"AFRICA RECOVERY": Maternal Mortality
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The following article was published in "AFRICA RECOVERY", Vol. 10, No. 3,
December 1996, issued by the Library and Publications Division of the
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Maternal mortality: shrouded in a 'conspiracy of silence'
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By Margaret A. Novicki
More than 600 women die in pregnancy or childbirth in sub-Saharan Africa
every day -- or 219,000 a year -- compared to eight a day, or 3,000 in
Europe. This startling fact, plus the finding that 20 per cent more women
worldwide than previously thought, or 585,000, die each year of maternal
causes, are among the key issues addressed in UNICEF's Progress of Nations
1996 report. In its fourth year of publication, the report measures
countries' progress on the goals agreed to at the 1990 World Summit for
Children.
While the 1996 edition, in examining trends in maternal mortality and
morbidity, concentrates on women as women rather than as protectors of
children, it also points out that the implications of these trends for
children are significant. About half of infant deaths occur in the first
month of life, most of those in the first week, while many lives could have
been saved by safe births and appropriate care in pregnancy and childbirth.
There is therefore "a considerable overlap" between action needed to
protect women and that needed to protect newborns.
Shrouded in "a conspiracy of silence," women's lack of access to modern
obstetric care has meant that over 140,000 pregnant women worldwide die of
haemorrhaging; about 75,000 die from self-inflicted abortions; another
75,000 die in the convulsions of eclampsia; 100,000 die of sepsis
infections from an unhealed uterus or retained placenta; and another 40,000
die from obstructed labour. For every woman who dies, an additional 30
incur hidden injuries, infections and disabilities which often go untreated
and cause lifelong, debilitating pain.
The Progress of Nations notes that little attention traditionally has been
given to maternal mortality and morbidity because they are seen as a
"women's problem" and women are conditioned "not to complain, but to cope."
The powerlessness of poor women in many societies causes them to suffer in
silence rather than defy cultural norms and traditions, some of which
contribute to pregnancy's costly toll.
Calling maternal deaths both "a tragedy for individual families" and "an
indicator of the wider tragedy of neglect" of women's lives and needs,
UNICEF notes that beyond simply improving health in developing countries
via prevention and awareness campaigns, priority must be placed on
providing every pregnant woman with access to modern obstetric care in a
health unit or hospital.
While it is important to put resources into high-quality family planning
and prenatal care, proper training of birth attendants, and the
identification of high-risk pregnancies, these measures alone will have
little impact on the overall death toll if modern care is not available on
time to the 15 per cent of pregnancies that require it.
UNICEF stresses that such care is affordable even in the largest and
poorest nations, which usually have health units and district hospitals
that, with minimum upgrading, can provide needed obstetric care. Reducing
maternal deaths and injuries, the report says, is "therefore not a matter
of possibilities but of priorities." At the end of the 20th century, the
world is guilty of "a colossal failure of imagination" if it fails to
address this key health issue.
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