“My mom is my best friend but has never let ourfriendship get in the way of her great parenting. I love everything my mother has taught me and passed on because now that I have become a mother myself; I hope I become half the mother and woman she is today”
Such is the joy of motherhood. As the world celebrates ‘world mother’s day’, the question is how safe is motherhood!
Maternal mortality at the end of a decade: signs of progress?
Millions of Mothers Lost. Once a minute, somewhere in the world, a woman dies in pregnancy or childbirth. The tragedy, says Kim Cochrane, is that most of these deaths could be prevented.
There is horrendous worldwide statistics surrounding maternal mortality: the fact that a woman dies in pregnancy or childbirth each minute, which adds up to a conservative estimate of 536,000 maternal deaths each year - some believe the toll could be as high as 872,000. While one in 8,200 women in the UK dies in pregnancy or childbirth, in the poorest, most conflict-ridden countries, including Niger, Mghanistan and Sierra Leone, that figure rises to a stark, inexcusable, one in eight.
Examples of as woman haemorrhages to death as she lies screaming in agony in a Spartan hut in a remote region of Mghanistan abound. There is no doctor or midwife to help and the hospital is several days journey away.
The story ofYeruknesh Mesfin’s death starts on the day of her birth, in an Ethiopian village so remote that its name, Goradit, literally means “cut off’”. At 10 days old, Mesfin was circumcised by a local woman, and by the age of seven, with no education, she was put to work looking after her family’s cattle. At 13, she was abducted and raped by a 32-year-old farmer, who married her; soon afterwards, she became pregnant. Without any medical advice during the whole nine months, she went into labour, “clutching her pillow, calling repeatedly for her mother while tears flowed down her cheeks”. Her husband called for help, but the complications proved too difficult for the village’s traditional birth attendant. In desperation, the men of the village carried Mesfm to the nearest hospital, where both she and her baby died. She was 15. This sad story is repeated in several remote and not so remote villages in Africa and some Asian countries and generally developing or the so called 3rd world countries.
The Challenge
The complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. It is estimated that around 529,000 women die each year from maternal causes. And for every woman who dies, approximately 20 more suffer injuries, infection and disabilities in pregnancy or childbirth. This means that at least 10 million women a year incur this type of damage.
The most common fatal complication is post-partum haemorrhage. Sepsis, complications of unsafe abortion, prolonged or obstructed labour and the hypertensive disorders of pregnancy, especially eclampsia, claim further lives~ These complications, which can occur at any time during pregnancy and childbirth without forewarning, require prompt access to quality obstetric services equipped to provide lifesaving drugs, antibiotics and transfusions and to perform the caesarean sections and other surgical interventions that prevent deaths from obstructed labour, eclampsia and intractable haemorrhage.
The foundations for maternal risk are often laid in girlhood. Women whose growth has been stunted by chronic malnutrition are vulnerable to obstructed labour, Anaemia predisposes to haemorrhage and sepsis during delivery and has been implicated in at least 20 per cent of post­partum maternal deaths in Africa and Asia, The risk of childbirth is even greater for women who have undergone female genital mutilation, with an estimated 2 million girls mutilated every year,
The factors that cause maternal morbidity and death also affect the survival chances of the foetus and newborn, leading to an estimated 8 million infant deaths a year (over half of them foetal deaths) occurring just before or during delivery or in the first week of life.
During the 1990s, a number of international conferences set goals for a reduction of maternal mortality. In 1999, during appraisal of the implementation of the Cairo Programme of Action, a reduction in maternal mortality was reiterated to be a high priority and countries agreed to strengthen information systems further to permit regular monitoring of maternal mortality. The reduction in maternal mortality was adopted as an International Development Goal’by the United Nations (UN), the Organisation for Economic Cooperation and Development, the International Monetary Fund, and the World Bank and endorsed by 149 heads of state at the Millennium Summit in 2000. This unprecedented global consensus creates additional stimulus for accurate monitoring of progress in the attainment of this goal in individual countries and across the world. Goal setting presupposes the ability to monitor progress; unfortunately, in the case of maternal mortality, this has proved to be a greater challenge than might have been anticipated. With the 1990s now behind us, and with several years of country data upon which to draw, this is an opportune moment to assess what progress has been made.
