|Home | Contact us | Links | Archives | Search|
Global Maternal Mortality Crisis Unnoticed
By Madeleine Brindley, Western Mail
A woman dies every minute in pregnancy or childbirth somewhere in the world – mainly in the 75 poorest countries where access to trained professionals and cheap but effective medicines is scarce. Health Editor Madeleine Brindley spoke to two Welsh women – MEP Glenys Kinnock and nurse Angela Gorman – who are trying to make a difference
Cardiff , Sep 15 2008 – CHILDBIRTH for the majority of women, in the developed West at least, is a joyous occasion and a time of celebration at the prospect of a new life.
But in the world's 75 poorest countries – largely in Africa and South-East Asia – childbirth is a deadly event, which claims the lives of more than half-a-million women every year.
In the world's poorest and most conflict-torn countries a women's lifetime risk of dying in childbirth is one in eight – 500 times higher than that in Wales . In some parts of the world, such as Afghanistan , it is one in four.
And for every death, around 30 more women will be left disabled.
Both Euro MP Glenys Kinnock, who is campaigning for women throughout the world to have the same healthcare as expectant mothers in the West, and Angela Gorman, a Cardiff nurse who set up the Hope for Grace Kodindo Trust to work in the Third World, initially in Chad, to improve conditions for mothers-to-be, have horror stories which – in the words of the former – will make most people's blood run cold.
Indeed, there was a saying in Chad – the initial focus of Ms Gorman's trust – that a pregnant woman has one foot in the grave.
Mrs Kinnock said: “A few years ago I met a woman in Tanzania who was heavily pregnant and had four of five children. She said that every time that she went into labor she said goodbye and hugged each of her children.
“I have seen and have spoken to husbands who have desperately tried to take their wives to some help – one man's wife died in a wheelbarrow. He was so ashamed that this had happened to his wife. His grieving was made even worse because of the memory of that.
“There was a woman in a hospital in Madagascar recently, who had a botched-up Caesarean. She had come back to this terrible clinic and was dying of septicaemia in terrible conditions. These things should not be allowed to happen.”
Women die in childbirth because of a lack of basic healthcare. Where maternal clinics are available they are often over-stretched, struggling to cope with an acute shortage of birth attendants and lack of equipment.
In the developing world most women give birth without even this bare minimum of assistance. Complications during pregnancy – in Chad , eclampsia, which is rarely seen in the UK , is a common and deadly complication – are often detected late and when they occur there is often no emergency travel to reach medical help.
There is also a dire shortage of the most simplest of medicines and equipment – some cost pennies – which could mean the difference between life or death.
Mrs Kinnock said: “One of the major factors is the lack of trained and skilled birth attendants, and 40% of women give birth without any assistance at all and the deaths are terrible to experience and see.”
And Ms Gorman, who will travel to Liberia next month and Somaliland in November, said: “Conditions vary from country to country. I had thought the problems were pretty universal, but in Chad it seemed that they had the doctors, what they didn't have were the medicines to treat the women. Once you provided the medicines, you were away.
“In one hospital where they look after 12,000 women a year, their mortality rate has dropped from 14% to 2.3%.
“In Liberia , it is a totally different problem, they have no medical staff and the midwifes have taken on roles for which they are not trained, they have done wrong things for the right reasons because there is nobody else there.
“On the first day when we were doing workshops there with the midwives, two women died – one from eclampsia and another woman was lying in the labour ward and I didn't even realise that she was dead initially. She had suffered an overwhelming infection following an illegal abortion.
“It's just a daily occurrence – it's tragic. After 32 years in nursing. I thought I'd seen everything, but I haven't. It's just incredible. We don't appreciate what we have in this country.
“We have been astounded at the success in Chad – it's going to be more difficult in Liberia , because they need the medicines and the medical staff, but we have to take the view we are going to achieve.
“Women go into the hospital in Chad not expecting to die, whereas a few years ago they expected to die.
“There are other countries that need our help. I've had requests from Sierra Leone , Uganda , Sudan – the need is huge. In Afghanistan one in four women are dying – it is dire.
“The sad part is it is achievable with relatively small resources, as we have shown.
“There's a lot of work to be done. I describe it as looking up at Everest and then you have to climb it, but we're not going to stop.”
These shocking levels of maternal mortality constitute a global health emergency, and yet, compared to other health crises, such as the global HIV/Aids epidemic, the plight facing pregnant women goes largely unnoticed, either in the wider world or by individual governments.
The international community signed up to a series of millennium development goals eight years ago. The fifth is specifically designed to improve maternal health.
The aspirational target, signed up to by 189 United Nations member states, is to reduce the maternal mortality ratio by three-quarters by 2015 and achieve universal access to reproductive health.
But despite this, the target is not being met.
Mrs Kinnock said: “In some cases things are going backwards – more women are dying.
“A statistic that is really shocking is that 20 years ago the figures were the same as they are now so that really shows that we're not giving the importance that we ought to these women's deaths, which leave grieving children and families.
“Their lives could be saved if this was problem was given enough political will to make this a priority.
