Bronwyn Hale /

Maternal mortality: Beyond our backyard, beyond our belief

FACT: One woman dies every minute during childbirth or from a pregnancy-related complication.

This is a significant, and certainly shocking fact, but a fact which does not appear relevant enough to penetrate and command a sufficient response.

 

Nor is it significant that, according to a 2008 World Health Organisation report, of the 136 million women who gave birth last year, nearly half of them received no medical assistance during and after birth, potentially putting their lives at risk.

 

As a midwife, I believe the high global maternal mortality rate is a point worth labouring.  With access to good medical care, women can expect and are able to celebrate a safe pregnancy and birth.  On International Women’s Day, we celebrate this fact.

 

In my professional capacity as a midwife, working for the international medical-humanitarian organisation Médecins Sans Frontières, I have the privilege of working between two worlds.  By this I mean the developed world and the developing world.  Our world and their world.

 

Our world has successfully reduced the maternal mortality ratio, in Australia for example to 8.4/100,000.  There is little doubt that there are three key reasons which have effected this change. 

 

The first is that women are able to access a skilled birth attendant during their pregnancy.  The question is not “will there be a professional to provide pregnancy care and birth my baby?”  The question is often the more mundane of “who will I choose?” 

 

The second reason is accessibility to essential drugs, antibiotics for example, which may be required during pregnancy or birth to treat an infection.  They are certainly available here, with the flick of a pen on a prescription pad.

 

Finally, we have access to equipment, should we require it during the birth.  Instruments to assist the delivery, for example, to expedite the safe arrival of a baby.

 

Access to these three things in Australia is key to assisting a safer pathway to pregnancy and birth.

 

On the other hand, “their world”, developing countries, continue to carry the burden of high maternal mortality.  In Somalia, their ratio is 1400/100,000.  Remember ours in Australia?  8.4/100,000.  Spot the difference?

 

Their pregnancy path is not a safe route but frequently that of the harsh terrain. A three day walk or rigorous ride on the back of a bike from a remote village to a small hospital which just might have some life-saving antibiotics.  Then again, it just might not.

 

Ninety-nine percent of maternal deaths occur in the developing world.  Just because this is not in our own backyard, does not absolve international responsibility to reduce this figure.  Indeed it should inspire the opposite reaction.

 

In 2000, the fifth millennium development goal scribed was “to improve maternal health,” the target being to reduce maternal deaths by 75% between 1990 and 2015.  In 2008, a review of this goal indicates that we have taken our eye off this target and there is a clear shortfall.

 

Written intention of a goal is not enough.  It salves a conscience and there is a certain “feel good factor” to have a target down on paper but it must be followed through.  The goal to reduce maternal mortality requires action.  The target being discussed is not statistics but people.  Potentially two, the woman and her unborn child.

 

Providing reproductive healthcare to women in its field projects is the action that the Médecins Sans Frontières has taken to begin to effect change to women dying needlessly in developing settings.  These women are not dying of disease but from something normal called pregnancy.  What they need is what women in Australia expect in order to have a safe pregnancy and birth.

 

This is what Médecins Sans Frontières strives to provide, often in settings that are precarious.  Unfortunately in many of the countries we work, we not only confront the reality of shocking maternal mortality statistics, we are also faced with the operational challenges of working in conflict zones.

 

Currently Médecins Sans Frontières is trying to get one vital, skilled health professional, a midwife, to work in a project in Somalia.  This Somali midwife will provide essential obstetric care.

 

In this country, one woman in ten will die during childbirth or from pregnancy related complications.

 

Due to war, this midwife will manage this task alone, as because of security concerns the co-ordination team must operate the project remotely from Nairobi, Kenya.

 

Due to war, this woman will be the only skilled attendant for dozens of women delivering their babies.  It may also be war which prevents women from leaving their ‘safe-house’ to access a birthing facility, therefore literally risking their lives to birth at home.  The irony of this should not be ignored.

 

With such a high maternal mortality rate in Somalia, women ARE more likely to die, not from the mortal wound of a gunshot but from a heavy and continuous bleed after the birth of their baby at home.

 

Access to a skilled attendant during birth; appropriate drugs to prevent infection or bleeding during a pregnancy; or equipment to facilitate the safe delivery of a newborn.  These are simple, cheap and effective medical interventions to prevent or treat the complications of pregnancy.

 

Why are they not readily available in developing countries when in the developed world we have had access to them for at least half a century?  Half a century of safe pregnancies and a falling maternal mortality.  This is what Médecins Sans Frontières strives to achieve for the populations of women throughout its projects.

 

As we anticipate celebrating International Women’s Day on 8 March 2009 and raise the proverbial glass to toast all that has been achieved to improve maternal outcomes in Australia, let’s scan our horizons a little further, to Somalia, in Africa perhaps?

 

Where one Médecins Sans Frontières midwife is working steadily, aiming to do what she can to reduce maternal mortality in her country, and where another woman is preparing to die during childbirth because her minute is up.

 

Bronwyn Hale is the Women’s Health Advisor for Médecins Sans Frontières Australia’s Project Unit. Based in Sydney, she travels regularly to Médecins Sans Frontières projects around the world to review and provide input into women’s health programs. Most recently, she visited Aweil, in South Sudan.