Choosing between high maternal mortality and population growth (Feature August ........., 2008)

Article: Lucy Adoma Yeboah

THE government’s policy of free maternal health care, which is seen as God-sent by many Ghanaians, especially poor women within child-bearing age, is being considered as a recipe for population boom and, therefore, raising eyebrows in certain quarters.
Since the introduction of the policy on July 1, 2008, almost every individual who has had the opportunity to comment on it, has touched on the issue of population growth and the need to educate women not to abuse the system.
That argument is being supported by a United Nations report which put Ghana's annual population growth rate for 2000–2005 at 2.17 per cent, a situation likely to push the country's population to 26,359,000 in year 2015, if not checked.
A Daily Graphic editorial comment on July 15, 2008 indicated that closely linked to the policy of free pregnancy care were the concerns expressed by the Minister of Health, Major Courage Quashigah (retd), over the steady drop in the rate of contraceptive use in the country, which to the paper, could further increase the size of the country’s population.
The rate of contraceptive use, according to the Health Minister, had dropped from 19 per cent in 2003 to 14 per cent in 2007, and because of that, the minister was con???
The paper went on to point out that those statistics were already disturbing and placing it??? under the already spiralling number of pregnant women registering under the National Health Insurance Scheme (NHIS). There was, therefore, the need for a careful analysis of the situation in order to avoid population explosion.
To the paper, the government could be dealing with an even greater population, which would mean a greater strain on the scarce resources, with the attendant issues of unemployment and food insufficiency.
Much as it is important for the women to be educated in order not to have more children because of the policy, some of us would want to argue that between increased population and high maternal rate, we would bargain for the former, since we believe that there is the urgent need to save our women and their babies from preventable deaths.
The reason for that position is the fact that in Ghana, just like any other developing countries, maternal mortality remains one of the major health challenges to human resource development.
Health experts define maternal death as the death of a woman while pregnant, or within 42 days (six weeks) of termination of the pregnancy from any cause related to, or aggravated by the pregnancy or its management. Deaths of pregnant women through accidents or incidental causes are not considered maternal deaths.
Although the current maternal mortality ratio is still unknown, it is estimated to be between 214 and 540 per 100,000 live births (LB).
Between 2006 and 2007, institutional maternal mortality (records from health facilities) was 197/100,000 live births.
The maternal mortality ratio indicates the risk of death a woman faces with each pregnancy. In areas with high fertility, such as sub-Saharan Africa, women face this risk many times in their lifetime.
According to the World Health Organisation (WHO), the probability that a 15-year-old girl will die from a complication related to pregnancy and childbirth during her lifetime is highest in Africa - one in every 26.
Statistics indicate that about 585,000 maternal deaths occur globally every year, and 99 per cent of these deaths are in developing countries, which include Ghana.
Looking at these figures, it will be quite difficult for everybody to refuse appreciating the significance of the recently introduced policy of free maternal care, in spite of the fear of adding to our already fast growing population.
Indeed, the pain of losing a mother or child because of a lack of medical care is enough to call for a change in policies to effect a change.
Although some women might want to get pregnant because of the free medical care, it is also important to note that those women who were said to have moved in large numbers to register under the policy became pregnant when there was no such policy.
That reminds me of the story of a group of young men who lived in a town in the Brong Ahafo Region who were accused by the elderly of drinking too much at the burial of a baby. The response they gave their “accusers” was that before the baby died, they were drinking at that same level, so why should anybody link their drinking to the death of a baby.
The policy, to some extent, can encourage some women to have more babies, especially those whose only interest in having babies is to organise outdooring ceremonies after delivery and then abandon the babies for others to take care of. Indeed, those type of women should be a source of worry to all of us, but the fact still remains that there are many responsible Ghanaian women who are aware that there is more to the act of bringing forth many children.
That is the more reason why many Ghanaians, especially women within child-bearing age welcomed it when the government recently announced the commencement of the policy of free medical care for pregnant women under the NHIS, beginning July 1, 2008.
At a meet-the-press programme organised on July 17, 2008, the Chief Executive Officer (CEO) of the National Health Insurance Authority (NHIA), Mr Ras Boateng, stated that the authority had recorded a total of 50,924 pregnant women who had registered under the programme since its inception on July 1, 2008.
Mr Boateng said the figure represented what the authority had, at that time, received from some of the districts.
Statistics presented by the NHIA boss indicated that the Ashanti Region was leading with 12,164 registered women, followed by the Greater Accra Region with 8,211; the Central Region, 6, 843; the Eastern Region, 5,870; and the Western Region, 5,012.
The rest are the Upper West Region, 3,608; Northern Region, 2,720; Upper East Region, 2,473; Brong Ahafo Region, 2,434; and the Volta Region, 1,589.
The CEO stated that there was the possibility that many of those women would have failed to go for ante-natal care if the policy was not introduced, a situation he observed was likely to create problems for them and their babies.
So now the question is, do we leave our women to suffer because of the fear of population growth or do we have a responsibility as a nation to save them? Have we also considered the point that some women decide to give birth to many children with the fear that some might not survive? To some of us, it is possible that many of the women would decide to bring forth to a fewer number of children if they are sure that there are better conditions to protect them.
Let us advise our women (and in fact, some of the men) to be responsible when it comes to child bearing, but at the same time, let us welcome the policy of free medical care, since it came to save many women and their babies from premature deaths.