“The international community has made a commitment for years now, but this year in particular it has been reiterated, to meet the commitments in the millennium development goals – all of them, on health and education and eradicating poverty by 2015.
“What Gordon Brown, in particular, was involved in doing at the G8 and in the Council of the European Union was to say we can't keep saying we're going to do it, we need to have benchmarks, we call to action.
“We say that in all our budgets we will increase over a two-yearly basis so when we reach 2010, we have made real headway.
“Some countries are not – the Italians, for instance, have a terrible record. The French are not doing very well and other countries are also guilty of reneging on the commitments they have made.”
The European Parliament this month acted to increase pressure on the international community as it called on the European Council and Commission to prioritize action on and increase funding for the fifth millennium development goal.
The resolution, which also calls for action to enable the training of and infrastructure for an adequate number of birth attendants, was co-authored by Mrs Kinnock.
At least part of the answer is to ensure that Third World countries have the necessary resources to properly equip maternal units and access to training and education to staff these units with appropriately qualified staff.
“We need to have funds – it is about money,” Mrs Kinnock said. “ Liberia is a very poor country, it hasn't long come out of a long and terrible civil war. Now they have a woman president who is extremely courageous and actively working to improve her country.
“But how can she do that without funds? Most of the day in Monrovia they have no electricity, no running water – how can you give healthcare in those circumstances?
“We need funds so governments can put in place a decent health system because the health infrastructure is very poor, especially in rural areas.
“You need to have a decent health system with trained staff – they don't all have to be doctors and obstetricians – there are ways of doing it that can work very fast. We know what needs to be done, we know how much it costs and, quite frankly, we also know what it costs if we don't do it and that's more and more lost lives.
“Most women who die in childbirth die from hemorrhaging. There is magnesium sulphate, which costs three cents and would save her life, but very often they don't have it.
ANGELA GORMAN met 38-year-old mother-of-five Zouzahbe at the General Reference Hospital in N'Djamena, the capital of Chad .
She was 36 weeks pregnant and unwell, with a high blood pressure and eclampsia – a life-threatening complication of pregnancy, which is rarely seen in the West, thanks to regular ante-natal check-ups.
Together with her husband and sister, she had travelled for nearly four hours in great discomfort to get to the hospital.
Her worried husband Gobnfanezouzahbe, a teacher, told Angela that they had already lost two babies in late miscarriages and a five-month-old child from malaria.
At the hospital Zouzahbe was treated free of charge with magnesium sulphate, which had been donated by Hope for Grace Kodindo, and her baby's heartbeat was checked with an electronic Doppler monitor, also donated by the charity.
Her blood pressure fell and she started to look better. Zouzahbe survived, but sadly her baby did not.
Angela met Gonfanezouzahbe outside the labor ward and despite his grief he insisted that God had sent them to his family.
Global effort for poorest
Oxfam Cymru has been working across the world to improve maternal mortality rates in some of the poorest nations.
The charity believes that change is possible even in low-income countries, for example women in Cuba, have nearly three times more chances of surviving pregnancy and childbirth than women in South Africa, a much richer country.
It works on the basis that a trained midwife is a basic right not a luxury.
Properly trained, paid and supported, midwives offer the most effective path to universal access to maternal healthcare.
In Yemen , Oxfam has been working with traditional birth attendants, providing midwifery training for them to improve their skills.
The programme was developed in response to a lack of midwives and the inability for many women to access healthcare. The difference midwives or trained birth attendants can make is clearly demonstrated in those countries which have achieved dramatic improvements in maternal health.
In Sri Lanka , where most of the population lives below the poverty line, the government made a commitment to strengthen the entire health-care delivery system.
This has produced a reliable referral systems for complicated deliveries, with health services, including family planning, offered free or at very low cost.
It also means that 97% of all births are attended by a skilled professional.
Just one more midwife could save the lives of 219 women. the World Health Organization estimated in 2005 that 700,000 more midwives needed over the next 10 years to achieve the fifth millennium development goal on maternal health.
On this basis Oxfam Cymru recommends:
An increase in aid delivery directly to health sectors in poor countries, by $36bn a year – $5bn extra for maternal health care to fund the 4.25m extra health workers and 700,000 midwives needed in developing countries;
Immediately abolishing user fees for pregnant women and children – as a first step towards free health care for all. Oxfam believes that encouraging free public health services is the best, and proven, way to help countries achieve the millennium development goals;
Scale up public health services – rich and poor women alike across the world chose public facilities over private to give birth. Investment in health must therefore focus on scaling up public not private health care.
As part of its latest drive to raise awareness of maternal mortality, Oxfam has been urging knitters to create nine inch squares, which will form a giant blanket. Each square will represent a mother who did not survive pregnancy or childbirth to be able to care for her baby, because she couldn't access the medical care she needed.
The blanket will be handed to the UK Government on Wednesday as a patchwork against poverty petition, to demand a world where everyone has access to free basic healthcare.
Once the petition has been presented, the blanket will be dismantled and sold in Oxfam shops and at festivals to help fund its current midwife training project in Yemen .