REDUCING MATERNAL MORTALITIES: A SHARED RESPONSIBILITY

Twenty-seven-year-old Helena BremaNyamekye, a PhD student of the University of Ghana, lost her life in November 2015 during childbirth at one of Ghana’s esteemed health facility and specialist hospital, the 37 Military Hospital.

The husband of the deceased started seeking‘justice’ for the soul of his beloved wife. His case was not to bring the wife back to life but have the medical facility allegedly responsible for the death pay for its sins.

After nearly half a decade legal tussle, an Accra High Court in July this year slapped the hospital with a GHc1million fine, in damages, for medical negligence leading to the death of the young lady.

Further details of the case referred to above are not the prime focus of this piece but that another life has been lost in labour, adding to the country’s maternal mortality ratio (MMR), which is of grave concern.

Despite several interventionsaimed at improving quality maternal and other reproductive healthcare servicesin Ghana over the years, it continues to struggle with high MMR.

Data from the 2010 Population and Housing Census (PHC) pegged MMR at an estimated 485 deaths per 100,000 births with one in every 10 female deaths within the age group of 10 to54.

The MMR was said to be generally higher in rural areas compared to the urban and in both rural and urban areas, prevalence was considerably higher among younger women (10-19) and older women aged 40 and above.

According to the World Health Organisation (WHO), 94 percent of all maternal deaths occur in low- and middle-income countries with approximately 810 women dying every day from preventable causes related to pregnancy and childbirth.

MMR is defined as the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

Ghana’sMaternal Health Survey report shows a gradual progress in MMR in the country with the number of women who die from pregnancy-related causes reducingfrom 378 in 2007 to 310 in 2017 per every 100,000 live births.

Currently, the country records an estimated 106 deaths per 100,000 live births with an average of 800 to 900 women dying annually from pregnancy-related complications.

In view of global MMR rates at 211 deaths per 100,000, the WHO entreats member countries to reduce the threatby 70 percent per 100,000 live births in line with achieving target 3.1 of the Sustainable Development Goal (SDG) three.

Goal three of the SDGs seeks to “ensure healthy lives and promote well-being for all at all ages” by 2030.

To achieve this, the Ghana Health Service (GHS) in January this year launched a five-year comprehensive reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCHAN) plan which seeks to, among other objectives, provide direction to health and relevant non-health stakeholders towards ending preventable deaths among Ghanaian women.

The document, aligned with the Global Strategy for Women, Children and Adolescent Health (GSWCAH 2016-2030), will serve as the pivot around which activities and programmes in reproductive health would be coordinated.

Dr. Kofi Issah, Director of Family Health of the GHS, in an interview, alluded to the fact that despite a steady decline in the total numberof maternal deathsfrom 876 in 2018 to 776 in 2020, there was the need to improve on the gains made by building a robust healthcare delivery system.

He mentioned that institutional MMR had reduced from 117 in 2019 to 106 in 2020 and whereas many regions stagnated or increased in maternal mortality last year, the Ashanti Region made asignificant reduction of 35 percent in its 2019 figure of 193 deaths to 124.

So far, this year, the Director disclosed that 285 women had died of pregnancy-related complications across the country, adding that obstetric and post-partum haemorrhage were the leading causes of deaths.

Others factors, he mentioned, were hypertensive diseases and infections, but the public health specialistdid not rule out the several indirect causes which contribute to the claiming of the lives of pregnant women in the country.

Issues pertaining to ethnicity, religion, education, economic growth, lifestyle choices among others, he said, had huge bearing on increasing MMR in the country and while calls to strengthen the health sector may be warranted, there was the need to focusing attention on such external factors.

“Maternal mortality cannot be solved entirely by the health system. At best, it can be reduced to a certain level and then the other factors that come into play would help sustain the gains,” he said.

The GHS, Dr. Issah said, was working at strengthening collaboration with non-health partners, building its human resource capacity, improving logistics and access to quality and respectful service as well as improving accountability for the lives of women and babies through the Maternal and Perinatal Death Surveillance and Response (MPDSR) plan, to reduce MMR in Ghana.

Nonetheless, he noted that “if we do not tackle all other issues like education, where women are empowered to control birth,improve infrastructure like road networks, solve malnutrition, poverty and cultural practices that lead to unplanned pregnancies among other things, we may achieve little.”

Quality health care starts from the household or community before landing at the health facility. If we are to reduce MMR in this country, then we have to see it as a shared responsibility between the health sector and all other critical factors which are indicators of development,” Dr. Issah stressed.

According to health experts, anytime a women gets pregnant, the risk of death is higher, and until we build bridges and linkages with all relevant sectors and stakeholders, reducing MMR by 70 percent by 2030 may not be feasible.

BY ABIGAIL ANNOH

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