Ranks 135 in new State of the World's Mothers Report
A mother with her child. (File photo)
A friend of mine lost his wife last year while giving birth at the Muhimbili National Hospital. I used to think that in Dar es Salaam, maternal deaths only occurred to women who can not afford to pay for specialised care. Muhimbili hospital offers private services in its fast track unit and this is where my friend’s wife was attending clinic.
I just could not understand how she could die giving birth, given that she was receiving care in the hospital’s private unit with all specialists at her disposal. The couple had chosen Muhimbili given that it is the country’s major hospital and the fact that it also offers private services for those who can afford.
In another incidence, a colleague’s wife escaped death by a whisker after giving birth to her second child at the hospital. She was bleeding heavily and when the nurses who delivered her took her to the theatre, no one was ready to attend to her fearing to be held responsible if she died. A mother had died from excessive bleeding the previous day and people had been taken to task.
“It’s my wife’s surname that saved her. Her cousin used to work at the hospital and when staff in the theatre saw the name, they realised she was related to their former colleague and immediately attended to her. Otherwise she would have died,” says Henry.
Many mothers in Dar es Salaam die during pregnancy and childbirth. One wonders if this is happening in the capital city, how about in remote areas where services are poor?
Save the Children’s 14th annual State of the World’s Mothers report released on Tuesday, which looks at the mothers’ well being ranks Tanzania near the bottom of the list, at 135 out of 176 countries around the globe. The report highlights the challenges facing mothers and newborns worldwide.
The Mothers’ Index shows countries that are succeeding and those failing in their support to mothers. It assesses mothers’ well-being using indicators of maternal health, child mortality, education and levels of women’s income and political status.
Every year 454 women die from pregnancy related complications for every 100,000 live births in Tanzania. This translates to close to 8,000 women dying every year. And they die from conditions that could be prevented or treated.
Causes of maternal deaths in Tanzania include excessive bleeding, unsafe abortions, eclampsia, obstructed labour and infections. Low availability of emergency obstetric and new born care services, chronic shortage of skilled health providers together with a weak referral system contribute to the high maternal deaths.
According to Population Reference Bureau (PRB)’s 2011 ‘World’s Women and Girls’ data sheet, the lifetime chance of dying from maternal causes in Tanzania is one in 23.
Healthcare quality
According to Unicef, maternal deaths in Tanzania are caused by poor quality of care due to an insufficient number of skilled health workers and lack of basic equipment, as well as long distances from home to health care facilities.
Between 2004 and 2010, 24 per cent of mothers did not access health services due to lack of money to pay for the services while 19 per cent did not access care due to long distance to a health facility.
These two factors led to 48 per cent of all deliveries that occurred between 2005 and 2010 to take place at home.
Over half (65 per cent) of mothers did not receive postnatal check up and only 31 per cent were examined within two days as recommended. Most of those who did not receive postnatal services (76 per cent) came from poor families.
Women living in rural areas, those who come from the poorest families and those who are less educated, have the least access to skilled attendance at delivery, according to Unicef. Women who start having children in adolescence tend to have more children and shorter spacing between pregnancies – all of which are risk factors for maternal and neonatal mortality. The neonatal mortality rate is highest among mothers under-20 years of age at 45 per 1000 live births compared with 29 per 1000 for mothers aged 20 to 29 years.
According to Save the Children’s report, the Democratic Republic of Congo is the world’s toughest place to be a mother and Finland the best.
The Nordic countries sweep the top spots while, for the first time, countries in sub-Saharan Africa take up each of the bottom ten places in the annual list.
The top five countries in the global mothers’ ranking are: Finland, Sweden, Norway, Iceland and the Netherlands. The bottom five (in descending order) are: Niger, Mali, Sierra Leone, Somalia and the DRC.
According to Save the Children, the startling disparities between mothers in the developed and developing world are summed up around maternal risk. A woman or girl in DRC has a one in 30 chance of dying from maternal causes – including childbirth – but in Finland the risk is one in 12,200. In DRC, which performs poorly across all indicators, girls are likely to be educated for eight and a half years compared to Finland, where girls can expect to receive over sixteen years of education.
“By investing in mothers and children, nations are investing in their future prosperity. If women are educated, are represented politically, and have access to good quality maternal and child care, then they and their children are much more likely to survive and thrive – and so are the societies they live in. Huge progress has been made across the developing world, but much more can be done to save and improve millions of the poorest mothers and newborns’ lives,” says Save the Children.
Child deaths
The Birth Day Risk Index, also contained in Save the Children's report, compares first-day death rates for babies in 186 countries. One million babies die each year on the day they enter the world, – or two every minute – making the first day by far the riskiest day of a person’s life in almost every country in the world.
This is despite the low-cost interventions that are available to tackle the high rate of baby deaths on the first day of life. Sub-Saharan Africa remains by far the most dangerous region to be born – with the deaths of newborns actually increasing in the past few decades. Here, babies are more than seven times as likely to die on the day they are born as babies born in industrialised countries. A baby in Somalia, the most dangerous country, is 40 times more likely to die on its first day than a child born in Luxembourg, the safest.
According to the report, two thirds of all newborn deaths occur in just 10 countries: India, Nigeria, Pakistan, China, DR Congo, Ethiopia, Bangladesh, Indonesia, Afghanistan and Tanzania.
Infant mortality rate in Tanzania stands at 51 deaths per 1000 live births and neonatal mortality at 26 deaths per 1,000 live births. Neonatal deaths are inextricably linked to the health of the mother during pregnancy and to the conditions of delivery and newborn care.
Throughout sub-Saharan Africa, according to Save the Children, the poor health of mothers, where between 10 – 20 per cent are underweight, contributes to high rates of death for babies, as does the number of young mothers, giving birth before their bodies have matured. Other factors are low use of contraception, poor access to decent healthcare when pregnant and a severe shortage of health-workers.
Speaking of contraception use, 22 per cent of women who need to control birth in Tanzania do not have access to the service. By meeting this need, it is estimated that 1.4 million unintended pregnancies, 1 million abortions, 18,000 maternal deaths and 500,000 child deaths can be prevented if access to family planning is granted.
According to Health and Development Tanzania, allocations of funds for family planning services in Tanzania have not been meeting the estimated annual needs for the service. Releases of the funds have also been low and irregular hence affecting the provision of the service.
The solution
Save the Children’s report identifies four lifesaving products that can be used universally: corticosteroid injections to women in preterm labour to reduce deaths caused by newborns’ breathing problems; resuscitation devices to save babies who do not breathe at birth; chlorhexidine cord cleansing to prevent umbilical cord infections and injectable antibiotics to treat newborn sepsis and pneumonia.
Save the Children calls on world leaders to strengthen health systems so mothers have greater access to skilled birth attendants. They can provide lifesaving interventions to all mothers and children, in addition to providing more funding for maternal, newborn and child health programmes. More should be invested in frontline healthcare workers and community health workers to reach the most vulnerable mothers and babies.
The organization suggests fighting the underlying causes of newborn mortality, especially gender inequality and malnutrition. Helping mothers become strong and stable – physically, financially and socially – make their children stronger and more likely to survive and thrive.
Countries are also advised to invest in low-cost solutions that can dramatically reduce newborn mortality. Proper cord care and newborn/paediatric doses of antibiotics can prevent and treat simple but deadly infections. Exclusive breastfeeding and skin-to-skin contact (known as “kangaroo mother care”) should be encouraged.
Such practices cost very little but can save hundreds of thousands of babies’ lives each year. Additionally, birth attendants should be trained and given proper support and supplies.
SOURCE:
THE GUARDIAN
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