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Maternal mortality in Africa: Causes, strategies for improving health outcomes

The unacceptably high level of maternal mortality is a health challenge worldwide and a common topic in global health discussions. Despite the significant progress made by some countries, little progress has been made in Africa as more than half of maternal deaths globally still occur in sub-Saharan Africa (SSA).

Various factors contribute to the maternal health crisis in Africa and globally. While there is no singular straightforward intervention that will eliminate maternal mortality, there is a strong consensus that strengthening healthcare systems, availability of skilled delivery attendants, and availability of quality medicines are crucial to improving pregnancy outcomes.

A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high-income countries, this is 1 in 5400, versus 1 in 45 in low-income countries

Statistics on maternal mortality

According to the World Health Organisation (WHO), about 99 percent of the maternal deaths globally occur in developing countries. In 2017, there were about 295,000 maternal deaths worldwide.

85 percent of these deaths occurred in sub-Saharan Africa and South Asia, with SSA accounting for roughly two-thirds of the maternal deaths. The maternal mortality ratio in SSA was 542 deaths per 100,000 live births compared to a global ratio of 216 deaths per 100,000 live births.

A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high-income countries, this is 1 in 5400, versus 1 in 45 in low-income countries.

The major complications which account for about 75 percent of maternal deaths include postpartum haemorrhage; which is the most common cause of maternal deaths and is responsible for over one-quarter of deaths and other common causes such as hypertensive pregnancy disorders (e.g. pre-eclampsia and eclampsia), complications resulting from unsafe abortion, pre-existing medical conditions which are worsened by pregnancy (e.g. cardiac diseases and diabetes), sepsis, embolism, and malaria.

Causes of maternal mortality in Africa

A major cause of maternal mortality in Africa is poor access to skilled healthcare workers.

Statistics show that there are about 985 people for every nurse-midwife and 3,324 people for every medical doctor in Africa.

Also, in a study carried out in 12 states in Nigeria, it was discovered that a high level of respondents both in private and public health facilities lacked certain knowledge critical to safe storage of oxytocin, which is a life saving commodity used to treat postpartum haemorrhage.

Only 46 percent of respondents (52.8% in private, 40.0% in the public sector) had proper knowledge that oxytocin should be stored in the refrigerator.

Most pregnant women have limited access to antenatal care, delivery and newborn care from health professionals.

This is particularly true of women living in poverty, who typically have no access to receive adequate health care and are more likely to experience maternal death.

A significant contributor to this challenge are the grossly unequipped primary health centres (PHCs), which often lack even the most basic requirements for quality healthcare, including good sanitary conditions and availability of safe drinking water, posing tremendous risk to pregnant women in rural communities.

Unfortunately, this is the state of many PHCs in rural communities across Africa. The result of such poor access to quality maternal healthcare has been an increased risk of death from severe bleeding, infections, or other complications.

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Strategies for improving pregnancy health outcomes in Africa

There is an urgent need for maternal mortality interventions in sub-Saharan Africa to reduce the maternal mortality rate from the current high levels to meet the Sustainable Development Goals (SDG). The SDG target is that by 2030, the global maternal mortality ratio will be less than 70 per 100,000 live births.

The WHO has been working with UN member states to improve maternal health by increasing research, establishing global standards, and providing technical support and clinical guidance. African governments should also match this with their commitment.

In view of these, strategies that must be adopted urgently to minimise maternal deaths and improve health outcomes include:

Strengthening of Primary Health Centres (PHCs) in Africa: This is a non-negotiable pathway to improving pregnancy health outcomes in rural communities. Well-equipped PHCs where rural women can access adequate antenatal, delivery, and postnatal care with access to safe drinking water are essential pillars for maternal health.

Collaboration and strategic partnerships between the government, private sector, and non-governmental organisations (NGOs) both internationally, regionally and nationally are also crucial for the establishment of new and innovative financing mechanisms.

Education and awareness campaigns to improve public awareness, particularly in rural communities, on the importance of adequate antenatal care as a critical determinant of pregnancy outcomes.

Antenatal care is necessary to ensure the management and control of risk factors that might adversely affect pregnant women and/or the pregnancy outcome.

Maternal deaths have a tremendous impact not only on the immediate families but also on the social and economic development of the wider communities. Bloom Public Health is therefore calling on all key players to rise to the challenge of strengthening health systems across Africa to provide equitable and quality maternal healthcare.

Anyakora is the CEO of Bloom Public Health and a public health expert.

Odibeli is a pharmacist and the Research and Communications Coordinator at Bloom Public Health.

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