Banjul, October 29 The Gambia Journal
Weeks ago, a colleague who works with me on a consultancy for an international NGO failed to appear for a scheduled interview with a health official in Banjul. It so happened that his 22 year old sister who is married to an Italy-based Gambian died in child birth. Earlier a housewife who shares fence with the compound I live in told me her step-daughter married in the peri-urban town of Brufut also died while delivering twins at the Brufut clinic. Then just two days ago I was hurriedly called to the Royal Victoria Teaching Hospital in Banjul where my niece almost died while delivering a baby boy. This time she survived but the baby passed away. Maternal mortality remains high in The Gambia and the rest of Africa, and it seems little is being done to scale down the rates;
one death a minute - half a million fatalities a year. Unlike emergencies caused by natural disasters or armed conflict, maternal mortality does not make the headlines. The suffering that it creates goes unrecognized by the international media. Yet deaths during pregnancy and childbirth represent a widespread and systematic violation of basic rights. Each mother’s death is an individual tragedy, made inevitable by the inequalities which condition women’s lives. But the vast majority of cases have two things in common: they occur in developing countries like The Gambia, and they are avoidable. In The Gambia, even Government has admitted that is lagging behind in both its MDG and Vision 2020 goals of reducing infant and mortality rates by three-fourths by 2015.
The international community has pledged to meet certain Millennium Development Goals (MDGs) by the year 2015; among them is the commitment to reduce maternal mortality by three-quarters. That target is achievable – but on current trends, it will be missed by a wide mark. The governments of the world are failing to honor their obligations. And this is an area in which broken promises cost lives.
Most immediately, they cost the lives of pregnant women. Furthermore, problems in pregnancy and childbirth are implicated in more than the deaths of more than three million children each year, and in debilitating sickness for countless millions of women across the developing world. Women in sub-Saharan Africa account for a large share of the maternal-mortality statistics. They represent 14 per cent of the world’s women, but suffer half of all the deaths that occur during pregnancy and childbirth. In a rich country such as the United Kingdom, the lifetime risk of maternal death is 1 in 5,800. In Ethiopia the equivalent risk is 1:14. Across much of Africa and South Asia, pregnancy and childbirth represent the single biggest cause of mortality among women of child-bearing age.
High maternal death rates have multiple causes, but ultimately, they can be traced to deep-rooted inequalities between men and women. Women have fewer opportunities for education; they do a disproportionate share of manual work; they have less influence on policy making; and they are disadvantaged in terms of nutrition and health care. These factors are compounded by chronic under-financing of health systems and inappropriate health-service delivery,which are pervasive features of countries with high maternal death rates. Lack of trained staff, inadequate drug supplies, and the high cost of treatment all contribute directly to the risks faced by women.
Experts agree that the nutritional status of Gambian women is severely compromised due to their heavy work load, low food intake, early, frequent and insufficiently spaced pregnancies. Malnutrition during pregnancy has serious health implications for both mother and the unborn child. Poor maternal nutrition is said to be closely linked to miscarriages, stillbirths and low birth weight. Health experts say Iron Deficiency Anemia (IDA) affects a large proportion of women, especially pregnant and lactating women, and contributes significantly to both ante and postnatal mortality. A recent maternal mortality study in The Gambia identified anemia as one of the leading causes of maternal mortality in The Gambia. Other micronutrient deficiencies may also contribute to the poor health status of mothers and children. And yet rapid reduction of maternal mortality is possible, as witnessed by the history of rich countries and - more recently - by many developing countries. The provision of trained staff and access to emergency obstetric care are critical factors. Increased finance alone is not a sufficient condition for achieving progress: fundamental changes in women’s rights and health institutions are also needed. However, increased financing is a necessary condition for achieving the MDG of reducing death rates.
Small investments can yield high returns in terms of lives saved. The cost of providing basic services for mothers and infants averages $3 per capita in developing countries. The learned estimate of health experts project that this year alone, 63,000 women will die from obstetric problems in The Gambia the two Guineas, Mali and Senegal. More than 80 per cent of these deaths could be prevented through basic health-care interventions said to cost about $411m: roughly $700 for every maternal and child life saved.
Is this investment affordable? For many developing countries, $3 per capita would represent a large increase in health spending. In The Gambia and Senegal, for example, annual public spending on health amounts to $2-3 per capita. Governments in most low-income countries can – and must – do more to raise revenue for health services. However, mobilizing the necessary resources will inevitably take many years – and people are dying today.
