In the 21st century falling pregnant should firstly be a choice and secondly should not result in the death of the pregnant woman. In the third world however these two goals are far from being realized. In a future blog I am going to write about contraceptive options and barriers to access in the developing world but in this one I will discuss maternal death and go through the current Zimbabwean statistics.
According to the world health organization, a maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Because pregnancy is not an illness, these deaths should never occur (ideally). Maternal deaths are used globally as an indicator of how developed a country’s health system is. This makes sense if you consider that the major causes of maternal deaths are avoidable and treatable as I will discuss later.
According to the Zimbabwe Demographic and Health survey of 2015, on average 651 maternal deaths occur for every 100 000 children born. Loosely interpreted this means that out of every 100 000 pregnant women, 651 will die as a result of that pregnancy. These figures are worrying when we compare them to Cuba ( a third world country) where it is 39 or our neighbours Botswana and Namibia with 160 and 200 respectively.
Why women die during pregnancy
The top three causes of death in women who are pregnant are hemorrhage (bleeding during pregnancy or after delivery), hypertension in pregnancy and sepsis (infections).
It is not surprising that the majority of women who die are those from the low socioeconomic class who:
- Cannot afford health care
- Live very far from any health facility
- Live in patriarchal societies where men make decisions on their behalf
- Are served by health facilities that are poorly resourced
- Do not believe in the modern health care model
In Zimbabwe we have some religious sects that do not believe in modern medicine and encourage (or force) their members to seek alternative care. There have been several cases of women dying due to complications that develop while giving birth in religious shrines. It is worth mentioning that the men in these sects marry young girls (sometimes under the legal age) and these girls practically give birth every other year.
What has bee done
A lot has been done (at least on paper) to try and address the social injustices that result in unequal access to maternity services between the rich and the poor. These services have been made free in the public sector but the statistics however show that this is not enough, or maybe our approach needs to be revised.
Soon after Independence the goal was to make sure everyone lives within a 5km distance from a health facility. If you live in a city you would think this is a long distance, and you would be right, but in some remote rural areas women walk up to 20km just to have access to a clinic, pregnant women, in labour. The fortunate ones make these journeys in ox-drawn carts on roads that are too bumpy for comfort, there is no modern transportation to talk about, even if there was they wouldn’t be able to afford it.
The rural clinics in most cases are not well equipped to deal with complicated pregnancies. This poor woman will have to be transferred further to a district hospital. After waiting a few hours for the ambulance to come and pick her up she will finally get to the hospital and pray that the doctor on duty is not tied up in another emergency.
Along this whole chain a woman could easily die, and we haven’t even discussed what could go wrong during the delivery itself and afterwards which is a lot. All this refers to a woman who has decided to go to a clinic and has been given that “permission” by her religion and/or her husband. For the other woman who has gone the other route, the risk of dying is actually higher.
As long as the poor are not prioritised in the provision of health services, women will continue to die while giving life. The solution may not necessarily come from those in political power but from the communities themselves. In other countries the people have come together to raise funds with the help of community business people to improve their road networks and even buy vehicles to be used in emergencies These innovations have resulted in their maternal mortality rates going down. We need to empower our communities to be self reliant and help save the women who decide to give life. It has been done elsewhere and it is very much possible.