Since the 1970s, the world’s attention has focused on the plight of women and children, especially those in the developing world.
Resulting from this, a number of international conventions and protocols have been instituted to raise the standard of women and children.
Some of these include the Safe Motherhood Initiative; the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW); the International Convention on the Rights of the Child (ICRC) and many others.
Other responses included the 1994 ICPD, the 1995 Beijing Conference and its Plaform for Action, etc.
These in turn have influenced many nations to pass laws and institute policies to protect the right of women and children.
For instance Ghana in 1975 and 1979, Ghana established the National Council on Women and Development and the National Commission on Children, respectively. Today both are incorporated into the Ministry of Children, Gender and Social Protection
In addition to these, laws have been passed to abolish female circumcision and to ensure fair distribution of estate in the event of a husband dying intestate.
In spite of these, in the developing world many women lose their lives in childbirth and this is considered an abuse of their rights.
Efforts to stem the tide have yielded little dividend because maternal mortality is the end product of a combination of factors – political, economic and cultural.
In Ghana, Ministry of Health statistics show that out of 1000 live births, about 240 women lose their lives.
This may be an understatement given the fact that many women die outside health institutions and in villages;
Families do not find it necessary to report such deaths to vital statistics offices; and
Private health facilities do not often send mortality and morbidity statistics to the appropriate places.
The impact of maternal death on children, the family and society is enormous. Thus, the state endeavours to carry out occasional public education in various communities and in the media.
The success rate of this is hard to measure.
WHAT IS MATERNAL MORTALITY
In medical terms, this refers to “death of a woman during pregnancy or within 42 days of the end of a pregnancy from causes related to or aggravated by the pregnancy, but not from incidental causes.”
MATERNAL MORTALITY: THE LAY PERSPECTIVE.
In the layperson’s language, MM is defined as the death of a woman due to pregnancy-related complications which may occur during pregnancy, delivery or after delivery.
Although MM is a global phenomenon it was forcefully brought to the attention of the global community in 1985 by Deborah Maine and Allen Rosenfield through a thought-provoking article they wrote in the Lancet titled: MATERNAL MORTALITY, A NEGLECTED TRAGEDY: WHERE IS THE ‘M’ IN MCH?
Resulting from all these, in 1987 an international conference on maternal mortality was held in Nairobi, Kenya.
The Safe Motherhood Initiative (SMI) was born out of this conference with the aim to half MM rates in developing countries by the year 2000.
Today, like many human problems mm has taken on a human right dimension. The current mantra therefore is: NO WOMAN SHOULD DIE GIVING LIFE.
Thus, the of quality of governance include the evaluation of maternal mortality ratio.
THE GHANAIAN CONTEXT
In Ghana, maternal mortality is very common; almost every Ghanaian knows of a relative or a friend or somebody died of mm.
As to be expected, often such deaths are attributed machinations in the spiritual realm.
MM is experienced by women of all classes: poor and rich; urban and rural dwellers.
However, as to be expected, it is experienced more by women who are less literate and live in the rural areas.
According to Family Health Division of GHS, Ghana recorded 1022 maternal death in 2011. This is an increase from 894 in 2010.
Unfortunately, these figures have not been disaggregated to distinguish the rural from the urban contribution.
THE MEDICAL MENU
Pregnancy induced hypertension (PIH)
Others (renal, cardiac failure, etc)
A number of measures have been taken to deal with mm. In 2003, the state introduced free maternal care covering normal delivery, assisted delivery including caesarian section and management of surgical and medical complications including the repair of vesico-vagina fistula.
The state’s responses have been rather medical oriented – build more health centers; train more doctors and nurses and expand community health, especially in the rural areas.
The success of these are hard to measure.
An appropriate starting point for appreciating the predisposing factors in maternal mortality is the society.
Indeed, as has been argued, the first step towards maternal mortality is for a woman to desire to be pregnant. This desire is itself induced by the society.
Ultimately, therefore maternal mortality is largely society-induced.
THE CULTURAL ANGLE
In traditional society, fertility is a cherished attribute. An adult, especially a woman who is unable to have her own children is looked upon with malicious pity: she is either a witch or a victim of witchcraft.
Women therefore visit all kinds of places- shrines, miracle-working pastors and fertility hospitals -in the search for children.
Among the Asante, the common prayer said for a new bride is: May you be blessed with the womb of an elephant.
And among the Ga the prayer is : May you bear 10 children and lie on ten mats.
