True documentation of the human cost of a maternal death (Tanzania)
October 29, 20162 min read
Disney movies often spring from the tragedy of a maternal death-- think Cinderella, Snow White, Bambi, the Fox & the Hound, Finding Nemo, Beauty & the Beast and on it goes. We know that not only is the premature death of any woman is a tragedy, but that obviously there are effects for at least a generation.
But [Alicia Yamin and colleagues published an article this summer](http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0071674) that looks in depth at the longer-term effects of maternal death in three regions in Tanzania (Rufiji, Kilombero, and Ulanga) where a diversity of ethnicities and religions are represented and maternal mortality is particularly high.
The study is a qualitative study, meaning that the authors used semi-structured interviews to capture the views, words and experiences of those affected by a maternal death; fathers, family members and others are interviewed. The findings point to the underlying low status of women and girls as being a pervasive issue throughout the life cycle. None of the women had a secondary level education. The female guardians who took over maternal orphans had limited economic power and were constrained in their ability to champion these children.
As is documented elsewhere, the study notes that the "maternal orphans" are typically not breastfed and often undernourished, giving them an disadvantage as far as health from the very beginning. They also faced additional challenges in accessing basic health care.
A finding in this study that has not been as well articulated elsewhere is the change in family structure and family dissolution as a result of a maternal death. In many cases, in this area of Tanzania, a woman may have several children, each with a different father. In the event that the mother dies in childbirth, the fathers will take a role is caring for their children, removing them from the home. Yamin and colleagues point the the grief and disruption for the older children-- not only have they lost their mother, but they are then removed from their household and other siblings. Repositioning in another home with a stepmother can sometimes work well but in other cases (again, think Disney stepmothers), the children of the newer union may be favored over the maternal orphans.
This study is an important contribution to our collective understanding, documenting what we know in our guts to be true: that the effect of a maternal death ripples for generations.
Identification of anemia in pregnant women is important, since it is an important cause of multiple complications during pregnancy (preterm delivery, low birth weight and perinatal death), so it is recommended to all pregnant women, in the first prenatal visit and at 28 weeks of gestation, the measurement of serum concentrations of hemoglobin and hematocrit as a screening test for anemia.
Prenatal assessment seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk.