Monday, December 22, 2008

Maternal Mortality: Death by Childbirth

Third world mothers face health risks that have been eliminated from the industrialized world. Mercator Net interviews Dr. Robert Walley, the founder and executive director of MaterCare International and an emeritus Professor of Obstetrics and Gynaecology at Memorial University of Newfoundland, Canada.

Dr. Walley: Mothers in the developing world are experiencing unimaginable suffering due to a scandalous lack of effective care during pregnancy and childbirth, with the consequence that many thousands are dying. The World Health Organisation estimates that there are over 500,000 maternal deaths annually, of which 99 per cent occur in developing countries. There is no accurate data to substantiate these numbers, the reason being that most developing countries do not report information on births, deaths, the sex of dead people or the cause of death. However, figures from my own experience at a mission hospital in Nigeria, where the in-hospital maternal mortality ratio was 1,700 per 100,000 live births, illustrates the enormity of the situation.

Some 200 million women are pregnant, world-wide, each year. Most mothers deliver in villages without access to safe, clean facilities and without a trained person to assist them. Most maternal deaths occur during the last trimester and in the first week following delivery. Practising in Canada prior to going to Nigeria in 1981 and since then, I have never had a mother die under my care from a direct obstetrical cause, or been present at such a death. Maternal deaths in Canada are at the level of what is called irreducible minimums, 1/100,000 live births. However, at the mission hospital maternal deaths were almost a daily event. I recall one weekend during which there were four deaths of mothers who had arrived at the hospital, two in extremis from haemorrhage, one in agony from obstructed labour, and another with a ruptured uterus after days in labour because she was young and consequently her pelvis was too small. Others would arrive unconscious due to pregnancy-induced hypertension, or suffering from malaria or severe anaemia resulting from malnutrition. Most mothers die in Africa alone and in terror in villages, as they have no way of getting to the hospital. These deaths of mothers and babies are the greatest tragedies of our times especially since they are readily preventable and treatable.

The disparity in maternal mortality and morbidity rates, between developed and developing countries, is greater than any other commonly used measure of health status. Pregnancy related deaths are one of the major causes of death and disability occurring among women in the reproductive age group. This loss is twice that of any other diseases including AIDS, malaria, TB or sexually transmitted diseases. There is no single cause for male mortality in this age group that comes close to the magnitude of maternal mortality and morbidity. The tragedy is that the solutions to this suffering have been known for decades and cost very little. ...

MercatorNet: It is 21 years since the Safe Motherhood Initiative was launched in Nairobi to address this problem, and 8 years since it was made one the UN's Millennium goals, and yet the director general of the WHO said recently that "the world failed to make a dent" in it. What is your analysis of this failure?

Dr Walley: A report in the British Medical Journal in July 2007 said that at the present rate of progress the 5th Millennium Development Goal will not be met for 275 years -- in 2282, not in 2015 as intended. The reasons are poverty, lack of compassion, lack of political and professional wills, a conspiracy of silence, and a lack of imagination. That any woman should die giving birth in the 21st century is an international disgrace.

The responsibility in my view lies partly with national governments but also very much with Western governments, the UN and other international agencies e.g. those of the European Union, DFID (UK), CIDA (Canada) and USAID and, of course, the radical feminist movement, which cares little for motherhood. These are compromised by their desire to control populations in developing countries. While billions of dollars have been and are being spent on reproductive health programmes (a euphemism for birth control) only a small fraction is focused on providing emergency obstetric services that ensures that women survive their pregnancies -- services which are freely available to all mothers in rich countries.

We have known the causes of maternal deaths for over 100 years -- haemorrhage, infection, hypertension, obstructed labour, septic abortion -- and we eliminated them in the our rich world by providing essential obstetrical care to mothers one at a time. The former Director General of WHO, Dr. Halfdan Mahler, commented in Nairobi in 1987, “We know enough to act now, it could be done; it ought to be done; and in the name of social justice and human solidarity, it must be done.” It hasn’t been.

MercatorNet: What we do hear a lot about is "unsafe (illegal) abortion", along with some alarming statistics. Is this a major cause of maternal deaths and ill health? What's the real answer to this problem?

Dr Walley: Abortion unfortunately has been around forever. In our times it has been promoted as choice, as a right; we are all familiar with the arguments which has brought us to the devastating numbers found in developed countries. Septic abortion is said to account for 8 per cent of maternal deaths in developing countries but, again, nobody knows as statistics are not kept. Nevertheless, abortion is a sad fact of life resulting from poverty, lack of education, coercion and a lack of alternative help. In panic the woman goes to the open door of the abortionist who may be a traditional birth attendant in the village, but is frequently is a health provider who has limited skills and equipment, who procures the abortion for money. However, the numbers are exaggerated to promote an agenda which is to have abortion legalized as a human right.

Read the whole interview here.

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