Challenges and opportunities in reducing maternal-child deaths

Pregnancy, pregnant women, maternal- child health

In my last article, I attempted to discuss the three delays in the maternal-child health discourses. I offered insight into their implication in practice and research. In this article, I will share briefs of some of the outstanding issues from my scoping review for a research project.

I have chosen to expound on the issue of maternal child health as stipulated in the Millennium Development Goals (MDGs) to elicit public debate. The purpose of which, is to shed light on the predicament of pregnant women in the inaccessible and deteriorating antenatal and emergency services in Uganda. The health of a woman is a key determinant of the health of the household. Undermining the health of women equally diminishes the society’s pursuit for economic prosperity.

MDG goals four and five are specific to the reduction of maternal child mortality rates among expectant mothers.  This topic interests me because in many studies and prevailing literature, Sub-Sahara Africa (SSA) has been found to be a commonplace for women to die during the course of pregnancy (54% of all global annual maternal deaths due to pregnancy). There are many causes for the malignancy of this problem, but what is important to note is that most of the underlying causes of these deaths are easily avoidable or preventable.

I have carried out an extensive but preliminary literature review on this subject of maternal –child health dyad. Out of the over 600 peer reviewed research articles, I found common and recurring themes. Top among these are; lack of political will to prevent, arrest or reverse deaths associated with pregnancy; that although fertility among poor and rural SSA is high, pregnancy related complications and deaths are associated with conditions of poverty. Communities that are isolated due to lack of infrastructure (Roads and telecommunication) and those that lack access to professional Emergency Obstetric care (Emoc), incur more deaths whether due to pregnancy or any ailment and; certain cultures, traditions and customs are enablers in facilitating these deaths.

Success stories have been registered where women have been able to generate household income and to support their pregnant peers to seek professional care. Other areas of success recorded involves rural communities indulging in cost sharing for public health services, where minimal membership fees is paid at village and sub-county levels, like in Rwanda which promotes performance based financing to healthcare. In some places, women incentivize Gaenecologists and Midwives to frequent their local health centers, like it is in Zegoua town of 22,000 people, situated 500 miles south of the Capital Mali, Bamako. Groundbreaking works have been reported in Bangladesh, Sri lanka, Tamil Nadu in India, South Africa and Egypt.

The high maternal-child mortality rate in Uganda is one that is very shameful. Our neighbor Rwanda, with functional 395 peripheral health centers, 40 district hospitals and three referral hospitals, have registered far better health outcomes than Uganda and they could inspire us to suceed.

I contend that Uganda has capacity to contain and eliminate maternal child deaths through its elaborate health institution structures. The problem which undermines the efficiency of the healthcare system is chronic lack of political will to invest in area of the economy that matters the most. Our healthcare system is easy to streamline and to strengthen, especially under the local government system. Lack of funding, poor leadership and lack of political will remain the key impediment to healthcare service delivery.

If all local authorities were encouraged to place health as priority on their political agenda, most of the health problems could have been eliminated. Most of the ailments in Uganda are primarily associated with poor hygiene and poverty as a consequence of lack of resources at the rural and peri-urban Uganda. If these fundamental components of health were addressed, the pressure on the healthcare system would be significantly alleviated.

According to WHO studies, on the average, a rural SSA woman spends 4 hours of the day looking for water and requires same time to collect firewood for preparing meals. The woman has no time to attend to her own health, such that when pregnancy comes, it finds her body already weakened. Unfortunately, the plight of the ordinary Ugandan woman of child bearing age will never be addressed until tragedy befalls a daughter or wife of a politician while giving birth at home or abroad.

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