May 15, 2009

A brief note on Maternal Mortality: Do women count? If so, why do we allow them to die in pregnacy and childbirth? (updated)

Filed under: manifesto,opinion article — newritings @ 11:39 pm mortality is defined as death occurring during or within 42 days of a pregnancy from causes related to pregnancy. The maternal mortality rate is the number of women who die as a result of childbearing in a given year per 100,000 births. According to the World Health Organisation: “every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million women each year.”

“Five direct complications account for more than 70% of maternal deaths: haemorrhage (25%), infection (15%), unsafe abortion (13%), eclampsia (very high blood pressure leading to seizures – 12%), and obstructed labour (8%). While these are the main causes of maternal death, unavailable, inaccessible, unaffordable, or poor quality care is fundamentally responsible. They are detrimental to social development and wellbeing, as some one million children are left motherless each year. These children are 10 times more likely to die within two years of their mothers’ death.”

The figures are horrendous, and the responses to reversing these deaths are slow and uneven, with some countries showing great progress and others like ours little to none. I hasten to add if it were men who were dying like this, we would not be this lethargic as we would have acted with greater vigor, and commitment to meeting the MDG 5 commitment.

In South Africa maternal mortality figures have gone up exacebated by the HIV epidemic. But I suggest the public (and here, I refer to the media and population at large) have to date only played a small and insignificant role in making this the political issue that it truly is. I looked at the Reconstruction and Development Programme (1994) and I did not see it first glance, but re-reading it, I found this clear commitment:

“There must be a programme to improve maternal and child health through access to quality antenatal, delivery and postnatal services for all women. This must include better transport facilities and in-service training programmes for midwives and for traditional birth attendants. Targets must include 90 per cent of pregnant women receiving antenatal care and 75 per cent of deliveries being supervised and carried out under hygienic conditions within two years. By 1999, 90 per cent of deliveries should be supervised. These services must be free at government facilities by the third year of the RDP. In addition, there should be established the right to six months paid maternity leave and 10 days paternity leave.”

I know that Apartheid neglect has a role to play in our current challenges but so too, must the democratically elected government take some blame for the serious missed opportunities in turning the corner on maternal mortality and other related health, poverty and inequality challenges. The major failing of the democratically elected government in this area has been the inability to translate good policy into good and effective working programmes that meets the objectives set.

Millenium Development Goal 5 commits nations to Improve maternal health by reducing by three-quarters the maternal mortality ratio.

The South African government has noted that this is one of their major challenges with an estimated maternal mortality ratio of 150/ 100,000 live births. This ratio was considered unacceptably high and thus government initiated an inquiry into maternal deaths. HIV/AIDS was found to be one of the major causes of the high maternal mortality rate with non-pregnancy related infections, which includes AIDS, increasing from 23% in 1998 to 31.4% in 2005.


During 1997, the Minister of Health in South Africa made maternal deaths notifiable and thereafter set up the National Committee for the Confidential Enquiry into Maternal Deaths (NCCEMD). The other country that has a similar committee is the UK, and by all accounts such initiatives are reported to be very successful in cutting down the number of avoidable deaths of mothers.

In preparing for my short essay (not this posting) I was amazed – despite all the talk about mobilisation of communities, women, families in this gigantic struggle – trying to access the documents electronically is not that easy. Part of the problem is that these documents are posted on the department of health’s website and they do not have a very user friendly programme based web resource.

The NCCEMD has produced three reports, with great loads of practical activies, that must be used NOT only by professional doctors and academics. I do not understand why the NCCEMD do not have their own blog, linked to the ( I will come back to this later).


In the UK, maybe the initiative appears to be more of a non govenmental one ( Having been started as a unit within CEMACH, it was set up in April 2003 as a unit within the Royal College of Obstetricians and Gynaecologists (RCOG) and has a dedicated website housing their reports. Confidential Enquiry into Maternal and Child Health (CEMACH) commenced its work in 2003 with similar objectives “to improve the health of mothers, babies and children by carrying out confidential enquiries on a nationwide basis and by widely disseminating our findings and recommendations”. According to their website, ICEMACH will become an independent charity on 1 July 2009 with the new name ‘Centre for Maternal and Child Enquiries’ (CMACE).

Earlier I wrote about the inaccessibility of vital documents necessary for inform discourse and action, and it must be clear that I am not proposing that SA go this way (CMACE), but simply that the documents so valuable to saving lives be upfront — so that others cannot say – they did not know it was that bad. This will not eradicate the problem, but information acted upon is powerful. ( I do know that a few NGOs such as Health Systerms Trust, have tried to keep detailed records of important reports and documents, but these have to be kept in a user friendly manner by those entrusted with the public mandate)

Back to the South African reports: a  valuable resource is
1. Department of Health, Saving Mothers, Report 1998, Pretoria:Department of Health 1999.
The electronic report can be found at:

2. Department of Health, Saving Mothers, second report on Confidential Enquiries into Maternal Deaths in South Africa 1999-2001, Pretoria: Department of Health 2002. This report is not available electronically despite the committee and the Minister of Health committing to dessiminate information as one tool to fighting marternal mortality. However, an  electronic sources simply list the Second Interim Report on Confidential Enquiries into Maternal Deaths in South Africa – 1999 [PDF], and I list them both hereunder.

3. Department of Health, Saving Mothers, third report on Confidential Enquiries into Maternal Deaths in South Africa 2002-2004, Pretoria: Department of Health 2006.
Electronic source: I am sorry but it does not even appear on the health department’s website, a search only shows a reference to it, as part of the annual report and financial reporting.
It was however located on If I am wrong, please send a comment, and I will reflect on the points, and if wrong, apologise and make the necessary changes.

4. A fourth report is to be released during this year. I hear it is out, but not yet public.

In solidarity

1:30am 16 May (for Leila and her mum, my partner)


1 Comment »

  1. A brief note on Maternal Mortality:Do women count? if so, why do ……

    According to the World Health Organisation: “every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who dies in childbirth, ……

    Trackback by MePregnant — May 16, 2009 @ 5:40 am | Reply

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