The State of Maternal Health in Africa

A woman and her child outside Lea Toto in Kangemi, Kenya. Picture: Carolilne Kaminju
A woman and her child outside Lea Toto in Kangemi, Kenya. Picture: Carolilne Kaminju

In Malawi one in thirty-six women are at a risk of dying while giving birth, making it one of the world’s highest mortality rate.

According to the World Health Organization, maternal death is described as the “death of a woman while pregnant or within 42 days of termination of pregnancy irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management excluding accident or incidental causes”.

For a long time, maternal health was not given much attention in Africa due to lack of accurate statistics and records.  More recently though, reports have been released that have measured the health situation around the world. According to the report, Trends in maternal mortality: 1990 to 2010”, 850 women were dying per 100,000 births in Africa. Some of the causes include severe bleeding after birth, infections, high blood pressure during pregnancy, and unsafe abortion.

In the year 2000, in a historic moment, more than 180 countries around the world signed the Millennium Development Goals (MDG’S). Adopted from the the Millennium  Declaration, the MDG’s were set in order to track progress and measure success in the areas of health, environmental sustainability, poverty and hunger, education, gender equality and women’s empowerment. Eight goals were set with the year 2015 as the deadline and maternal health is listed fifth among these. Over the last ten years there has been a reduction of maternal mortality by 41 per cent worldwide.   In 2008, the Maternal Mortality Ratio (MMR) was 640 deaths for every 100,000 births and most of these deaths occurred in the Sub-Saharan Africa region. The MMR is considered low if it is under 300 but the target has been set to 150 by 2015.

According to the Global Health Diplomacy report 2012 Africa accounts for half of all maternal deaths despite the fact that it contributes to 12% of the world’s population. Dr Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA), says that the organization  “knows  exactly what to do to prevent maternal deaths: improve access to voluntary family planning, invest in health workers with midwifery skills, and ensure access to emergency obstetric care when complications arise. These interventions have proven to save lives and accelerate progress towards meeting the Millennium Development Goal 5.

Recent reports show that maternal mortality has reduced significantly. UNFPA attributes this reduction to the the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) initiative. It is hoped that by 2015 it will be further reduced by 71 per cent.

Launched in 2009 by the African Union (AU), CARMMA’s  main objective is  ‘to expand the availability and use of universally accessible quality health services, including those related to sexual and reproductive health that are critical for the reduction of maternal mortality’. One of the challenges this initiative is facing is getting accurate statistical figures especially in the rural areas in Africa where not every birth or death is recorded.

A total of 37 countries in Africa have launched the campaign such as Liberia, Madagascar, Morocco, Angola, Egypt, Burundi, Swaziland, Zambia, Botswana and Lesotho which are on track to achieving the MGG 5 goal.

The political commitment in some of these countries has contributed to the significant reduction of maternal deaths. Most governments have increased their percentage expenditure on health.  Rwanda tops the list with the 20% of the government’s budget going to health financing. As a result the MMR is 340 per 100,000 births. Chad on the other hand allocated 3.3% of its budget to health and 1,100 women die per 100,000 births.

Several countries have come up with interesting ways to reduce the number of maternal fatalities. Gambia for instance initiated a campaign that is undertaken by the National Assembly select committee on Health. Headed by the Vice-President, the initiative has partnered with the private sector and civil authorities to ensure the public sensitized.  Countries such as Rwanda, Liberia and Malawi have involved African women in politics to push their agenda forward.As at November 2012, Chad and Somalia recorded the highest number of maternal deaths with over 1000 per 100,000 births.   This is perhaps due to the proportion of births attended to by skilled personnel and the low percentage of budget allocation to health sector by the governments. According to the 2013 CARMMA report, inadequate human and financial resources, poor health infrastructure, high turnover of health providers, religious and cultural barriers are some of the challenges that contribute to the high rate of maternal mortality.

A mother and her child at the Hlengisizwe Community Health Centre in Durban, South Africa
A mother and her child at the Hlengisizwe Community Health Centre in Durban, South Africa

Newly appointed Chairperson of the African Union commission Dr Nkosazana Dlamini-Zuma stated that this year “in terms of health, the Union will focus particular on maternal and child health under the CARMMA”.

According to a recent report (2012) by the UNFPA, family planning is said to reduce MMR by 33 per cent and reduce infant mortality by half. Apart from preventing pregnancy as a family planning methods such as the condom can reduce HIV infections and will help to reduce mother to child transmission of HIV.

The report further showed that there is a connection between education, high fertility rates and family planning use. Sub-Saharan Africa has the highest fertility rates with women having more than 6 children compared to developing countries where the birth per woman is 1.7.  The report also showed the link between reproductive health and economic outcomes. Fewer births mean low child and maternal mortality, improved foetal and women’s health, increased life expectancy, schooling and income.