Sarah Brown, safe motherhood advocate and wife of former Prime Minister of the UK Gordon Brown once said, “I don’t believe that we will make the progress on HIV/Aids without addressing maternal mortality. We will not make the progress we want on malaria without addressing maternal mortality. We will not make progress on getting more children to school without reducing maternal mortality. When a mother survives, a lot survives with her.”
We have heard and read a lot about causes and statistics of pregnancy and childbirth and it is time we step up our act to save the mothers of this nation. Whereas the ways of ensuring safe motherhood are of the much part straightforward, their implementation can be complex.
But first, allow me send my sincere condolences to the family of the late Cecilia Nambozo from Mbale District who would probably be with us today had she received the necessary attention on time. Her tragedy depicts the plight of many other mothers out there in labour wards. Nicholas D. Kristof, a New York Times journalist, once noted that “Half a million women die each year around the world in pregnancy. It’s not biology that kills them as much as neglect.” Well said, I bet. There are those health workers who uphold the good image of the profession by acting professionally and these should be acknowledged but those who abuse the profession by neglect of duty in any form must be held accountable.
In fact, there is undisputed evidence that improved performance doesn’t necessary have to cost a lot. Developing countries such as Egypt, Tunisia, China, Malaysia, etc have embraced good practices which have remarkably reversed the rate of maternal mortality and morbidity. They have put their existing resources to better use by exploring cost-effective options to enhance the capacity of national health demands, systematically strengthened the healthcare systems, and drummed up grassroots support for the cause. I, however, acknowledge that the facilities and incentives of healthcare workers need to be improved.
Maternal death hugely compromises all the key human rights you can imagine such as right to life, family, education, health, etc. Human rights violations such as female genital mutilation/cutting, forced early marriages, gender-based violence, violation of women’s economic and property ownership rights, etc, constitute a major violation of a woman’s right to make decisions regarding her life and body leaving her vulnerable to social evils. It is obvious that the poorer the household, the higher the risk of maternal death.
According to the UNFPA fact sheet; worldwide, there is an estimate of 210 million pregnancies, 80 million unwanted pregnancies, 50 million induced abortions, 20 million unsafe abortions, 68,000 deaths from unsafe abortion, and 20 million infections and disabilities following childbirth. We need to make sure that Uganda is not affected by such statistics by avoiding unwanted pregnancies and encouraging family planning.
Within the context of inadequate financial resources, mounting health demands, escalating healthcare costs, rising population, and heightened public expectations, midwifery and nursing services present a platform from which we can scale-up health interventions to assist in meeting national health targets. We need to strengthen and make affordable midwifery and nursing education while efficiently managing maternal and neonatal health challenges. Without adequate fully qualified midwives at their work stations, almost all the other strategies to reduce maternal mortality and morbidity are bound to fail.
Among other key interventions, we need to invest in midwives and increase availability of emergency obstetric care, address unwanted pregnancies, encourage delayed first birth for adolescents, promote cross-sectoral linkages, reduce the risk of unsafe abortion, stamp out Female Genital Mutilation and address contextual factors such as women’s education, lack of male involvement, access to economic resources, etc.
Most importantly, all workshops discussing strategies must ensure that they have the active presence of policy makers to cultivate ownership on their part. Otherwise, the great ideas will always remain on paper.
Mr Masake works with Uganda Law Society. email@example.com