Story: Jasmine Afari-Mintah
Maternal mortality remains one of the major health challenges that retard the human resource development of the country.
Although the current martenal mortality ratio is unknown, it is estimated to be between 214 and 540 per 100,000 live births.
Between 2006 and 2007, institutional maternal mortality was 197/100,000 live births.
The maternal mortality ratio indicates the risk of death a woman faces with each pregnancy. In settings with high fertility, such as sub-Saharan Africa, women face this risk many times in their lifetime.
According to the World Health Organisation (WHO), the probability that a 15-year-old girl will die from a complication related to pregnancy and childbirth during her lifetime is highest in Africa: 1 in 26.
Statistics indicates that about 585,000 maternal deaths occur globally every year, and 99 per cent of these deaths are in developing countries.
Such deaths, are as a result of unsafe abortion, pregnancy-related complications and unplanned or unwanted pregnancy by women.
To achieve MDG 5 and reduce the maternal mortality ratio by three quarters before 2015, improving health care for women and providing universal access to reproductive health services must be prioritised. This includes access to family planning, prevention of unplanned pregnancies and provision of high-quality pregnancy and delivery care, including emergency obstetric care.
While an annual decline of 5.5 per cent in maternal mortality ratios between 1990 and 2015 is required to achieve MDG 5, figures released by WHO, UNICEF, UNFPA and The World Bank show an annual decline of less than one per cent. In 2005, 536,000 women died of maternal causes, compared to 576,000 in 1990. Ninety-nine per cent of these deaths occurred in developing countries.
The maternal mortality ratio in 2005 was highest in developing regions, with 450 maternal deaths per 100,000 live births, in stark contrast to 9 in developed regions and 51 in the countries of the Commonwealth of Independent States.
Experts on reproductive health have painted a bleak picture of maternal and child health in Africa and warned that the situation could worsen in the next decade if no immediate remedial actions were taken by African governments and development partners.
According to a WHO-sponsored study made available at a regional workshop on improving maternal and neonatal health in Zimbabwe, neonatal morbidity and mortality rates is currently estimated at 45 deaths per 1,000 live births and contribute about 50 per cent of the infant mortality rate in the regions.
“Only 42 per cent of births in the African region are attended by skilled personnel,” an expert at the regional conference on maternal and new-born health in Zimbabwe revealed. Unsafe abortions are also high among adolescents, according to him.
“The percentage of gross domestic product devoted to health in sub-Saharan Africa remains at between one percent and 3.7 per cent compared to the large percentage spent on arms,” they conveyed.
“If nothing is done to arrest the trend (of high and growing maternal and child deaths), it is estimated that there will be 2.5 million maternal deaths, 2.5 million child deaths and 49 million maternal disabilities in the region over the next 10 years”, Prof. Joseph Kasonde noted.
He states that more than half of the 600,000 women who die every year from pregnancy-related causes were in the African region which constitutes only 12 per cent of the world’s population and 17% of its births. Maternal mortality ratio in Africa remains the highest in the world with the average actually increasing from 870 per 100,000 live births in 1990 to 1,000 per 100,000 live births in 2001.
In response to the aforementioned factors militating against the attainment of the MDG 5, the Minister of Health, Major Courage Quashigah at a recent Health Summit held in April this year, declared martenal mortality an emmergency issue in the country.
He has, therefore, inaugurated a task team to ensure the reduction of maternal mortality.
The task team would mobilise additional resources for maternity care,
identify areas for technical support to strengthen implementation actions for the reduction of maternal mortality, define milestones for the implementers to reduce maternal deaths and monitor progress being made in the reduction of maternal mortality in the country.
The health minister tasked the team to focus on the strategies to ensure that the country doubled the coverage of supervised deliveries from the current low level of 35 per cent to 70 per cent.
He said ensuring that women delivered in a safe environment and by competent health professionals was a human rights issue.
“It is also a developmental issue since that is the only way we can ensure that we have healthy and productive Ghanaian population,” he said.
Major Quashigah observed that Ghana’s high maternal mortality rate could be reduced if the greater proportion of pregnant women were delivered by trained midwives.
He said the current supervised delivery coverage of 35 per cent was unacceptably low.
He expressed worry that although the situation was a major problem in Africa, few African countries had developed comprehensive polices and instituted national programmes in that direction.
He said the risk of maternal deaths posed both medical and social problems that could be effectively tackled in a developmental context.
However, he noted that health services can only help when women were able to make use of them explaining that when obstetric emergencies arose during pregnancy and delivery, the importance of recognising danger signs and seeking care quickly was critical.
Major Quashiga added that the President was committed to making deliveries free at the various health facilities through the National Health Insurance Scheme (NHIS).
Specifically, he said, “ We will exempt pregnant women from paying NHIS premiums. We will also waive the up to six month mandatory waiting period under the NHIS to enable pregnant women enjoy free services”.
A member of the task team for the maternal mortality, Mrs Virginia Ofusu-Amoah, said the team would work closely with the Ministry of Health to monitor the progress being made in the reduction in maternal mortality in the country.
Mrs Ofosu-Amoah who is also the chairperson of the National Population Council observed that socio-cultural barriers prevented access to maternity services and created delays at the community levels, adding that the team would ensure that the maternal mortality was reduced.
The Deputy Minister of Health, Mr Abraham Odoom, for his part said it was important to train quality midwives to enable the country to meet its Millennium Development Goals before 2015.
Mr Odoom said about 40 midwives from the University for Development Studies would be sponsored to Israel for training to enable them to acquire skills in health delivery.
The country’s efforts to reduce maternal mortality received a major boost when on July 1st, His Excellency the President declared maternal care including deliveries free at point of service delivery.
With this policy, which is being implemented through the National Health Insurance Scheme, Ghanaians are expecting to hear good news when women go to the labour wards.
However, this policy is unlikely to be sufficient to double supervised deliveries by 2010 if we do not implement concurrent strategies.
The majority of these deaths are among the poor and un-educated women. Empowering them will ensure that they make informed decisions about when to seek help without waiting endlessly for the man to come back from work before the woman is taken to the hospital.
Additionally, most of these women need prenatal check-ups and immediate treatment of diseases like malaria and anaemia. In addition to having a skilled attendant during delivery, it is also important for women with complications to reach emergency obstetric care services in time.
There is the need to sensitise men to get more involved in maternal health.
There is also the need for government to support traditional birth attendants in rural places in Africa and to increase resources for reproductive health.
It is hoped that the free delivery policy will reduce the financial barriers that women face particularly those in the Brong-Ahafo region (the hardest hit region) in accessing health services.