pregnant woman suffering complications.
Again, there are times when there are delays before a pregnant women gets to the nearest health care centre as result of inability to recognize early pregnacy related emergency. In some cases, there are some delays at some health facilities due to lack or shortage of professionals or skilled midwives. Most trained professionals refuse to live and serve rural communities. Some also migrate to the West to seek greener pastures because of low income at home.
Economically, Poverty plays a major role in maternal death. There is a correlation between poverty and maternal mortality as poor pregnant women and their families have less money for adequate health care services such as drugs etc. Affording a balanced diet or three square meals a day is another challenge for the poor pregnant woman due to lack of money.
Politically, political will and commitment is not strong enough to create or implement policies on maternal mortality .Where there are projects, programmes and policies on Maternal Health, there exist weak or zero systems or plans to monitor and evaluate progress of maternal health programmes.
Maternal Mortality affects every of sector society and the optimum development of any country as the socio-cultural, economic and political development of any nation depends largely on the good health of its women and children.
Socio-culturally, women play a vital role in socialization, teaching of values and ethics to children. As many babies loose their mothers to maternal mortality, their survival is threatened, their personal development may be stunted, and social structures may fail because women are not there to guide and develop them -- be they schools, social services, women helping women.
Economically and politically women contribute effectively as economists, ministers, policy makers to mention a few.
What is being done to save mothers in Ghana individually, locally and internationally? Since the 1990s the Ghana Government introduced some interventions to reduce maternal mortality. They include: -Safe-Motherhood Initiative where at the grass root levels, in various district hospitals, clinics and health centres women can access antenatal care, labour and delivery care, postnatal care, family planning, prevention and management of unsafe abortions, and health education. These interventions are to help make pregnancy and child birth safer in Ghana - Prevention of Maternal Mortality Programme (PMM). This programme focuses on interventions that improve the availability, quality and utilization of emergency obstetric care. Activities range from improving services at health facilities to improving access to care. - Making Pregnancy Safer Initiative. This include care during pregnancy and involves Antenatal Care, Treatment of Severe anaemia, Treatment of syphilis, Treatment of other STDs such as gonorrhea, Chlamydia, and Treatment of malaria; -Again, the policy provides for delivery by skilled birth attendant including routine newborn care, management of eclampsia, management of postpartum haemorrhage, management of obstructed labour, Caesarean delivery Management of sepsis, management of basic of newborn complications, postpartum care management of abortion complication, and management of post surgical care. There is also postpartum family planning including condom, depo-provera, and IUD, norplant, oral contraception, and sterilization; maternal and neonatal health programme, antenatal care, labour and delivery care, postnatal care, etc.
In 1998, the Ghana Government again introduced free antenatal care to all pregnant women and in September 2003, a policy of exempting all users from delivery fees in health facilities was introduced.
In July 2008, to further increase efforts to reduce maternal mortality the government of Ghana granted free access to maternal health care for all women, covering them from pregnancy through to one year after birth.
Tightening our belts
Although the above mentioned policies and programmes that target reducing maternal mortality in Ghana exist, there are still many more women who cannot afford or access quality medical health care that they need during emergency. There is therefore the need to review as well as strengthen existing maternal mortality policies, interventions, strategies locally and globally through socio-cultural, economic and political means.
Socio-culturally, more projects and programmes should be introduced to educate people on traditional beliefs, practices that threaten the health of a pregnant girl or woman. There should be increased information on maternal health for girls and women. More health centres, clinics and hospitals should be built to serve communities. Roads should be constructed and new transportation systems should be put in place for pregnant girls, women and their families to easily access health facilities and services. Again, we need to train more professionals and treat them well.
Economically, the national budget should respect maternal mortality programmes, projects and policies for effective delivery. There is also the need to empower women economically through girls’ education and helping them acquire entrepreneurial skills. Educated pregnant girls and women take better care of themselves during pregnancy. Economically empowered women are also able to afford quality maternal health care during pregnancy or emergency as compared to poor women.
Reducing maternal mortality calls for international and local political commitment to support adopted strategies for -All girls and women access drugs, free medical care, information and education on pregnancy; -Pregnant girls and women to have access to skilled care at the time of birth -All those with complications have timely access to quality emergency obstetric care There should also be systems to monitor and evaluate existing policies on maternal health and ensure that polices are not only on paper but effective.
On the international front both action plans from the International Conference on Population and Development and the Millennium Development Goals to reduce about 75 per cent of maternal mortality between 1990 and 2015 worldwide should be carried out religiously.
The international community can help by supporting projects and programmes in developing countries like Ghana that aim at reducing maternal mortality.
Making motherhood safe is urgent, critical and wise as we need mothers alive and healthy. No country can attain optimum development without healthy mothers to nurture their babies, groom and educate their children and to contribute positively to national development.
As Obama’s government pumps money into family planning around the world will it trickle down to mothers like Lariba? "Intervensions like free medical care for all women like myself is not only necessary but the best thing for women like us" says Lariba.
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