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CHALLENGES 2006-2007: Pregnancy Is a Dangerous Pursuit in Zambia

Isabel Chimangeni

LUSAKA, Jan 17 2007 (IPS) - “Being pregnant in Africa is like having an unknown disease,” says Zambian mother Alice Tembo, referring to many of her compatriots’ lack of basic knowledge about pregnancy and childbirth.

She has recently given birth without any complications, which is exceptional in a country where the maternal mortality ratio is 728 per 100,000 live births.

However, Zambia’s maternal death rate is still lower that the rate for the whole of the sub-Saharan African region, which stood at a shocking 920 per 100,000 live births in 2000 according to the United Nations Statistics Division.

Internationally, sub-Saharan Africa has by far the highest ratio of maternal deaths. It is more than double the rate for the world as a whole, which is 400 deaths per 100,000 live births.

The region also compares poorly with other developing regions, which collectively stood at 450 deaths per 100,000 live births in 2000.

These statistics make Tembo’s observation all the more salient. “One of the things that the government should do to protect pregnant women is to empower them with knowledge and finance. Secondly, we need things like good roads, clean hospitals and trained hospital staff.”

Tembo’s experience of childbirth was without incident because she was attended to by skilled health personnel and a midwife at one of the country’ largest hospitals, the University Teaching Hospital in Lusaka.

In Zambia, only those women who have the money to afford decent health care are assured of surviving a difficult delivery. A well-to-do family can afford to send the expecting mother to the best possible hospital in an urban area.

Being pregnant is potentially tragic if you come from a poor family in the rural areas. Although it is generally difficult for rural people to access timely healthcare, it is doubly difficult for women, who are more often poor and voiceless.

Their position as women also means that they often defer to customs that encourage women to put their families’ needs, rather than their own, first. Therefore some seek medical help when it is too late.

Poor women’s choices are usually limited to delivering their babies under the supervision of local medicine women or traditional midwives. If things turn wrong, it can be fatal for the mother or the baby – or both.

It is estimated that 70 percent of deaths during childbirth in Zambia occur in rural areas where women have to walk long distances before they can reach a clinic. Sometimes, even if they get there, the staff and the facilities are too ill-equipped and ill-prepared to handle the delivery.

In case of complications, there are no ambulances to transport the mother to the nearest town or points of care. It is therefore not uncommon for mothers to die while making their way to find heath care – especially in far-flung areas of Zambia.

A study by the United Nations Population Fund (UNFPA) found that excessive bleeding at the time of childbirth accounted for some 34 percent of maternal deaths in Zambia. Haemorrhaging occurs more often in deliveries which take place in rural villages: 27 out of 48 women compared to five out of 14 women at health care facilities.

According to Mulindi Mwanahamuntu, a consultant at the University Teaching Hospital who headed a study on maternal mortality, rural women who do manage to get to medical facilities are often “in such bad shape that we cannot save them”.

Health minister Angela Cifire says that maternal deaths are unacceptable because they can be prevented. However, to change the situation in Zambia more assistance from its international development partners will be needed.

The government, in collaboration with UNFPA’s Safe Motherhood Project, has been working at reducing maternal mortality by educating and involving communities.

This project motivates people to identify pregnancy early, prepare for births, involve men, and to seek the help of a traditional birth attendant if a woman cannot be brought to a health centre in time. Pregnant women are also encouraged to go to a health centre for antenatal care well before their babies are due.

Communities are being helped to build mothers’ shelters at clinics so that women who arrive early have somewhere to stay. But getting women to clinics and hospitals will not save lives if these facilities are short of supplies and trained staff, and cannot provide emergency care when necessary.

Therefore, the UNFPA project is also aimed at improving the equipment and staffing of provincial health services by, for instance, providing and replenishing birth kits. However, although UNFPA has also provided one ambulance for each district, there are not enough to serve the rural areas.

To fill the gap, the prototype bicycle-driven “mama car” is currently being tested in Solwezi district in Zambia’s north-western province. If the project proves successful, the bicycle and its special trailer will be produced in large numbers.

According to Cifire, the government has also embarked on programmes to train caregivers, including midwives, as well as pregnant women.

“The lack of obstetric care in rural areas is very worrying, and that is why we have decided that traditional birth attendants need additional clinical training. As it stands, many of them do not have the skills to deal with birth complications,” says a ministry of health spokesperson.

A pilot project for women-friendly services was established in Lusaka in 2000 to provide affordable quality healthcare, particularly for poor urban women. The government has only recently started to roll out these services.

The reason for the delay was the government’s decision to cut healthcare delivery in its bid to comply with International Monetary Fund conditions stipulating reduced state spending.

This was done in order to achieve the Highly Indebted Poor Countries completion point, which makes poor countries eligible for debt relief. Zambia managed to reach the completion point last year but the process placed its national health system under enormous pressure.

It is largely believed that the maternal health situation in Zambia is unlikely to improve rapidly enough to meet the U.N. Millennium Development Goal of reducing the maternal mortality rate by three quarters before 2015.

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