AFRICA: Medical Experts Africa Say Maternal Mortality is a Human Rights Violation

An International expert on Women's and Health Specialist has spoken out on the topic in the number of deaths occurring worldwide from maternal mortality. “It is a human rights violation because most countries in the world had signed to the United Nations declaration on the right to life,” says Ottowa, Canada based Dr. Andre Lalonde, former executive vice-president of the Society of Obstetricians and Gynaecologists of Canada.

Speaking at the East, Central and Southern African Association (ESCSAOGS) conference in Maputo, Mozambique, Dr. Lalonde talked about solutions for the plight of global women who face
losing their lives in childbirth.

“Most countries have forgotten about this global crisis,” Dr. Lalonde declared as he pointed to what he felt was to blame for the failure. “Post Partum Hemorrhage (PPH) is a system failure by governments, why are we letting women die unnecessarily?” Dr. Lalonde added.

Today many women are dying because they are being asked to pay before they can receive assistance during childbirth as they try to reach medical facilities or remote healthcare clinics. Even in the most remote areas when women are suffering from extreme poverty without any financial resources, they are often asked to go back home if they cannot pay for medical assistance for reproductive healthcare.

Maternal mortality, the death of a woman who is pregnant or who has delivered her child, can occur anytime during the months of pregnancy or within 42 days following childbirth. PPH – Postpartum hemorrhage is the deadly bleeding that sometimes follows delivery as the uterus fails to contract back to its normal position.

To reduce the deaths of women from complications occurring during or following childbirth, Dr. Joseph Karanja, chairperson for ESCSAOGS, professor and consultant for the department of Obstetrics and Gynaecology at University of Nairobi, has publicly encouraged more doctors, medical personnel, pharmacies and midwives to openly provide the drug misoprostol to women to help them reduce deaths from excessive bleeding 2-4 hours following childbirth.

Even with its low cost and ease of use that allows it to be administered orally and requires no refrigeration, misoprostol as a ‘drug-of-choice' has been placed on the front lines of the abortion debate in many regions of Africa. Advocates argue for its use in rural areas where women cannot reach medical clinics saying it is “essential to saving lives.” Those against its use say the drug has a history of use for abortion.

Early 2001 trials in the UK for safe use of the drug during early stages of labour did show misoprostol to be dangerous to women who are trying to speed up their labour, but later trials narrowed the safest use to late-stage labour use only.

In a recognised May 2011 triumph, the World Health Organization (WHO) added misoprostol to its List of Essential Medicines for the prevention of PPH and to prevent the dangers of incomplete abortion. The recommendation has come on the culmination of years of research and advocacy.

“Bleeding after childbirth (postpartum haemorrhage) is an important cause of maternal mortality, accounting for nearly one quarter of all maternal deaths worldwide,” says the WHO.

With less than five years left until the deadline for the 2015
Millennium Development Goals (MDG), Zambia has one of the highest maternal mortality rates in the world where assured and safe motherhood in the region still seems out of reach for many as newborn and child mortality rates remain high. The latest UNDP (United Nations Development Programme) July 2011 figures show the rates of maternal death in Zambia to be 591.2 deaths per 100,000 live births.

The critical use of misoprostol may be the best and most accessible answer to reduce deaths. “Misoprostol tablets offer a safe, effective, affordable and easy-to-use solution to women,” says Dr. Karanja.

Zambia's Ministry of Health, and its partners, are now supporting a vigorous campaign for accelerated reduction of maternal mortality as they intensify existing strategies to better the lives of women and prevent maternal deaths in Zambia.

Although there has been a decrease in maternal mortality ratios much still needs to be done as women continue to die unnecessarily especially those in remote areas. “The known success factors are the presence of trained midwives at births, and rural feeder roads and transport that get pregnant women to health clinics on time,” says the 2011 UNDP Zambia MDG Factsheet.

A woman with an obstetric emergency in a rural area may find the closest facility is not properly equipped. Some clinics work mainly as classrooms for regional health education or as a clinic for basic treatments. Many rural women may have no way to reach a more equipped regional center where proper medical resources do exist.

Distances to medical facilities for many rural women in Zambia range from 5 to 20 kilometers (3 to 12 miles). Too many women who have started labour end up losing their babies or die themselves it they cannot manage to reach the proper facilities.

Other problems that include shortages of qualified staff, essential drugs and supplies, coupled with administrative delays and clinical mismanagement, have become documentable contributors to maternal deaths.

“According to the latest UN official figures, more than 500,000 women die every year from pregnancy-related causes. This means one death every minute,” said Navi Pillay, United Nations High Commissioner for Human Rights at a high level meeting at UN Geneva June 2010. “Meanwhile approximately 10 million women annually suffer pregnancy-related injuries and disabilities,” continued Pillay.

“The known success factors (to slow maternal mortality) are the presence of trained midwives at births, and rural feeder roads and transport that get pregnant women to health clinics on time,” says the UNDP.