Maternal health is a critical issue that affects not just women, but entire communities and societies.
Despite progress in recent years, there are still many preventable deaths and complications related to pregnancy and childbirth, especially in low- and middle-income countries.
It is saddening to know that every two minutes, a woman dies during pregnancy or childbirth.
According to a new report from the World Health Organization (WHO), maternal deaths have either increased or deteriorated nearly everywhere, from 223 maternal deaths per 100,000 live births in 2020, down from 227 in 2015 and 339 in 2000.
Maternal mortality is unacceptably high. About 287 000 women died during and following pregnancy and childbirth in 2020. Almost 95% of all maternal deaths occurred in low and lower-middle-income countries in 2020, and most could have been prevented.
Many of these deaths occur in sub-Saharan African countries, making it the region with the greatest maternal mortality burden and there are concerns that these estimates may be underestimating the true number of maternal deaths.
One of the reasons for this is that many maternal deaths go unreported or misclassified. For example, deaths due to indirect causes, such as pre-existing medical conditions exacerbated by pregnancy, may not be recognized as maternal deaths. Additionally, deaths that occur outside of health facilities or during the postpartum period may not be captured in official statistics.
Meet 30-year-old Kiwala Zubeda, a resident of nkombe in Mayuge district eastern Uganda who explains how her young sister succumbed to pregnancy complications.
“It was the worst experience of our lives, especially after my 18-year-old sister passed on due to childbirth complications,” said Kiwala* about her recent trauma, which typified how maternal and child health can suffer in hard-to-reach areas.
Kiwala’s sister’s story started in early September when she was forced into marriage following her desire of dropping out of school. Compounding her misfortune was the fact that she was already pregnant as a result of having unprotected sex with her boyfriend.
My sister was attending antenatal at kombe health center II and everything was going on well, she narrated. One evening my brother-in-law comes to tell me that I was urgently needed by my sister. No sooner had I reached her place than I heard her scream in pain and bleeding endlessly something I felt was abnormal.
“I did not realize what was really happening to her,” said kiwala, recounting the experience. “I was just focusing on getting my sister to the hospital.”
Amidst the struggle of searching for the easiest means of transport to the hospital, we had to opt for a bicycle that wouldn’t maneuver quickly through the bumpy road to the hospital in time.
By the time we reached the hospital, her bleeding was intense and after a quick check-up we were informed by that her uterus had ruptured, they transferred us to Mayuge health centre iv for better treatment and operation to save the mother and baby.” Recounted Kiwala.
Unfortunately, we lost both mother and daughter, they would have made it if we had better means of transport and good roads. She concluded.
If we note what is happening and the lessons from the history of maternal death causes, a renewed push needs to be placed on expanding the referral and emergency obstetric care capacity of Ugandan and beyond health systems, including well-trained, incentivized, and supervised teams of community health workers, midwives, nurses, and doctors, to provide quality services to deal with direct obstetric complications, which occur around the time of childbirth and cause more than 60% of maternal deaths like hemorrhage, hypertensive disease, sepsis/infection, obstructed labor, and other direct causes.
To improve maternal mortality estimates, there are several strategies that can be employed. One approach is to strengthen vital registration systems in weak data collection countries. This includes improving the accuracy and completeness of death certificates and training health workers to correctly identify and classify maternal deaths.
Another strategy is to use multiple data sources to estimate maternal mortality. This includes conducting population-based surveys and using medical records and other sources of information to identify maternal deaths that may not be captured in official statistics.
Efforts should be made to address the underlying causes of maternal mortality, including improving access to quality maternal healthcare services, addressing social determinants of health, and reducing gender inequalities.
In a nutshell, improving maternal mortality estimates is crucial for tracking progress toward reducing maternal deaths and for identifying areas where additional attention has to be directed.
Compiled by Judith Grace Amoit.