Mothers are Dying

From the time you had your morning coffee today until the same time tomorrow, 1,450 women will have died from complications of pregnancy and childbirth. Most of these women (90%) lived in sub-Saharan Africa and Asia (UNICEF, 1996). Put another way, a woman in Africa has a lifetime risk of 1 in 16 of dying from pregnancy-related complications. IN the industrialized world, it is 1 in 4,000 (UNICEF, 2003).

Consider sixteen of your female acquaintances. If they lived under the conditions of Africa, one of them would be destined to die from maternity complications. By contrast, most North Americans and Europeans will simply never know a woman who dies in such a manner. Incredibly, in the 20th century, this stubborn scourge killed more than tuberculosis, suicide, traffic accidents, and AIDS combined. More women died from childbirth complications than the number of men killed in both world wars.

These dead women also leave many children without mothers. And many of those women who do survive have a fistula, a torn birth canal that leaves them incontinent: women who will be thrown out of their families and villages, like lepers.

Women's lifetime risks of dying from
pregnancy-related complications
(WHO, UNICEF, UNFPA estimates 2000)

Obstacles to Safe Motherhood
The death of a mother is complicated by many factors and obstacles. Think of a mother's death as the result of one of these three delays: the first delay is in the decision to seek care, the second is the delay in reaching the appropriate medical facilities and the final is at the level of the health care system itself.

The first delay in deciding to seek care is influenced by many things: the pregnant woman may not be able to seek care. She may have to wait for her husband or mother-in-law to allow her to go. The woman and her family may not recognize that there is a serious problem until it is too late. There may be many cultural expectations and prejudices which prevent mothers from seeking care. For example, in some cultures, pregnant mothers are thought to be in a battle. Any woman who does not deliver naturally, is seen as a failure. She lost the battle.

The second delay is a result of lack of transportation or communication which are necessary for the mother to reach the care she needs. There may be no vehicle available or the roads may be washed out by the rain. In order for the mother's life to be saved, she must be able to get to the medical facility in time.

The final delay: once the birthing mother arrives at the health center, it is just as important that she accesses the proper emergency care services needed. Sometimes, there are no medical staff available, the pharmacy is empty or no blood is ready for an emergency transfusion. These delays can lead to a mother's death.

Why Do Mothers Die?
The largest cause of mothers dying from pregnancy complications is severe bleeding. One in four deaths result from haemorrhaging that can often be prevented by medication costing less than a coffee. Other causes include infection (15%) and high blood pressure in pregnancy (12%). Most of these causes are preventable.

CAUSES of Maternal Mortality (WHO, 1997)
(% of total maternal deaths)

At the heart of the issue is that about half of all women in developing countries don't have a skilled birth attendant at their delivery. They may have an untrained traditional birth attendant, or their mother-in-law. Or they may be on their own.

A Global Picture (WHO, 1997)

The death of a mother severely reduces the chance of her child's survival. Approximately four million neonatal deaths and stillbirths are caused by inadequate maternal care during pregnancy and delivery (WHO). The death of one mother and her infant often leaves a family of orphans. When a mother dies, her surviving children are 3 to 10 times more likely to die within 2 years than children who live with both parents (WHO, 1998).

The Need for a Broad Based Approach
The hindrances to maternal care are many, yet none are impossible to overcome. These include distance from health services, finances (cost of treatment, transportation), lack of drugs and supplies, excessive demands on women's time, and women's lack of decision-making power within their families. In certain situations, the treatment provided by the health care team is substandard, and so it is shunned by pregnant mothers.

Women, themselves, must be better educated and gain increasing power over their own health choices. The local and national governments need to take active steps in elevating the status of women within their district and country. The media is an important tool to educate the public and lobby for mothers' health and rights.

All pregnant mothers should have access to emergency obstetrical care. his care includes trained midwives who will provide services at village posts. It is preferable to have local women trained as midwives to ensure their commitment to the region. These midwives need a functional referral system when they must transfer a patient in trouble. This means that a hospital with competent physicians and staff is ready to receive and treat complicated patients.

In addition, the referral system requires both a communication component (e.g., two-way radio) and emergency transportation (e.g., motorized ambulance, cycles or a roster of local vehicles to be designated for this purpose). Outpost clinics and hospitals must be stocked with areliable source of drugs and equipment. Coca-Cola successfully reaches these remote areas!

One strategy will not meet all the needs within a community. A wholistic plan must be tailored to the individual district. The community must be mobilized and take a significant stand on the importance of safe motherhood. It needs to be seen as a social norm and not a random happening.