We need collective effort to reduce maternal deaths

David R. Walugembe

What you need to know:

  • Functional health system. Rather than blaming health workers, we should examine our individual and collective efforts towards reducing the avoidable maternal and perinatal deaths. From the expectant woman, family members, health workers, general public, policy makers, media, funders, religious leaders, to ministries, we should all become advocates of a responsive and functional health system

A few days ago, I woke up to the sad news of the death of a younger, outgoing and jolly friend from the Rotary family. She passed on while giving birth at one of the hospitals in Kampala. Before this, a media personality also lost a daughter while she gave birth at another hospital in Kampala!

These two cases are among the 19 women that die every day while giving birth in Uganda! They are referred to as maternal deaths or death of women from pregnancy- related causes during or within 42 days after termination of the pregnancy. The national statistics for perinatal deaths – deaths of babies aged between 0 and seven days that occur every day in Uganda, is unknown although it outnumbers the maternal deaths.

Many times, maternal and perinatal deaths are blamed on health workers and/or health facilities where they occur. Health workers are usually described as negligent, cold hearted, insensitive and corrupt! Whereas some allegations of negligence may be proven beyond reasonable doubt, solely blaming health workers for all these deaths is unrealistic!

Instead, adopting a holistic approach into understanding the factors that contribute to maternal and perinatal deaths in Uganda may help us appreciate why we should advocate for multisectoral approaches to reducing these deaths.

Most maternal and perinatal deaths stem from three types of delays. These are delays at home, delays on the road, and delays to receive care while at the health facility. It is common practice to forget about the other delays and focus on the delays to receive care while at the health facility, which is the responsibility of the health workers and health facility. However, knowing how delicate pregnancy is, some mothers delay seeking appropriate healthcare from the health workers. Some miss the antenatal visits, while others prefer traditional birth attendants or family members to deliver them!

Worse still, some husbands or partners deter their women from seeking care from skilled health workers! As a result, these women only resort to seeking care from health facilities when their situation becomes complex and constitutes an emergency! So, this constitutes the first type of delay-delay at home.

The second type of delay relates to accessing the health facilities. This can be explained in form of poor transport infrastructure and services, including bad road networks, lack of ambulances and fuel to transfer mothers with complications from either their homes or from one health facility to the next in case of a referral.

Even where the road networks may be available, their impassable state due to weather and sometimes heavy traffic congestion often contributes to maternal and perinatal deaths. Imagine the traffic jam in Kampala and how we tend to react to the ambulance sirens! Would a mother in a critical condition easily make it to Mulago if an emergency struck at either 7.30 am or 5pm on a regular weekday with all that traffic jam?

But guess what, nobody considers the other delays when the often few health workers are finally accessed, but are still unable to rescue the mother and/or baby! Usually, focus shifts to the third delays delay to receive care at the health facility and it all becomes the fault of the health workers!

What if the expectant mother braves the other delays and makes it to the health facility only to discover that they lack drugs and supplies to deliver her? Whose responsibility will it be?
Regardless of the responsibility centre, no woman deserves to die while giving birth to a new life and neither should the new life end when it ought to begin! As such, losing an estimated 19 lives of women and so many babies everyday should concern us as a nation.

All stakeholders should advocate for effective operationalisation of the maternal perinatal death surveillance and response (MPDSR) policy. It seeks to ensure that all maternal and perinatal deaths are identified, reported, reviewed and responded to so that lessons learned from them are used to prevent similar deaths from happening.
However, the implementation of this policy is affected by many system-related factors, especially inadequate health financing, limited data utilisation as well as inadequate multisectoral collaboration.

Rather than blaming it all on the health workers, we should examine our individual and collective efforts towards reducing the avoidable maternal and perinatal deaths. From the expectant woman, family members, health workers, general public, policy makers, media, funders, academics, religious leaders, to ministries, departments and agencies - we should all become advocates of a responsive and functional health system.

If we choose not to care, these avoidable deaths will become normalised although they will never cease to shock us every time they claim our friends and loved ones!

Mr Walugembe is a health information scientist,