Abstract Maternal mortality is an important measure of women’s health and indicative of the performance of health care systems. Several international conferences, most recently the Millennium Summit in 2000, have included the goal of reducing maternal mortality. However, monitoring progress towards the goal has proved to be problematic because maternal mortality is difficult to measure, especially in developing countries with weak health information and vital registration systems. This has led to interest in using alternative indicators for monitoring progress. Recent trends in two indicators associated with maternal mortality are: the percentage of births assisted by a skilled health care worker and rates of caesarean delivery. Globally, modest improvements in coverage of skilled care at delivery have occurred, with an average annual increase of 1.7 per cent over the period 1989-99. Progress has been greatest in Asia, the Middle East and North Africa, with annual increases of over two per cent. In sub-Saharan Africa, on the other hand, coverage has stagnated. In general, caesarean delivery rates were stable over the 1990s. Countries where rates of caesarean deliveries were the lowest-and where the needs were greatest-showed the least change. This analysis leads us to conclude that whereas there may be grounds for optimism regarding trends in maternal mortality in parts of North Africa, Latin America, Asia, and the Middle East, the situation in sub-Saharan Africa remains disquieting.
Experience has shown that reducing maternal mortality depends critically on the availability. and use of obstetric care for managing complications. Unfortunately, data on this remain extremely limited at present. Current estimates indicate that globally, skilled attendants assist only around 56 per cent of births (WHO and UNICEF databases). The lowest levels in developing countries are in South Asia (29 per cent) and sub-Saharan Africa (37 per cent). The highest levels are in Latin America and the Caribbean (83per cent) and the Central and Eastern Europe/Commonwealth of Independent States regions (94 per cent). only six (Ghana, Guinea, Niger, Nigeria, Senegal, and Togo) have significantly increased levels of overage since 1988. The percentage of births assisted by a skilled attendant and the rates of caesarean delivery, taken together, they appear to show that while progress has been generally slow, most parts of the world have succeeded in increasing the use of medical care at deliveries. The exception is sub-Saharan Africa as a whole, where, despite progress in a few countries, in general coverage has stagnated or, in several countries, actually declined.
Only a few developing countries, accounting for 24 per centoflive births worldwide, have complete vital registration, according to the UN. In these countries, while there has been a decline in maternal mortality, most of the decrease took place during the 1970s and early 1980s. Since then, progress appears to have slowed despite the increased interest in the issue generated around the Safe Motherhood Initiative, which started in 1987.
Data currently available suggest that there may be grounds for optimism regarding trends in maternal mortality in parts of North Africa, Latin America, Asia, and the Middle East. In contrast, the situation in large parts of sub-Saharan Africa is disquieting, with unchanged or declining levels of coverage of skilled care for women during the crucial period of childbirth. This is a particular cause for concern in settings with high prevalence of HIVIAIDS, where the need for skilled care during labour and childbirth is critical.
In 1999, at the Special Session of the UN General Assembly, to mark five years after the International Conference on Population and Development held in Cairo, Egypt, it was agreed that all countries should strive to ensure that 80 per cent of deliveries are assisted by a skilled attendant by 2005. Based on current trends, only countries of Latin America and the Caribbean will attain this goal. Countries in the Middle East and North Africa will not reach the goal until around 2010 and Asian countries as a whole will fall short of the goal even in 2015. In sub-Saharan Africa, there is no overall sign of progress towards the 2015 goal. If the validity of using process indicators to monitor trends in maternal mortality is accepted, we must conclude that while there have been modest improvements in Asia, the Middle East, and North Africa it is likely that levels of maternal mortality in sub-Saharan African countries have remained unchanged or have even deteriorated.
 

©2005 New Nigerian Newspapers Limited.