Africa, Development & Aid, Gender, Headlines, Health, Human Rights, Poverty & SDGs, Women's Health

SOUTH AFRICA: Redouble Efforts to Reduce Maternal Mortality

Patrick Burnett

CAPE TOWN, Sep 10 2009 (IPS) - For Katriena Anthony, being four months pregnant comes with hazards particular to her living conditions.

Maternal, neonatal, and child health services in South Africa still fail poor women and children, recent research says. Credit:  Patrick Burnett/IPS

Maternal, neonatal, and child health services in South Africa still fail poor women and children, recent research says. Credit: Patrick Burnett/IPS

The 38-year-old resident of Mandela Square informal settlement in the rural town of Montague, three hours drive from Cape Town, she lives in a two-roomed shack made of wood and zinc sheets.

She has no electricity or running water, and every morning she has to walk long distances to collect wood, while water for drinking and cooking must be carried to her home from a nearby tap in a plastic bucket.

On a morning in late August, she is about to embark on a visit to the state clinic for a check-up on her second pregnancy, and has been lucky enough to get a lift.

She says usually such a visit would involve a one-hour walk there and back, because the ten rand ($1.25) needed for a taxi is not always available in the household budget.

Later on in her pregnancy, if there is an urgent need to get to hospital, she says she can call an ambulance or pay someone with a car 50 rand ($6.25) to take her to hospital; if she doesn’t have the money, she’ll have to borrow it somewhere.

Another woman in the settlement, also four months pregnant, says she is suffering from tuberculosis. She was diagnosed about a month ago after suffering a continuous cough, she says, and is now on medication, but complains about her living conditions.

”We don’t have toilets and we have to walk in the mountains to get wood. It’s not good. The wind blows through the shack and it floods when it rains.”

Both women are receiving regular health care in a province that has one of the better health systems in the country, but rural women with poor living conditions are more at risk of pregnancy complications.

Maternal health has been under the spotlight in South Africa after an analysis of maternal deaths was released in July showing an increase in the country’s maternal mortality rate (MMR).

Over 4,000 maternal deaths were reported in ‘Saving Mothers 2005-2007: Fourth Report on Confidential Enquiries into Maternal Deaths in South Africa’, a 20 percent rise from the 3,406 deaths in the previous three-year period.

The top three causes of death were non-pregnancy related infections caused mainly by AIDS (43.7 percent), complications of hypertension (15.7 percent) and obstetric haemorrhage (12.4 percent).

Researchers found that nearly four out of every 10 deaths (38.4 percent) were avoidable. They identified non-attendance and delayed attendance as common problems, together with poor transport facilities, lack of health care facilities and lack of appropriately trained staff.

This report was followed by the publication of a Lancet study in August on the health of South Africa’s mothers and babies, which said poverty and poor conditions in rural areas and urban townships partly explained the situation.

”Poor women and children bore the brunt of the injustices of the apartheid regime. Our analysis shows that maternal, neonatal, and child health services still fail them and that an estimated total of 76,600 women, neonates, and children die unnecessarily every year,” the report concluded.

Marije Versteeg, Project Director of the Rural Health Advocacy Project, said factors in maternal health included the inability to pay for transport due to high levels of poverty, unemployment in rural areas and a shortage of health care professionals. 
”Hospitals don’t have enough staff to monitor women in labour. There are districts where professional nurses can’t be appointed, because there is no interest,” she said.

With HIV/Aids – along with improved reporting – blamed as the reason for the increase, the ‘Saving Mothers’ report noted that the institutional maternal mortality rate of women who were HIV infected was almost ten times that of HIV-negative women.

The Lancet study notes that the MMR for HIV-negative women is 34 per 100,000 live births, similar to middle-income countries such as Brazil, Argentina, and Thailand, with the MMR for HIV-infected women also almost ten times higher. 
Versteeg said if rural women didn’t access clinics for health services due to issues of affordability, they also missed out on health promotion and risked being less aware of services intended to prevent prevention of mother to child transmission PMTCT of HIV.

Stigma attached to HIV and AIDS also led to non-disclosure and a subsequent missing out on PMTCT treatment. 
Professor Sue Fawcus, vice chairperson of the National Committee on Confidential Enquiries into Maternal Deaths, which produced the ‘Saving Mothers’ report, said it was “quite clear” that the provinces with the bigger rural base – KwaZulu-Natal, Eastern Cape and Limpopo – had the higher rates of maternal mortality.

Fawcus puts the increase in deaths down to a mixture of both HIV/AIDS and better reporting. “I think HIV/AIDS has been a big problem for us,” she says, pointing out that looking only at HIV negative deaths paints a far more positive picture.

”This illustrates that HIV has been a big challenge in trying to achieve it (the Millennium Development Goals),” she says, but adds that improvements can be made because South Africa has better health financing compared to some other countries.

Versteeg calls for the district health system to be strengthened, and for more funding as well as more efficient spending of current funding.

Researchers that undertook the Lancet study estimate that interventions to save child lives would cost US$1.5 billion per year, or 24 percent of public sector health expenditure. 
This would also have benefits in reducing maternal deaths and put South Africa on track to meeting both the fourth and fifth MDG.

”The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision,” they wrote.

The ‘Saving Mothers’ report concludes with a quote from the 1999-2001 report, which noted that deficiencies in fulfilling the expectations of mothers to deliver a healthy child and watch that child grow needed to be “urgently addressed”.

The 2005-2007 report concludes simply: “Unfortunately this, with the notable exception of women dying from complications of hypertension in pregnancy, has not come to pass. We will have to redouble our efforts.”

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