A decade after the United Nations International Conference on Population and Development, maternal mortality continues to plague Africa. Delegates to a meeting held in the Kenyan capital, Nairobi, recently heard that of the 585 000 deaths caused every year by obstetric complications, many occur in sub-Saharan Africa.
The UN gathering, held in the Egyptian capital, Cairo, in 1994, developed a plan of action that calls on nations to increase the money and attention given to reproductive and other health issues.
However, efforts to reduce maternal mortality in Africa do not appear to have benefited greatly from this plan, leaving pregnant women vulnerable to haemorrhaging, eclampsia (seizures) and other complications when they give birth. While deaths from these conditions can be avoided, they frequently are not.
The conference held in Kenya from June 23 to 26 gathered representatives from a wide variety of NGOs to discuss the reasons why African governments are struggling to meet the commitments made in Cairo.
“For the sub-Saharan region in particular, we have to confess that the importance of health issues, and more specifically of reproductive health, is not reflected by the very low level of resources allocated to them in countries’ general budgets,” said Tamaro Toure, regional chairperson of the International Planned Parenthood Federation’s Africa bureau.
Solomon Marsden, deputy head of the division of reproductive health at Kenya’s Ministry of Health agreed. In an interview on Monday, he noted that the East African country’s “government has [had] no specific reproductive health budget allocation. It is now that there are attempts to come up with one.”
Despite the government’s plain speaking on this matter, its statistics on maternal mortality in Kenya have been disputed. According to the latest Demographic and Health Survey, which is done every five years, the country has a maternal mortality rate of 590 deaths for every 100 000 births. However, the Kenya Medical and Education Trust (KMET), an NGO, claims the rate is about 1 000 deaths per 100 000 births.
Across the continent in Côte d’Ivoire, maternal mortality has increased from 540 deaths per 100 000 births in 1994 to 856.
Ade Marie Claire, president of the Ivorian Association for Family Health, said the inaccessibility of clinics that offer delivery services is partly to blame.
“Women in my country, as in other African countries, have to walk over long distances to birth babies. As a result, many of them opt to deliver in their homes, increasing the risk [of death due to complications],” she said at the Nairobi meeting.
In other parts of Africa, the rate of maternal mortality can be as high as 1 800 deaths per 100 000 births. And as KMET’s executive director Monica Aguttu noted, this is only part of the picture.
“These maternal deaths do not include women who died from other causes such as the Aids pandemic,” she said in an interview.
Added Claire: “For nations to [adhere] to the ICPD [International Conference on Population Development] plan of action, and the UN Millennium Development Goal of reducing maternal mortality by 2015, we need health institutions to be brought closer to women even in the remotest parts.”
Eight Millennium Development Goals were set by global leaders at the UN Millennium Summit in New York four years ago, to tackle the scourges of poverty and underdevelopment by 2015. They include the goal of reducing maternal mortality by 75%, by this date.
According to Marsden, Kenya is trying to ensure that even the most rudimentary of health facilities — the medicine dispensary — has staffers who are trained to deliver babies.
“This has been going on for the last two years or so. We have an arrangement to offer delivery services in the dispensaries because they are closest to the people, [who] will not have to be walking miles to district or provincial hospitals.
“Right now we are offering these services in just a handful of the dispensaries but we intend to spread our tentacles to all the country’s 1 630 dispensaries.”
Whatever the convenience of having a place for giving birth closer to hand, questions remain about whether women will be able to afford this service.
“Most of the mothers in the rural areas cannot afford to pay even for delivery costs which in some cases are 500 Kenyan shillings [about $6,40],” said Margaret Meme of Kenya’s Reproductive Health Division. She believes that free reproductive health services are essential in this regard.
Others say reform of abortion law is also important, as the current, restrictive legislation in many states prompts women to undergo unsanitary “back street” abortions — with disastrous consequences for their health.
“A major cause of these unnecessary [maternal] deaths is the restrictive laws in African countries, almost all inherited verbatim from pre-independence colonial countries, which have all since repealed those laws in favour of women’s enhanced health and the right to choice,” said Eunice Brookman Amissah, vice-president for Africa at the International Projects Assistance Services (Ipas), during the Nairobi meeting. Ipas lobbies for women’s reproductive health rights.
“African countries have continued to hang on to these archaic laws which cause the deaths of so many women,” she added.
The World Health Organisation estimates that more than five million African women undergo unsafe abortions every year. — IPS