Maternal mortality needs a multifaceted approach

Oct 29, 2009

Sixty-year-old Alice Nabulobi is perhaps one great grandmother whose family is haunted by maternal mortality through the generation.

By Frederick Womakuyu

Sixty-year-old Alice Nabulobi is perhaps one great grandmother whose family is haunted by maternal mortality through the generation.

A native of Kabeywa parish in Kapchorwa district, with no health centre, Nabulobi has lost a daughter, grand daughter and great-granddaughter — all during pregnancy or childbirth.

When her daughter Sarah — a mother of already seven children was pregnant, she failed to give birth.

She needed a Caesarean section, but because the nearest health centre was 40 kilometres and six hours away, over a mountainous terrain with no single means of transport, the local medicine men tried much to assist her deliver, but Sarah bled to death.

On another occasion, Nabulobi’s granddaughter Mary, a mother of five children was pregnant. With all the children at school and nobody to assist her, Mary went to fetch water over a hill ridge, but she slid and had a miscarriage. Mary fell sick for a week and never woke up again — she died.

Nabulobi’s family reveals the disparity and dire situation thousands of women undergo everyday during pregnancy and childbirth.

According to the United Nations Fund for Population Activities (UNFPA), each year, more than 500,000 women die globally from complications in pregnancy and childbirth.

Sixteen Ugandan women die per day while giving birth due to complications during pregnancy or delivery, according to the statistics from the ministry of health. As a result, Uganda is unlikely to achieve the Millennium Development Goal 5, which aims at reducing maternal morality by three quarters by the year 2015.

Uganda’s maternal mortality ratio remains high, at 435 deaths per 100,000 live births. Health experts say the major cause of mothers’ death is excessive bleeding after delivery. This is defined as blood loss greater than 500 milliliters during vaginal delivery or greater than 1,000 milliliters during ceasarean delivery.

In an attempt to reduce maternal deaths from bleeding, the Ministry of Health has started pilot projects on the use of the drug misoprostol, an effective and relatively cheap medicine by making it available to selected rural public health centres.

Health facilities in rural areas are inadequately equipped with staff, drugs and equipment necessary for safe deliveries. But also illiteracy of the rural poor compounds the problem. An uneducated woman may not know the importance of antenatal visits and delivery in the health centre. At 41%, unmet need for family planning is also hindering safe motherhood in Uganda.

At the UNFPA meeting on how to reduce maternal mortality in Addis Ababa last week, health ministers around the world agreed that swift action must be taken to reduce the number of women dying during pregnancy and childbirth.

The ministers seemed to agree that family planning was the cost-effective way of tackling the problem. Uganda should move swiftly to emphasise family planning to safeguard the health of mothers as well as have a national family planning policy to avert the problem.

For example in Busoga region, each woman produces an average of seven children. And the chances of such a woman dying during pregnancy or childbirth complications are high.

The unmet need for family planning stands at over 60% according to Family Life Education Programme dealing in family planning in Busoga under the Busoga Diocese.

The ministers also recognised that more investment was needed in primary and emergency healthcare to save the lives of both mothers and babies. This means more midwives need to be trained, paid well and sent to rural areas.

Without a multifaceted approach of family planning emphasis, poverty reduction, improvement of health care and reduction of illiteracy amongst women, we are fighting a lost war against maternal mortality. Let’s wake up and save our mothers.

The writer is a journalist

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