Tuesday, February 4, 2014

Maternal mortality: Malawi’s Steps Towards 115 Deaths

A decree, introduced in the country without the involvement of the National Assembly, the Legislature and the Judiciary, has come to be embraced without the slightest hint of protest; a decree that, out of 100, 000 expectant women, 460 have to die!

Still, 100, 000 women still fall pregnant and hope against the statistics that they will live! Such is the paradox facing Malawi’s safe motherhood scene.

“The situation is so ironic that it could easily be equated to the frantic efforts of family members who cannot face up to the reality that their relative is technically dead, and advises medical workers to keep their man on life support machine on the fallacious reasoning that it is better to have a dead relative alive than live with the memories of a dead one,” Michael Mandele Chanza, a Malawian sexual reproductive health expert who works in Kenya’s capital, Nairobi, observed in a writen response on Thursday.

But Mandele-Chanza was quick to point out that balancing the efforts between hope and fact can be a strange, and great, battle, observing, however, that it was imperative for Malawians to be deeply sensible of the imposibility of achieving a zero-mortality rate in the world.

Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. The data are estimated with a regression model using information on fertility, birth attendants, and HIV prevalence.

“But, somewhere along the line, we come to accept and embrace the fact that it is natural to die. But death becomes painful when it occurs without medical workers’ best efforts and, in the case of pregnant women, it pains when they die because they did not go to the hospital in time, or proclastinated. It is painful because they (the women) did not give medical practitioners a chance to put their best efforts,” Mandele-Chanza added.

He said, while death will always prick the skin of people, it was still possible to minimise cases of unnecessary deaths, and pointed at increasing access to healthcare services as one of the strategies through which maternal mortality rates can be reigned in.

However, while the Ministry of Health has been providig Sexual Reproductive Health (SRH) services, including maternal and new-born health care, since independence in 1964, the death rate shows no sign of abating.

Information on Safe Motherhood, sourced from the Ministry of Health, indicated that, despite all efforts, the maternal mortality remains at 675 per 100, 000 live births, with 56 percent of the deaths occuring in the Southern Region, 26 percent in the Central Region, and 17 percent in the Northern Region of Malawi.

That means, while one in every 2,400 women were at risk of dying in the course of giving birth in the United States of America, it is a totally different case in Malawi, where one out of every 36 pregnant women have to throw the ghost away in the ironic process of giving life.

“This is mainly because of poor infrastructure and accessibility problems,” Catherine Gotani-Hara, the Health Minister, said on Monday last week. “But we are doing our best to reverse the situation.”

Among other strategies, Hara cites the ban imposed on TBAs, and renewed efforts to construct building and shelter meant for the accommodation of pregnant women and their guardians as good examples.

However, Gotani-Hara acknowledged that the ban on TBAs had attracted its own problems.

“One of the problems with are grappling with is that of congestion. The ban (imposed on TBAs) has lead to an upsurge in the number of women who flock to the hospital as time for labour approaches. Our position, however, is that it is better to have women at the hospital than at home. We don’t want women to die while delivering at home,” Gotani-Hara said.

The International Federation of Gynecology and Obstetrics reported on its website in April that the maternal mortality rate in Malawi registered a “significant decrease in 2012-13”, observing that the rate had been “reduced from 675 maternal deaths per 100,000 live births to 460 per 100,000”.

However, the change is not happening fast enough to meet the United Nations’ Millennium Development Goal 5, which seeks to reduce global maternal mortality rates to “one-quarter of 1990 levels by 2015”.

To many countries, even those that speak the same language, one-quarter means different figures.

For instance, President Joyce Banda told people who gathered at Ntcheu District Hospital’s dusty grounds on Monday that, for Malawi, the one-quarter means reducing the death rate from 460 to 115 death per 100, 000 deaths.

The Maternal mortality ratio in Malawi was last reported at 460 in 2010, according to a World Bank report published in 2012.

“But, while we have managed to reduce the rate to 460- this is a figure based on latest United Nations findings, by the way- it is still unacceptable that women should die in the process of giving birth. Even the 115 (deaths) target established in the Millennium Development Goals is also unacceptable,” Banda said.

Banda said she could not comprehend how pregnancy among local women marks the departure point from peace-of-the-mind to anxiety. She said, in developed countries, labour time was hopeful time, as characterised by purchases of clothes before the child is born- locally mocked as Kugula Mbereko Mwana Asadabadwe.

Banda, then, shared her own life story, and disclosed that she nearly died while giving birth in 1984.

“I suffered from post-partum haemorage and lost a lot of blood. I was only saved by the timely intervention of my husband’s gaenacologist friend, Dr. John Chiphangu after my husband sought him out,” Banda told a touched audience.

For her troubles in 1984, she spent seven days in hospital. And, for her troubles, she said she was glad to inherit the mantle when she was appointed African Union’s Goodwill Ambassador of Safe Motherhood.

The President said, without the gaenacologist’s effort, he would not have become President, and would merely have been a part of the obscure statistics of women who succumb to maternal complications.

The United Nations Population Fund, in a report released last week, observed that the Millennium Development Goals "most off track" for the scheme's 2015 target are those "directly linked to gender equality".

But Senior Chief Kwataine, chairperson for the Presidential Initiative on Maternal Health and Safe Motherhood, is confident that Malawi can bridge the gap between MDGs targets directly linked to gender equality and those that are not directly linked to the same.

“We have engaged an extra-gear, including the construction of shelters to ensure close monitoring of pregnant mothers and encouragement to seek quality maternal health care,” Kwataine said on Monday.

Kwataine said, in addition, the initiative is courting the private sector to train 1, 000 community midwives, the cosntruction of 130 maternity waiting shelters, and the training of 20, 000 traditional leaders.

“It’s a tall order, yes, but it can be achieved. That’s what we are doing at the moment: removing the huddles one step at a time, until we make one grand step and travel a thousand metres in our quest to stem maternal mortality rates,” Kwataine said.

Before that is achieved, however, 675 (is it 460?) have to die!

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