Tuesday, July 5, 2011

"No Woman Should Die..."

Caroline came by to tell me the sad and shocking news. One of the driver's wives (the group she is organizing for mutual aid) died in childbirth this week. The baby died, too. She wondered if I would like to contribute to the collection of funds for the family. The husband is left with four children to care for, the youngest only two years old. Because three of the four children are girls, and it is not considered suitable in this culture for a single father to raise girls alone, Caroline thought the children might have to go live with the grandmother.

This was not the first death in childbirth I had heard about, but the first where I had met the woman. The maternal mortality rate in sub-Saharan Africa is more than twice as high as in other developing countries in different regions. The United Nations adopted a set of eight Millennium Development Goals to guide its work for the period 1990-2015. Countries were asked to sign on and to give priority to the goals in their budgets and their development plans. One of the eight goals is to reduce maternal mortality by three-quarters by 2015. Zambia signed on and has succeeded in making some progress, although not enough. The rate was 750 deaths per 100,000 live births in 2000, and today it is 591/100,000. Eight Zambian women die each day from pregnancy related causes. Infant mortality is significantly higher, with 48 newborns dying each day. Zambian women carry a lifetime risk of maternal death of 1:38.

Maternal mortality rates also include pregnant women whose death is related to abortion. Abortion is culturally unacceptable in Zambia. It is viewed by most people as sinful or even as murder. While medical abortion is legally available under certain limited conditions, it is a rare occurrence in clinics or hospitals. So some women die from botched or "backstreet" abortions. Many don’t die but suffer serious illness or disability. Newspaper articles have reported on women swallowing battery acid, taking herbs which turn out to be toxic, and being internally injured by other means to try to cause a miscarriage.

"No woman should die while giving life." This is the motto of a Zambian campaign to reduce the number of deaths that occur to women during pregnancy, delivery, and the month immediately following childbirth. The needs are many, especially for trained birth attendants and accessible clinics and hospitals. Only 47% of births happen with a skilled attendant present. Only 60% of pregnant women receive four prenatal visits with a health care provider. Few receive postpartum checkups. Early marriages are common in villages, and very young girls who become pregnant often experience prolonged and obstructed labor. One UNICEF report called the high rates of maternal mortality "the scandal of our times."

The maternal mortality rate is much higher in rural areas than in cities. There, medical facilities are often too far away to reach by walking, and transport is expensive or unavailable. One innovative project in a rural district in Zambia involves providing villages with sturdy bicycles to which a trailer is attached designed to carry the pregnant woman to the clinic when she is in labor. Another program is extending and improving the training and equipping of midwives.

Just for comparison, I looked up the figures for maternal mortality in the United States and was troubled by what I read. Thirty-nine countries have rates lower than ours, which is reported to be 17 per 100,000 live births in 2008. Our rate has been increasing; it was 12/100,000 in 1990. And it is four times as high for African-American women than for white women. So I would suggest that we have some work to do at home on this issue.

"No woman should die while giving life." Good goal to keep in mind as we look at our health care system in its brokenness and limitations. Of course, not all maternal deaths are preventable, but most are. And so we should.

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