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SAVE MOTHERHOOD. By Dr. Mrs. Henrietta Odoi-Agyarko

What is Safe Motherhood?
It is woman’s ability to have a safe and healthy pregnancy and delivery.

How can Safe Motherhood be achieved?
Safe Motherhood can be achieved by providing high quality maternal health services to all women. Services to help make motherhood safer include:
· Care by skilled health personnel before, during and after childbirth
· Emergency care for life-threatening obstetric complications
· Services to prevent and manage the complications of unsafe abortion
· Family planning to enable women to plan their pregnancies and prevent unwanted pregnancies
· Health education and services for adolescents
· Community education for women, their families and decision-makers

Women’s poor health is linked to their low status in society, their lack of education, and poverty. Efforts to reduce maternal death and disability must therefore also address these issues.

What is the Safe Motherhood Initiative?
The global safe Motherhood Initiative was launched in 1987 to improve maternal health and cut the number of maternal deaths to half by the year 2000. Ghana also launched her Safe Motherhood programme in 1987 in 12 districts. The implementation of Safe Motherhood interventions is within the context of a broader reproductive health programme. The millennium goal is to reduce by 75% the rate of maternal mortality by the year 2015.

Deaths associated with pregnancy that have been virtually eliminated in developed countries, still affect over 500,000 women in the developing world. In West and Central Africa, about 120,000 women die every year from complications during pregnancy or childbirth. The average maternal mortality ratio in sub – Saharan Africa, about 120,000 women dies every year from complications during pregnancy or childbirth. The average maternal mortality ratio in sub-Saharan Africa is estimated at 940/100,000 live births with a regional variation as high as 500-800/100,000 live births. In the year 2001 alone, 954 women died in health institutions through pregnancy and childbirth. A greater proportion of maternal deaths however occur in the rural communities and urban and pri-urban disadvantaged communities.

The magnitude of the tragedy becomes even more vivid when it is considered that for every woman who dies as a result of pregnancy such as leakage of urine, persistent lower abdominal pain and infertility.

Maternal death is largely attributed to preventable causes including severe bleeding, infection, unsafe abortion, difficult labour, and hypertensive disorders of pregnancy. Other important and emergency causes of maternal deaths include HIV/AIDS, anaemia and malaria.

In Ghana , Infant Mortality rate has dropped from 77/1000 live births in 1988 to 66/1000 in 1993 to 56.7% in 1998. Under-five mortality has also dropped from 155/1000 live biths in 1988 to 119/1000 live birth in 1993 to 107.6/1000 live births in 19998. However maternal mortality remains high. A recent study of maternal mortality in one district in Brong Ahafo region revealed a ratio of 800/100,000 live births.

Cultural beliefs that promote harmful traditional practices and inappropriate attitudes towards pregnancy and childbirth are well known and they exist in many of our communities. Cultural perceptions and expectations have a bearing on how a woman and the community respond to medical problems related to pregnancy, and offer some explanations as to why women do not present or present late for antenatal care, or choose to deliver at home unassisted.

What lessons have we learnt?
1. Gender inequalities and discrimination limit women’s choices and contribute to their ill health and death. Legal reforms and community mobilization can help women safeguard their reproductive health by enabling them to understand and articulate their health needs.
2. Every pregnancy faces risk: every pregnant woman, even if she is well-nourished and well educated-can develop sudden, life threatening complications that require high quality obstetric care.
3. There is the need to ensure skilled attendance during childbirth, i.e. a health professional with the skills to conduct a safe, normal delivery and mange complications. Unfortunately, there is chronic shortage of these professionals in poor and rural communities in the developing world. As an interim strategy for setting where TBAs attend a significant proportion of deliveries, TBAs need to be provided with adequate training and support to help them refer complicated cases effectively.
4. Maternal deaths can be significantly reduced by providing client-centered family planning services to prevent unwanted pregnancies. Contraceptive counseling for women who have had an induced abortion is necessary to achieve this.

What other Measures can we put in place to make Motherhood Safer?
1. Problem: Women and their families don’t recognize dangerous complications.
· Raise awareness about signs of life-threatening complications
· Provide education to men and women about when and where to seek care.

2. Problem: Women and their families’ delay in deciding to seek care.
· Raise women’s status
· Educate community members about the importance of seeking care swiftly
· Develop plans for obstetric emergencies
· Create insurance programmes to take care of emergencies

3. Problem: Women don’t reach appropriate care on time:
· Create emergency transportation plans in the community
· Upgrade transportation systems
· Enhance referral systems

4. Problem: Women don’t receive prompt care at health facilities:
· Upgrade the quality of care at health facilities (training)
· Ensure adequate stocks of medical supplies and safe blood
· Ensure referral systems between communities and health facilities. ( the Ministry is providing communication equipment, ambulances, Bajaj tricycles to assist in this)

Ladies and Gentlemen, the celebration of an annual safe motherhood week, starting from this year is to help create awareness on the causes of the high maternal mortality and how to prevent them. The theme for the celebration is “Death in Pregnancy and Childbirth is Preventable: Act Now!”.
To conclude, we need to focus on:
The lack of knowledge about pregnancy and childbirth complications as well as the prevalence of traditional beliefs and practices, that are linked to the poor health status of pregnant women and more importantly, under utilization of health services.

There is the need to improve our understanding of all cultural practices related to reproduction health in our society with the view of making the required policy changes that will help to discourage the undesirable ones and uphold the desirable. There is also the need to focus on the socio-economic status of women.

The attainment of Safe Motherhood is very challenging but together we can make it a reality.

Thank you.


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