AFRICA -- Alarming Health Figures for Women

The scandal of maternal deaths is not only a matter of health care but also an issue of social justice. The risks that women face in bringing new life into the world are not just mere misfortunes or unavoidable natural disadvantages

Fifty years ago on April 7, 1948 the Constitution of the World Health Organisation (WHO) came into force. In pledging to improve the health of the peoples of the world, the founding member states also affirmed the need to pay special attention to the health of women and children and, in particular, that of mothers.

Pregnancy and childbirth are special events in women's lives, and in the lives of their families. This can be a time of great hope and joyful anticipation. It can also be a time of fear, suffering and even death. Every day, at least 1,600 women die from the complications of pregnancy and childbirth. That is a minimum of 585,000 women dying every year.

In addition, each year over 50 million more women suffer from complications during pregnancy or delivery, many of which lead to long-term debilitating health problems. Although pregnancy is not a disease, it does pose risks to the health and survival of a woman, in addition to the risks faced by the infant she bears.

These risks are present throughout the world and in every setting. In developed countries they very rarely lead to death or disability because every pregnant woman has access to special care during pregnancy and childbirth.

This is not the case in many developing countries where each pregnancy represents a journey into the unknown from which many women never return. "This situation cannot be allowed to continue," says Dr. Hiroshi Nakajima, former Director-General of the World Health Organisation. "We know what needs to be done to make motherhood safe and the resources needed are obtainable.

"Pregnant women need special care that is neither sophisticated nor very expensive. An investment of as little as US$3 per person could prevent most of these maternal and newborn deaths and disabilities. Women need care particularly at the critical time of birth to help ensure that childbirth is a safe and joyful event."

The scandal of maternal deaths is not only a matter of health care but also an issue of social justice. The risks that women face in bringing new life into the world are not mere misfortunes or unavoidable natural disadvantages but rather injustices that societies have a duty to remedy through their political, health and legal systems.

There is therefore urgent need to stimulate countries to take a closer look at the position of women in society, including their access to resources, education and health care when they most need it. This must, of necessity, involve families, communities and societies as a whole and both the public and the private sectors.

The majority of deaths during pregnancy and childbirth - almost 90 per cent - occur in Asia and sub-Saharan Africa; approximately 10 per cent in developing countries in other regions; and less than one per cent in the developed world. In many developing countries between a quarter to one-third of all deaths of reproductive age women are a result of complications of pregnancy or childbirth. Of all the health statistics monitored by the World Health Organisation, maternal mortality is the one with the largest discrepancy between developed and developing countries. For example, in the developing world, infant mortality is about seven times higher than in developed countries whereas maternal mortality is about 18 times higher.

Burden of disease

For every woman who dies, many more suffer from debilitating longer term health problems as a result of complications during pregnancy or childbirth.

Long-term complications include uterine prolapse, fistulae, incontinence, pain during intercourse and infertility. Problems such as these currently affect as many as 300 million women.

Up to 80,000 women each year develop fistulae - holes in the birth canal that allow leakage of urine or faeces from the bladder or rectum, making a women permanently incontinent. Between 500,000 and one million women are currently living with fistulae and are unable to reach medical care where fistulae can be repaired. Many of these women become social outcasts turned out of homes and rejected by their husbands and families. Obstructed labour - one of the most common complications - can result in permanent nerve damage and muscle deterioration in the feet and legs; women worst affected become crippled.

The facts and figures

Globally, there are 430 maternal deaths for every 100,000 live births. In developing countries, the figure is 480 maternal deaths for every 100,000 live births; in developed countries there 27 maternal deaths for every 100,000 live births. In Africa, one woman in 16 will die of pregnancy-related causes compared with one in 65 in Asia , one in 130 in Latin America and one in 1,800 in developed countries as a whole. In addition to maternal deaths, the majority of stillbirths and newborn deaths could be avoided with improved maternal health, adequate nutrition and the right care during pregnancy and delivery.

Each year, nearly 8 million stillbirths and newborn deaths occur, largely the result of the same factors that cause the death and disability of mothers - poor maternal health, inadequate care, poor hygiene and inappropriate management of delivery, as well as lack of newborn care.

Each year, 60 million births take place in which the woman is cared for only by a family member, an untrained traditional birth attendant - or no one at all. Only 53 per cent of deliveries in developing countries take place with the assistance of a skilled birth attendant (a doctor, midwife or other person with midwifery skills).

Only a small proportion of women in developing countries - less than 30 per cent - receive care after the baby is born (postpartum care), yet this is the time when most deaths occur.

In very poor countries and regions, as few as five per cent of women receive such care. In developed countries, 90 per cent of new mothers receive postpartum care.

Millions of women in developing countries lack access to adequate care during pregnancy. Only 65 per cent of women in developing countries receive ante-natal care at least once during pregnancy.

The figures are 63 per cent in Africa; 65 per cent in Asia; and 73 per cent in Latin America and the Caribbean. In developed countries, 97 per cent of women receive ante-natal care, usually several visits during the course of each pregnancy. (Africa News, November 19, 2001)