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Thursday June 6, 2013
Investment in the well-being of women and girls is key to reducing maternal and child mortality.
IN a conference where experts spoke about the latest numbers, outcomes and approaches, it was still the accounts of people and lives that resonated most.
You could have heard a pin drop in the hall as Dr Imane Khachanirelated the story of a young woman who died from complications in childbirth after delivering her eighth child.
“The term ‘maternal mortality’ means something different to each one of us: a statistic, a ratio, a Millennium Development Goal, a fund, a conference … Woman Deliver. It is all that, of course, but to me it is a name. It is a face,” said Dr Imane, a 32-year-old resident in obstetrics and gynaecology at the Maternity Hospital Les Oranges in Rabat, Morocco, at the Women Deliver conference here last week.
The doctor told the story of Fatna, a young mother who, for lack of choices and resources, sacrificed her life to give life. It was to illustrate the toll that childbirth takes on women when they have no access to reproductive health services, including family planning.
“Fatna didn’t want to become pregnant again. She was 42 and already had seven children and a husband with an unstable job. She knew she could get some pills at the nearest health centre but had heard stories from her neighbours about how the pills could cause cancer and other terrible illnesses. A volunteer midwife or nurse had suggested she use an IUD (a form of birth control) but her husband refused as he’d heard from his friends about how, if the IUD broke, the coil could injure his penis. So she went with the rhythm method which worked … until she got pregnant again,” explained the young Moroccan doctor who, despite her young age, has extensive experience in sexual and reproductive health research and advocacy.
Fatna’s delivery was quick, shared Dr Imane. She delivered a healthy baby boy. Soon after the baby arrived, however, she began bleeding profusely and despite their best efforts, the medical team could not save her. She died from postpartum haemorrhage.
“Her death left me with profound feelings of sadness, failure and helplessness,” shared Dr Imane.
Distressed by Fatna’s death, the doctor sought some answers from her husband.
She found out Fatna was born in a rural village about 60km from Rabat. She never went to school - as her husband put it, “in those parts, the only school for a girl is the kitchen”. She was married off when she was 15 and had her first child 11 months later (a conception so soon after her marriage is so girls can prove to their spouses that they are fertile).
“As I thought about her life, I realised that Fatna didn’t die from postpartum haemorrhage. She didn’t start bleeding on my labour table. She started bleeding way before that … when her parents didn’t send her to school and she didn’t receive the education that could have empowered her to choose the life she wanted. She started bleeding when she was married at 15… when she should have been playing hide and seek. She started bleeding when she had her first child being a child herself. She started bleeding when she couldn’t decide if and when she became pregnant and when she could not get the care she needed. This is what killed Fatna and what continues to kill women every day around the world. Maternal mortality does not just happen,” said Dr Imane.
The story of Fatna, unfortunately, is not uncommon. Despite progress made in many countries, some 800 women die from pregnancy and/or childbirth-related complications every day. A large majority of these deaths are preventable.
Preventing deaths like Fatna’s was one of the core issues discussed at the three-day Women Deliver conference on reducing maternal and child mortality.
Speakers at the conference emphasise of that we know what to do to prevent mothers dying in childbirth and the deaths of children. The challenge now is in implementing the best practices.
Chief health officer for the United Nations Children's Fund (Unicef)Dr Mickey Chopra said poor governance and the lack of accountability are often seen as the root problems in countries which are not meeting their targets of reducing maternal and child mortality rates. But Dr Chopra also acknowledges that addressing this problem is a complex undertaking that requires a multi-disciplinary approach involving not just the the health and education sector.
“If we look at the progress we have made with HIV/AIDs and malaria, for example, we’ve made huge strides in a relatively short time because we’ve had governments, donors and the public get behind these programmes wholeheartedly. We’re urging that a similar coalition and movement be started for maternal and children deaths.
“If we get that focus, we could eliminate preventable child deaths by 2035. The probability of a child dying in rural Ethiopia would be the same as one dying in Europe ... we believe we can turn things around within a generation,” he said, citing Malaysia as an example of how investment in women and girls in particular has paid off.
Providing access to education, particularly to girls, is crucial in overcoming cultural beliefs that prevent people from getting better healthcare.
“We know the longer women and girls stay in school, the less likely they are to become pregnant and get infectious diseases. And there is a generational effect… if you look at the levels of malnutrition in children, you will see that it is five times higher in a family where the women have not been educated.
“Maternal care and the education of girls is such a powerful medicine and the history of Malaysia has proved this. There have been rapid gains within a generation and the country transformed mainly because of the investment in girls, in particular,” he said.
According to the Women Deliver reports, South-East Asia has made remarkable progress in reducing maternal mortality rates, with Malaysia recording the lowest rates in the region, having reduced its rates by more than 45% in the last two decades.
Other success stories come from Rwanda, Bangladesh and Nepal where the decline in mortality has been 7% to 8% a year, which is the fastest rate of decline recorded in history. “This shows that even with two years left, if we can mobilise government leaders to do more and to pay more attention, countries can transform themselves in a very short span.
“These issues are in everybody’s interest. No child should die and no mother should die giving birth,” he stressed.
To move forward, Dr Chopra acquiesces that several areas that have been overlooked in the implementation of the Millenium Development Goals have to be paid full attention.
One such area is the sexual and reproductive rights of girls and women which includes family planning, access to contraceptives and safe abortions. Another is the supply of skilled birth attendants and skilled delivery in births that are still running far too slowly, says Dr Chopra.
“We also need to look at funding. In our previous report, we noted that a lot of funding doesn’t always correlate with the need. Donors have ‘favourite’ countries or for historical reasons, give to certain countries and so, others lose out. Countries like Yemen or those in Central Africa, for example, have very high rates of mortality but get very small amounts of aid. We have to not just monitor the coverage of interventions but also the inequity of how donations are made and distributed,” he said. – By S. Indramalar
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