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Maternal Death Reviews to be Strengthened
East, Central and Southern African Health Community (ECSA)
November 02, 2004

This material was prepared during the ECSA 40th Regional Health Minister's Conference held in Victoria Falls Nov 01-05, 2004

"Hundreds of pregnant women, alive at sunset last night never saw the sunrise this morning. Some of them died in labour, some died of hemorrhage in hospital, some died in the painful convulsions of eclampsia and some died on the table of an unskilled abortionist trying to terminate an unwanted pregnancy," according to Mr. Nakajima from the World Health Organization. Nearly half of all estimated global maternal deaths (515,000) occur in Sub Sahara Africa. To reach the Millenium Development Goal target of reducing maternal mortality by three-quarters requires immediate action.

In his presentation on "Maternal Death Review in East, Central and Southern Africa", UNICEF Regional Health Advisor Dr. Ramishael Shoo said maternal death was an important indicator of the quality of reproductive health services available in a community, along with who had access and who was actually using these services. In many countries in the region, evidence indicates that rural women are often left underserved, with few delivering in a clinic or hospital and in turn more at risk of dying from complications. To reduce maternal deaths effectively, programs must be able to delay the child bearing age of young women, and prevent, where possible, complications during pregnancy and delivery.

The Global Safe Motherhood Initiative, introduced in 1987, was intended to reduce maternal death. However, in most sub Saharan African countries, maternal mortality rates have increased over the past decade, rather than decreased as anticipated. Dr Shoo said the main direct causes of maternal deaths were obstetric hemorrhage, obstructed labour and ruptured uterus, abortion complications and hypertensive disorders, and indirectly compounded by amongst other diseases such as AIDS, malnutrition, TB and Malaria. In recent years, many Demographic Health Surveys of countries in the region have witnessed quite significant increases in MMR. For example, in Malawi, the maternal mortality ratio had dramatically increased from 620 per 100,000 live births in 1992 to 1120 in 2000. This increase reflects the gradual deterioration of the social and economic situation in the country compounded by the high levels of chronic malnutrition, and illiteracy, especially among women, and high prevalence of HIV/AIDS.
He said for more than a year the ECSA Association of Obstetrics and Gynecological Societies with the support of UNICEF Eastern and Southern Africa Regional Office (UNICEF ESARO) and the World Health Organisation Regional Office for Africa had been working to develop a maternal death review process in eight countries. The countries are Ethiopia, Kenya, Malawi, Mozambique, Swaziland, Tanzania, Uganda and Zambia. The five methods promoted by WHO and UNICEF are: verbal autopsy, facility-based death reviews, confidential enquiries into maternal deaths, near-misses review, and clinical audit. As countries set up systems for maternal death review, they should incorporate the activities into the routine health systems, build in sustainability from the beginning, start simple and practical, and then expand gradually.

Dr Shoo added that constraints faced by all countries were lack of political will and commitment, lack of a legal framework to facilitate maternal death review, financial limitations and lack of co-ordination within organizations "The tools and strategies are in place to scale up the maternal death review in the region. What we need is the support of all decision makers and advocacy for even higher support given the magnitude of the problem. We need the support all ECSA ministers to support mandatory maternal death notification motion throughout Africa," said Dr Shoo.

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