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Dr. Gian Luigi Gigli
MOTHERS MATTER –
WHO ON EARTH CARES
Delivered during the UN Side Event: "Best Practices for Maternal Health Care in Africa" on March 17th, NY, NY
Motherhood for Africans, has special significance. For Christians the most important event in history is the Incarnation, which came about because of the most intimate of relationships ever between God and a human being, when a young woman accepted to nourished and nurtured His son in her womb and thus a special family was created. It may be said that all mothers share a little in that intimacy through their birthing experiences and therefore deserve respect and concern for the welfare. Two of the greatest tragedies of our times is the suffering and deaths of hundreds of thousands of mothers and the deliberate killing of an unknown number of unborn children, supposedly to prevent their mothers dying from pregnancy complications. It is an international disgrace that since the inception of the first Safe Motherhood Conference in Nairobi in 1987, none of the goals set by the international community to reduce the number of maternal deaths, have been met, including most recently the 5th Millennium goal, simply because they did not receive adequate care. MaterCare International (MCI), a group of obstetricians, feels it has a special responsibility to develop new ways of providing care for poor mothers and babies based on comprehensive obstetrical care, life and hope, rather than on death and despair.
According to the WHO, 333,000 mothers die annually (Lancet 2009) from pregnancy related causes, ninety-nine per cent of these deaths occur in developing countries mostly in sub-Saharan Africa. The lifetime risk of a mother dying as a direct cause of pregnancy and labour in developing countries is 1:180 whereas the risk in developed countries is 1: 4,900. These deaths do not take place in a visible and concentrated way, but occur to young women who are frequently alone in their manyattas (homes) in small villages, unknown to anyone. The obstetrical causes are well known; post-partum haemorrhage, (35%); convulsions due to hypertension (18%); malaria, HIV, severe anaemia (18%); obstructed labour, ectopic pregnancy, pulmonary embolism, (11%), infection, (8%),and complications of spontaneous or induced abortion (9%) (WHO 2012). Of these deaths 91% occur in the last 3 months of pregnancy, during labour and delivery or the first week following delivery. 85% may be prevented by identifying risk factors early and treated – the 91% Solution.
Other factors leading to deaths are; lack of adequate delivery facilities; or trained midwives or doctors to provide skilled care; poverty; lack of information; poor roads, transport and communications, but also lack of compassion; of political will; a conspiracy of silence; and a reliance on abortion and birth control which are irrelevant given the causes and timing of maternal deaths. This culpable neglect amounts to a form of violence as a result of omission against mothers, who are women too.
Sadly, these deaths represent only the tip of the iceberg. It is estimated that for every death, 30 more suffer long-term damage to their health and well-being from obstetric fistulae. These arise as a consequence of unrelieved obstructed labour as caesarian section was unavailable, resulting in damage to the bladder and/or rectum and consequently incontinence of urine and/or feces (obstetric fistula). In 2006, the WHO estimated that more than 2 million young women throughout the world live with untreated fistulae, and between 50,000 and 100,000 new mothers are affected each year who frequently suffer discrimination and humiliation.
The former Director General of WHO, Dr. Halfdan Mahler, commented at the Safe Motherhood Conference in Nairobi in 1987, “We know enough to act now, it could be done; it ought to be done; and in the name of social justice and human solidarity, it must be done.” The poor, of whom mothers and their babies are among the most vulnerable, have a claim upon our consciences and upon the resources and services of national governments and rich philanthropists. This option for the poor does not mean that they have rights which no-one else enjoys, but implies that the urgency and gravity of their need demands that attention be given to them as a matter of priority, before turning to other less urgent needs. On this basis civil governments, as well as other public and private institutions, should consider their policies and their efforts, or the lack of these, to meet the health-care needs of these very marginalized persons.
The consensus of the obstetrical community is that the tragedy or maternal mortality will only be solved one mother at a time with essential obstetrics termed by MCI, the 91% Solution, essential obstetrical care. In 2009 MCI introduced a model of comprehensive care which takes maternal health services closer to village communities to Isiolo County, one of the poorest and most neglected counties in Kenya. The county is 300 kms to the northeast of Nairobi and covers an area of 25,605 km2 situated in a arid valley below Mount Kenya which reaches to Somalia on the east, Ethiopia and South Sudan to the north and Uganda on the west and has a population of 188,000, mostly pastoralists. The maternal mortality ratio is officially reported at 570 per 100,000 live births, (Isiolo County Strategic Plan 2014). According to the county epidemiologist however, due to under-reporting, the ratio, is nearer 790 per 100,000 live births. The health infrastructure in generally rudimentary with three government hospitals but with only one poorly maintained operating theatre. There are 45 health related facilities but only 9 offer maternity services. It is no wonder that the county is the most dangerous place in Kenya to have a baby.
Project Isiolo began in 2007 at the village level where 80% of deliveries take place and consequently where most deaths occur. It began with maternal health education utilizing diocesan structures e.g. parishes, women’s groups, schools etc. As well other tribal community groups, elders, especially traditional birth attendants (TBAs). All are shown that maternal deaths and birth injures are not inevitable but can be prevented with prenatal care and by all mothers delivering in a maternity clinic or hospital with trained help.
The project has adopted a comprehensive approach to the delivery of services consisting of;
A maternity hospital with 28 beds that is able to treat most life-threatening conditions for mothers and babies, opened in 2013.
One rural parish maternity clinic 225 kms from the hospital staffed by midwives providing normal prenatal, delivery and post - partum care, and referral of mothers with potential complications to the hospital opened in 2009. Supervision of mothers in surrounding villages is aided by a motorbike ambulance for travel for a midwife and patients.. The clinic has two manyattas (maternity waiting homes) where mothers from distant village may wait for the onset of labout but can care for themselves or cared for by a relative. A second clinic will be developed in 2016.
An emergency obstetric transport, 4 x 4 ambulance established in 2009, which goes to the maternity clinic for mothers, r with life-threatening complications them resuscitates and transport them safely to the hospital.
Training of TBAs to recognize and refer high risk mothers early, using a pictograph, a pictorial ante-natal card.
An under 5’s follow-up clinic at the hospital and maternity clinic.
Education sessions in breastfeeding and nutrition at the hospital.
Course in Naprotechnology and fertility awareness methods of family planning for doctors and midwives.
Most mothers even in Africa are optimistic and want to have babies as they know they are the insurance for the future of their families, villages, tribal communities and countries. They do not expect to die or to suffer birth injuries and therefore do not demand the care they need and have rights as stated by Article 25 of the UN’s Universal declaration of Human Rights. “ Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. Motherhood and childhood are entitled to special care and assistance.” Those who die obviously have no voice, only ours, to plead their case for adequate care, care of the sort mothers have access in the rich world. Every mother however, has a right to respect for her dignity, religious, moral, social and cultural values and the right to be free from unjust discrimination and coercion during pregnancy, childbirth and afterwards.
MOTHERS MATTER, especially in this Year of Mercy, MCI cares and believes there is no greater act of mercy than caring for neglected and suffering mothers.
Dr R. L. Walley
Founder and Executive Director,
Professor Emeritus of Obstetrics and Gynaecology
Telephone: +1(709) 579-6472
March 17th 2016