Addressing Ghana’s high maternal mortality rate

Sat. February 13, 2010
GHANA, like other developing countries has a high maternal mortality rate. The Ghana Maternal Health Survey, 2007 indicates that maternal mortality ratio in Ghana remains unacceptably high at 451 deaths per 100,000 live births
In addition, statistics from the Ghana Health Service (GHS) also indicates that 953 women died in 2008 from pregnancy and delivery complications in our health facilities. This figure, according to the GHS, did not include those women who died silently in communities who were quietly buried without registration.
It noted that out of that number, adolescents represented 104 which is 10.9 per cent with Ashanti Region recording the highest figure of 22 adolescent maternal deaths, followed by Greater Accra with 15, Western had 11, Brong Ahafo regions with 13, Volta, Central and Eastern regions recorded nine each, while the Upper East and the Upper West regions had two each.
Health experts refer to maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy. That is irrespective of the duration and the site of pregnancy from any cause related to or aggravated by the pregnancy or its management. The death should not be accidental or incidental but purely pregnancy related.
The United Nations Population Fund (UNFPA) says maternal mortality represents the greatest health inequity in the world. Aside it, no other health indicator starkly illustrates global disparities in human development.
It went on to state that the tragedies of maternal mortality is a key indicator of not only the value placed on women, and by extension, children's lives, but also a reflection of the level of development in the country.
“Apart from the human tragedy associated with the death of any woman through preventable maternal causes, another family is deprived of a principal breadwinner and reduction in the survival of the existing children in the family”, it pointed out.
Information provided by the Country Midwifery Advisor of UNFPA in Ghana, Mrs Fredrica Enyonam Hanson indicated that the linkages between women's sexual and reproductive rights; inequality; lack of opportunities and choices; as well as poor sexual and reproductive health and its manifestation in high maternal mortality, made maternal mortality a recurring challenge affecting the pace of development in Ghana.
Mrs Hanson pointed out that despite heightened efforts to reduce maternal deaths in Ghana over the last decade, the country lagged behind in achieving both national and internationally agreed targets as stated under MDG 5.
These intervention, according to her, included the priorities of the Sector Programme of Work, the Poverty Eradication Action Plan, and the country’s declaration of maternal mortality a national emergency in 2008.
Results recorded by the UNFPA indicate that in spite of all those efforts, low coverage of skilled attendance at birth in Ghana remains a major contributor. The inadequacies in skilled attendance at birth are further evidenced by the high neo-natal mortality of 45 deaths per 1000 live births contributing almost 60 per cent of infant deaths in Ghana (GMHS 2007).
Looking at the statistics, it is important the health sector, individual organisations and families make efforts to ensure that mothers are safe.
Safe motherhood is defined as “creating the circumstances within which a woman is enabled to choose whether she will become pregnant, and if she does, ensuring she receives care for prevention and treatment of pregnancy complications, has access to trained birth attendants, has access to emergency obstetric care if she needs it, and care after birth, so that she can avoid death or disability from complications of pregnancy and childbirth”.
Safe Motherhood, according to health professional meant the well-being of a woman during pregnancy, labour and delivery as well as the period thereafter.
In the words of Mrs Hanson, it is unacceptable for 451 women out of every 100,000 babies born alive to die through pregnancy related complications in Ghana. She like other like-minded individuals see safe motherhood as a public health as well as a human rights issue.
She said a woman's health affected every area of her life because of the multiple roles she played in the family, community and the society as a whole and as such, the need for a concerted effort from all stakeholders in maintaining the health of a woman during pregnancy, labour and delivery and in the post-partum period should not be taken for granted adding that women needed to be empowered to decide freely on issues that affected their health.
“We cannot make this happen in our part of the world when we do not involve men. Men should see women as partners who should be supported”, she stressed.
She observed that complications of pregnancy and child birth were usually not predictable but prevention of the fatality was possible when there was early recognition and effective management of the situation.
A 2007 WHO report indicates that 15 per cent of pregnant women may develop complications during pregnancy and childbirth as against 85 per cent who will go through pregnancy and childbirth without any complications. This means that out of every 100 pregnancies, there is a probability that 15 of them will develop complications. It is these 15 per cent mentioned above who suffer complications that contribute to the maternal deaths we record. Among these obstetric complications, haemorrhage/bleeding is the leading cause of death in Ghana accounting for 29 per cent of maternal deaths last year (GHS annual report).
This situation is further worsened by the three delays which are: Delay in the home, delay in accessing the health facility and lastly delay in receiving care at a health facility. Other major causes include obstructed labour, infections, pregnancy induced hypertension and complications of unsafe abortion.
There are lot to be done to prevent this unfortunate situation and among them is increasing women's access to health services which is seen as a major factor in decreasing maternal mortality.
It is stated that while the majority of women receive ante-natal care, 45 per cent of births still occurred at home and only 55 per cent were assisted by skilled providers, making it difficult for women to receive the care they need in case of complications.
Another issue is preventing unplanned pregnancies, which health workers maintained could reduce unsafe abortions and maternal deaths, especially among young women by about 30 per cent.
Most maternal deaths occur during labour, delivery, or the first 24 hours after delivery, and most complications as mentioned earlier cannot be prevented or predicted. Skilled care during pregnancy, childbirth, and the immediate postpartum period, by health care professionals with appropriate skills have been recognised as the key interventions to reduce maternal mortality. Skilled birth attendants include midwives and other health professionals with midwifery skills.
It must, however, be noted that for skilled birth attendants to effectively perform, they need the necessary emergency obstetric care facilities and equipment in order to prevent the senseless deaths of our mothers and sometimes their children which had continued over the years.