THE VALUE OF CHILDREN
Traditionally, children are regarded a blessing and the more one has, the more blessed one is considered to be.
Our fertility practices are reflected in our funerals and marriage ceremonies and in our outdooring (christening) ceremonies.
THE RISK OF DEATH
A woman’s risk of death in childbirth over the course of her life is a function of many factors, including the number of children she has and the spacing of the births as well as the conditions under which she gives birth and her own health and nutritional status.
Traditionally, it was customary to have several children as status symbol and as farm hands.
Thus, until recently the average number of children a Ghanaian woman had was 6.5; today it has decreased to 4.2. In comparison with Euro-American one-child family, Ghana’s TFR is still high. Multiparity is a cherished cultural value but a danger to the health and life of women.
Traditionally, spacing of birth was cherished. Thus, a woman spent at least 2 yrs with her mother who nursed her and her baby till they were fit enough to return.
Thus, a woman who did not space her birth is seriously ridiculed and called all manner of names.
The polygynous marriage system took care of the absence of the woman.
CONDITION OF BIRTH
Some women prefer domiciliary delivery because of poor quality or unavailable health facilities.
In the northern regions, women do so to prove their marital fidelity; unfaithful wives are said to be those who prefer hospital delivery because they fear to experience obstruction and consequent vesico-vaginal fistula.
HEALTH AND NUTRITIONAL STATUS
In some communities, a pregnant woman’s diet is restricted: she is not supposed to eat eggs, meat and a range of vegetables supposedly in the interest of the unborn baby.
Although such dietary restrictions may control the growth/weight of the foetus and allow for spontaneous delivery, it can also affect the woman and the unborn child in several ways.
There are two types of abortion:
Spontaneous (due to medical factors)
Induced (abortus provocatus) – due to socio-cultural factors.
In Ghana, induced abortion is criminal and punishable by a term in prison.
However it is permissible under 3 conditions:
CONDITIONS FOR LEGAL ABORTION
This abortion regime operates in a social context of low contraceptive prevalence rate (<25%).
Yet in spite of legal, religious and cultural strictures, many young girls and women die of abortion because often, it is found more expedient to have an abortion than to have a child whose father is unknown; whose birth is unplanned; whose birth is likely to disturb personal life’s path.
Thus, abortion rate is very high in Ghana and its consequences can be fatal.
THE MAJOR DELAYS
Any obstetric complication is an emergency. On the average, an obstetric condition that is delayed for more that ten hours may lead to death. Eg a women with a raptured uterus may survive only 3 hrs without medical intervention.
Studies show that in Ghana, there are 6 critical delays that lead to death. These are:
DELAY NUMBER ONE
Delay in recognising a risk factor due to illiteracy or positive community sanction of risk factors (eg blood spotting; PIH; etc).
For instance, a woman with signs and symptoms of PIH is said to be expecting a baby boy or twins!
A woman who rushes to hospital before she breaks the amniotic sac is said to be weak!
DELAY NO 2: DELAY IN TAKING APPROPRIATE DECISION
DELAY NO 3: DELAY IN ARRIVING AT A FACILITY
Due to lack of transportation or exorbitant charges.
Most health centres in the rural areas have no ambulance service and they are located in very remote areas. Thus, women in labour may arrive in the hospital in very bad condition.
The following slides highlight the poor state of transportation in rural Ghana, especially:
DELAY WITHIN THE FACILITY (4)
No competent personnel
No equipment (partograph, etc)
No good theatre
No regular supply of electricity and water
No (blood) bank
No emergency medical supplies
No bed etc
DELAY IN PRODUCING BIRTHING REQUIREMENTS (5)
Pad – Faytex
6 cot sheets
Gloves (in the district)
DELAY IN POST-PARTUM CARE (6)
The general reluctance to attend postnatal clinic, especially by teenagers.
This may also be due to ‘wardrobe syndrome’; marital status or general poverty.
Improving maternal health and reducing infant mortality in Ghana is as much a medical as well as a socio-cultural issue. Reducing mm requires the combined effort of the state and her citizens , especially women who are empowered educationally and financially.
No nation sends its troops to war without guaranteeing their safe return. But for generations, men have been sending women to war to replenish the human stock without guaranteeing their safe return.
( Prof. F. T. Sai).
“Since the world began, women have delivered for society. It is now time for the world to deliver for women.”
(Beth Fredrick, Int. Women’s Health Coalition, NY. USA)