Maternal mortality is one of the main public health challenges worldwide. The World Health Organisation (WHO) estimates that every single day ‘about 830 women die from pregnancy or childbirth-related complications around the world.’
In recent years, there has been a general decrease in maternal mortality rates as countries have been undertaking steps to achieve the Sustainable Development Goal to reduce the global maternal mortality ratio to less than 70 deaths per 100,000 live births by 2030. Sadly, some regions of the world are still far from achieving this goal. Maternal mortality remains a serious problem in developing countries where maladies and unsafe abortions are prevalent.
In sub-Saharan Afrrica the maternal mortality level has stagnated and the regionis home to the world’s highest maternal mortality rates. According to data published by UNICEF that equals around 200,000 maternal deaths a year, which represents almost seventy per cent of all maternal deaths worldwide.
Causes of high maternal mortality rates
Most maternal deaths are preventable, but in sub-Saharan Africa, there are a number of factors that make them more likely than elsewhere in the world.
Sub-Saharan Africa has a shortage of maternity care providers. The World Bank reports that in the region there is only one nurse or midwife per 1000 people. That is more than eight times fewer than the ratio recommended by the WHO. Nurses and midwives play a critical role in reducing the risk of maternal and newborn deaths, and they are essential to providing sexual and reproductive healthcare. Without their help, new mothers become vulnerable to infectious diseases and conditions such as pregnancy-induced haemorrhage, hypertension, or ruptured uterus that are amongst the main direct causes of maternal deaths in sub-Saharan Africa.
Some of the biggest challenges to lowering maternal mortality rates in sub-Saharan Africa are also the lack of adequate sexual health education and limited access to contraception. Women living in sub-Saharan Africa have the highest rate of unwanted pregnancy. Hence, many resort to unsafe abortions, putting their lives at risk.
Unsafe abortions, which are responsible for one maternal death per 150 cases, are done either by a person who is not a healthcare worker or using non-recommended methods. Moreover, they are often performed in unsanitary conditions, which makes complications extremely likely.
African countries with the highest maternal morality rates
In Africa, there are apparent disparities in maternal mortality rates in various countries. South Sudan is the country with the highest mortality rate of 1,150 mothers’ deaths per 100,000 live births. These numbers represent some of the worst health outcome indicators not only in Africa but globally. As the country carries a high malaria burden, the disease is considered one of the main causes of high maternal mortality rates. South Sudan is one of the poorest areas in the world and is home to a number of diseases that are not found elsewhere in the world. Such conditions are not favourable for anyone, especially new mothers vulnerable after giving birth.
Nigeria, which is the most populous country in Africa, has a ratio of 917 deaths per 100,000 live births. The progress in reducing these numbers have been very slow despite the government’s efforts to deploy skilled health workers in rural areas and promote safe deliveries at health facilities rather than at homes. In Nigeria, there is a big variation between the North and the South. Most maternal deaths occur in the North of the country inasmuch as the region is much poorer and less developed than the South.
Are maternal mortality rates high everywhere in sub-Saharan Africa?
In the African countries where maternal mortality rates are elevated lack of adequate sexual and reproductive education leads to delays in women seeking professional health, deciding to be admitted to a health care facility before it’s too late, and receiving necessary treatment. These things are caused by the lack of education about possible complications, limited numbers of health care facilities and shortage of staff and supplies, as well as poverty.
While in some countries of sub-Saharan Africa pregnant women do not attend any pregnancy-related appointments, there are parts of the continent where women’s access to healthcare is much better. When that is the case, maternal mortality rates are significantly lower.
Mauritius, for example, has a maternal mortality ratio lower than 100 deaths per 100,000 live births. In South Africa and Botswana the numbers are slightly higher, with 119 and 144 deaths per 100,000 live births respectively. A lot of progress still needs to be made there, but the situation is far better than in the three countries of sub-Saharan Africa that perform the worst.
If all women in sub-Saharan Africa had access to comprehensive education on sexual and reproductive health, the rates of unwanted pregnancies leading to unsafe abortions would be much lower. Then, lower maternal mortality rates would follow. All women, whether they live in sub-Saharan Africa or other regions of the world should be able to get help from professional health workers and give birth in safe, sanitary conditions. Sadly, for now that remains a rare luxury for millions of women living in developing countries.
The BiliDx is a novel system for diagnosing jaundice. The device uniquely meets the Target Product Profile (TPP) developed as part of the NEST 360 initiative in that it allows blood-based testing at the bedside. This initiative is part of an emerging global consensus in the Every Newborn Action Plan that countries need functional WHO level-2 inpatient units to care for "small and sick newborns."
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.