Women and maternal mortality

By Brenda Zulu

Too many women are suffering and dying from complications of pregnancy and childbirth in Zambia.  These women are in the reproductive age group of 15 to 49 years.  Most of these deaths occur amongst the poorest in our society.

According to the 2007 Zambia Demographic Health Survey (ZDHS) maternal deaths are a subset of all female deaths and are associated with pregnancy and childbearing. Maternal death are defined as any death that was reported as occurring during pregnancy, childbirth, or within two months after birth or termination of a pregnancy. Estimates of maternal death are solely on the timing of the death in relationship to the pregnancy.

A specialist in Maternal Health at the University Teaching Hospital (UTH) Dr Swebby Macha says that the major causes of maternal deaths in Zambia were excessive bleeding, infection, unsafe abortion, high blood pressure and obstructed labour. 

“Pregnant women who suffer from malaria, HIV/AIDs, TB, anemia and poor Nutrition are more likely to die.  Poverty, low levels of education, low status of women and violence against women in our society also increases the risk of women dying in pregnancy and child birth,” said Dr Macha. He also observed that Zambia’s Maternal Mortality Ratio (MMR) which currently stands at 591 deaths per 100, 000 live births were unacceptably high.

 “There has been only a marginal decrease from the MMR of 729 deaths per 100, 000 live births (2003),” said Dr Macha.

He also observed that many women in the developing world and most women in the world’s least developed countries give birth at home without skilled attendants and when they seek help for complications at local health facilities; basic equipment, medicines, blood transfusion services are lacking.

Zambia officially launched the Campaign for Accelerated Reduction of Maternal Mortality in Zambia (CARMMA-Z) in June 2010 aimed at successfully tacking the major issues behind Maternal Mortality.  The theme for this campaign is “Zambia Cares:  No woman should die while giving life”.

Under CARMMA there is hope that every pregnant Zambian woman will have access to the availability and use of universally accessible quality health services including those related to reproductive and sexual health which are critical for reducing maternal mortality.

A main challenge to women’s maternal health arises from inequitable distribution of health care services, particularly in rural areas. Service delivery in Zambia is characterized by many challenges, not limited to lack of availability of emergency obstetric care.

A visit to Haabulile Rural Health Center in Chief Chikanta’s area revealed that the health centers are not staffed. The nurse in charge had gone to church and there was a pregnant girl and a woman who had just given birth.

In an environment that respects women, pregnancy, birth and motherhood could powerfully affirm women’s rights and social status without risking their health.  The enabling environment for safe motherhood and child birth depends on the care and attention provided to pregnant women and newborns by communities and families, availability of skilled health personnel at delivery and the availability of adequate health care facilities, equipment, and medicines and emergency care when needed.

Globally according to Dr Macha, 530, 000 women die of pregnancy related complications during child birth of which 99% occur in developing countries.  For every woman who dies from causes related to pregnancy or childbirth, it is estimated that there are 20 others who suffer from pregnancy related injuries, infections, diseases and disabilities, often with lifelong consequences.  The truth is that most of these maternal deaths are preventable. Research has shown that approximately 80% of maternal deaths could be averted if women had access to essential maternity and basic health- care services.

High fertility, close pregnancies and large families are still the norm in rural areas, partly because of lack of reproductive health services and the lack of choice of women in the matter. These factors contribute significantly to the high levels of maternal mortality. Current mortality trends are linked to among others poor nutrition, a lack of education, ill health and a lack of access to appropriate health services, factors that impend human and social development.

The main causes of the high maternal mortality in Zambia include lack of national commitment; limited financial support; weak coordination and partnership; increasing poverty; the low status of women on the continent; weak health systems; the adverse effects of HIV/AIDS, tuberculosis and malaria and the exodus of medical personnel to overseas destinations. Experience has shown that safe motherhood can be achieved if every birth is attended to by a trained health worker with midwifery skills, if transport is available for referral services and if quality basic emergency obstetric care is available. Without such interventions Zambia might not achieve the fifth Millennium Development Goal (MDG 5) to improve maternal health by 2015.