A mother with her child. (File photo)
Most of us know someone who lost their life giving birth, or who died from pregnancy-related complications.
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.
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