Mothers Dying At Birth – an Opportunity for Businesses’ Social Responsibility

DR Kudakwashe Chani

13 May 2011

Maternal mortality, which is defined as the death of a woman during pregnancy, childbirth or within 42 days after giving birth, continues to be a major challenge facing ministries of health in the developing world.

Concerted and accelerated efforts from all sectors, particularly the private sector, are required if the increasing trends in maternal mortality are to be curtailed and reversed.

The Millennium Development Goals (MDGs) have placed the care for pregnant women and young children at the core of the struggle against poverty and inequality and illuminated the lack of proper maternal and child care as a human rights matter. MDG 5 aims to reduce the maternal mortality ratio by three quarters, between 1990 and 2015. The African Union has followed through with the launch of the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA). The campaign aims to save the lives of mothers and newborns and is active in about 20 African countries, including Namibia.

The ramifications of a mother dying are often underestimated; studies indicate that surviving infants of the mothers who die are more likely to die before reaching their second birthday than infants whose mothers survive. In Namibia, maternal mortality has almost doubled during the past decade and a half, reaching a high of more than 500 deaths per 100 000 live births in 2008 according to a study published in the Lancet of April 2010. What is of even greater concern is that this figure may be an underestimation as some deaths are not reported.

The major direct causes of maternal deaths in Namibia are eclampsia or high blood pressure in pregnancy, haemorrhage, prolonged labour and infection. Unfortunately, none of the complications or causes of maternal deaths listed above are easy to predict during routine antenatal visits. It has been widely accepted that what makes a difference is ensuring all births or deliveries are done under “skilled attendance”. This term refers not only to availability of trained midwives, nurses and doctors but an enabling environment which includes the necessary equipment, medicines and supplies to manage these complications. It also includes appropriate and timely referrals services when needed.

The good news is that Namibia has the major ingredient for success in reducing maternal deaths – the political will demonstrated by the support from the highest offices of the President, the First Lady and the Minister of Health and Social Services.

The MoHSS and its development partners are working around the clock to ensure all women who come to deliver in health facilities do so under “skilled attendance”. However, even in situations where skilled attendance is available, utilisation of such services may be affected by delays in patients seeking care and/or the fact that very often women must travel significant distances to reach a health facility equipped to provide appropriate treatment.

Due to the vastness of the country and lack of reliable transport in most rural areas, pregnant women often reach the health facility in the late stages of childbirth and in some cases too late. Although evidence suggests that more than 80 per cent of women deliver in health facilities in Namibia, a significant number of these women reach the health facility too late to receive the treatment needed to ensure a positive pregnancy outcome.

In order to mitigate the impact of distances and reduce inadvertent delays in accessing appropriate care, countries such as Egypt and Zimbabwe have successfully embarked on projects to construct maternity waiting homes for pregnant mothers located in direct proximity to the hospital. These are usually basic houses with sleeping rooms, ablution and kitchen facilities. Maternity waiting home cater specifically for pregnant women living a distance from the hospital, those likely to experience transport problems if an emergency arises and those with high risk pregnancies. Maternity waiting homes have been proven to be useful in reducing not only maternal mortality but also perinatal or newborn mortality as the mothers can access the appropriate care immediately. Of course the impact of this intervention presupposes that the health facility is well equipped to provide “skilled attendance” for the pregnant woman.

The Namibian government has created an environment for companies and individuals to prosper in Namibia and the country has been classified as a “middle-income” country. Most companies do or should have corporate social responsibility mechanisms.

It is my opinion that the private sector in Namibia, and particularly the many successful profit making companies, should contribute to efforts to reduce maternal and child mortality, by partnering with the government to build maternity waiting homes. The initial focus could be on a few facilities in the rural areas focusing on those with high rates of maternal mortality. This is not only an opportunity for the important public/private partnerships needed in a time of declining donor funding but it is also a noteworthy contribution to the development of Namibia. Through maternity waiting homes pregnant mothers can easily access and utilise much-needed care at the most appropriate time.

A multi-pronged approach is needed if we are to win this war and ensure that no woman dies while giving life and it is unrealistic to expect government to do it alone. Companies need to give back. What more useful contribution to this nation’s development than ensuring the health of our mothers and newborns?

I would therefore urge all businesses to prioritise reduction of maternal and newborn deaths, through construction of maternity waiting homes high on their social responsibility agendas. We often say that today’s children are tomorrow’s great leaders. But to be great leaders of tomorrow, these children have to be born first, and not only that but they have to be “born alive”. Being “born alive” is also not enough. Their mothers have to live to nurture them to be the great leaders that we all desire them to be.

Dr Kudakwashe Chani, is a public health physician.

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