This interview with H. E. Adv. Mrs. Bience P. Gawanas was recorded in May 2012 - in it she describes why maternal mortality is a problem that Africa can fix - and how CARMMA is working to mobilise action and save the lives of mothers babies and children accross Africa.
1. What is maternal mortality?
Maternal mortality is when a woman dies due to pregnancy-related complications. This could be during pregnancy, at the time of delivery or even after delivery.
I think it is important to state from the onset that the focus is not just on the death of a mother but rather on the causes which leads to such deaths as many times such information is not always readily available. This is also link to the whole issue of a woman’s right to choose when and how many children she wants to have and therefore the importance of educating both men and women on sexual and reproductive health.
2. What are the main causes of maternal mortality in Africa?
Hemorrhage is the leading cause of maternal death in Africa. Sepsis and Infections including HIV/AIDS, Hypertensive disorders, Anemia, Abortion, obstructed labour, ectopic pregnancy, embolism, early childbirth and lack of family planning are other major causes. In southern Africa, HIV complications are one of the leading causes.
3. Can maternal mortality be avoided?
Absolutely. Regular check-up during pregnancy can help detect problems early and timely measures can be taken to ensure a safe delivery - a pregnant woman should have at least 4 antenatal consultations. A pregnant woman, who does not regularly attend antenatal clinics, misses much needed early detection of possible problems. Contraception and spacing between pregnancies is also very important to maintain good health of women, and avoid deaths during pregnancy and childbirth.
4. What should Africa do to reduce maternal mortality?
Across Africa, the challenge of preventing maternal deaths is enormous. While progress has been made in some countries, a lot still needs to be done. There is the need for increased political commitment, evidenced based communication, efficient flow of information and communication from the national to the community and household levels and to achieve change on a large scale. In Africa there is a need to shift from an emphasis on awareness raising, information dissemination, and individual behavior change to mass action for social change.
Documentation of good practices is also crucial for developing “lessons learnt”, so that all our Members States can get to know what works and what does not work
There are secondary factors that contribute to maternal mortality (especially in rural areas) like the cost of healthcare, waiting lines and long distances to health facilities and fear; how has CARMMA been addressing these problems?
These are indeed matters which contribute to maternal mortality. We have an Africa Health Strategy that deals with strengthening of health systems to ensure access to health care by all women. We are mobilising political commitment to address these issues and hope to raise public awareness of these issues to put pressure on decision makers.
5. There are a lot of conflicting statistics around the rate of maternal mortality in African; is this a problem?
It is not only in maternal mortality where you find conflicting statistics; you can find this in economics, labour, HIV - in many other fields.
However, it is important to note that there are specific organisations that have been conventionally agreed as the publishers of genuine statistics. Statistics change every day, and slight changes do not significantly affect the main outcome. It is always better to take note of the risk instead of the absolute number. I can tell you that 1 in every 16 women in Africa is at risk of dying during pregnancy.
6. How are the results collated and calculated?
Demographic health surveys collect information from the primary sources and households. They are conducted every 5 years.
7. In the case of rural areas where deaths/cause of death is not recorded, how can we be sure that these figures are not misleading?
The key is to promote maternal death reviews (MDRs) in Member States. The MDRs shall not only help us collate the statistics, but also enable us to document the causes of death and develop lessons learnt.
8. What is your view on national governments and their commitments to the health care system of their countries? What measures have been taken to draw their attention?
One of the main objectives of launching CARMMA was to raise awareness of policy instruments adopted by our governments and to advocate for their effective implementation. In this regard, we are mobilising political commitment and social involvement of communities to address this issue.
9. Mother and child are the continuity of life, what role do men play in reducing maternal mortality?
Male involvement in reducing maternal mortality is absolutely critical. As both men and women desire to have a healthy mother and baby. Therefore, men should physically, financially and emotionally support women especially during pregnancy, at and after childbirth. They should participate in their wives antenatal visits and not cause stress for their wives as stress can lead to high blood pressure, which can lead to hemmorhage and then death.
Men sometimes engage in cultural and traditional practices which are harmful to a woman’s health and should be discouraged from such practices. Men can be strong advocates for maternal health and survival too – CARMMA seeks to encourage this.
10. Teenage pregnancy, lack or access to contraception and abortion are problems we face. What has the AUC done to educate teens on sexual and reproductive health including the risk of childbirth and maternal mortality?
The Maputo Plan of Action developed by the AU addresses all these issues. It is a term plan built on nine action areas:
- Integration of sexual and reproductive health (SRH) services into PHC
- Repositioning family planning
- Developing and promoting youth-friendly services
- Preventing unsafe abortion
- Improving quality of care
- Resource mobilization
- Commodity security
- Monitoring and evaluation
We reviewed the Maputo in 2010 and recommendations were later deliberated upon the Heads of State in the same year and extended the plan to 2015. The CARMMA is now advocating on these issues.
11. Is there any plan of including sexual and reproductive health in secondary school curriculum? How important is it for young men and women to be educated in this aspect?
We need to be careful not to overload the school curricula. We also need to decide what we should do now and what we should do later. The schools are teaching basic health sciences and sex education, this can suffice for now as it shall equip the pupils with the basic life-saving knowledge. The youth themselves should also promote dialogues especially between girls and boys and be taught the importance of respecting a girl’s right to be equal.
12. Considering the goals targeted at reducing Maternal Mortality, are there exclusive progress reports to show that more women are surviving childbirth in Africa?
Africa has improved its performance in meeting MDGs 4 & 5, but it is not sufficient to meet the MDGs by 2015. We should however desist from looking at the negatives but scale-up the positives
13. In the eventuality of the death of a mother, are there palliative methods on ground to ensure the child’s survival in Africa?
The AU has developed the Social Policy Framework that is meant to take care of those who fall between the “cracks”. Let us popularize and domesticate it in Member States.
We start with reference to the African Common Position of Africa Fit for Children as well as the Call for Accelerated Action on Africa Fit for Children which all specifically deal with child survival issues. Then follow with the Social Policy Framework and the Africa Regional Nutrition Strategy as malnutrition is a high cause of death amongst children.