September 10, 2012
September 10, 2012
BOLGATANGA, GHANA – When Regina Adado Mensah, now the mother of four children, had her first child at age 17, medicine in the local clinic where she gave birth in northern Ghana was in short supply.
“The problem we faced was the access to medicine before one gives birth,” she says. “Since it was in short supply, some nurses sold them to us when the head nurse was not around. Therefore, if you had no money, you [could] not buy the medicine to use.”
Mensah, who is not related to the reporter, says that she was one of the lucky ones. She says that because she was young, a midwife took pity on her and assisted her throughout her stay in the hospital. This, she says, is rare.
“The population was less by then as compared to now so we had all the care we could get,” she says.
By the time she gave birth to her fourth child in 2002, many of the women in labor, including Mensah, were not attended to because the nurses and doctors were on strike.
“I witnessed some women giving birth without being assisted,” she says. “Some women did not have money to pay for their hospital bills. As a result, they were made to sleep on benches until they delivered.”
The high maternal mortality rate in Ghana is largely attributed to the lack of access to medical care for expectant mothers, which leads to delays and complications that could otherwise be avoided. But advocates say there are also cultural challenges, such as traditional beliefs, which often limit care options, and decisions to have illegal – and sometimes self-induced – abortions. Since 2007, the government has made an effort to slow the country’s maternal mortality rate, but it is not on track to meet the global target of a 75-percent reduction by 2015.
According to UNICEF, 80 percent of maternal deaths could be avoided with access to essential maternity and basic health care services. About 1,000 women die from preventable causes related to pregnancy and childbirth around the world every day, according to the World Health Organization, WHO. And 99 percent of all maternal deaths occur in developing countries, according to WHO.
In Ghana, 450 mothers died per every 100,000 live births in 2008, according to a 2010 government and U.N. joint report. Maternal mortality tends to be even higher in rural communities in northern Ghana, according to IRIN, a U.N. news service.
While pregnancy and childbirth tend to be joyous times for families in developed countries, both are dangerous and even fatal in developing countries. UNICEF calls the gap between maternal health care for women in rich and poor nations “the greatest health divide in the world.”
In Ghana, delay in medical care remains the primary cause of maternal mortality.
The United Nations Population Fund, UNFPA, has identified the three most common medical delays that can lead to maternal death. The first and most common delay occurs while family members make the decision of whether to take a woman to a health center for care. The second delay occurs as a result of unreliable and lengthy transportation required to get a woman to the health center. And the third delay occurs at the health center, where most women have to wait because of a backlog of patients and paperwork often caused by understaffing.
Kparigu Health Center, located in northeastern Ghana, is a 15-hour bus ride from the capital, Accra. David Kansuk, the center’s only medical doctor, says he is on duty 24 hours a day, seven days a week. There are only three other clinical staff members: a midwife, a community health nurse and a lab technician.
In a case study of the northern region, Ghana Broadcasting Corporation, GBC, a local broadcasting company, found that inefficient transportation often leads to prolonged labor, which can be fatal for the mother and the baby. GBC found that a 10-kilometer, or six-mile, journey to the nearest hospital could take more than an hour because of rough road conditions. Moreover, sometimes there aren’t even vehicles or ambulances available to transport women in labor to the hospitals. In these cases, men must carry the women or transport them by motorcycle, bicycle or even wheelbarrow.
Kansuk says that Kparigu Health Center has only one ambulance, which is currently inoperable. Until it is fixed, Kansuk says he must use his own car for emergency transportation.
Maama Tenyi, a UNFPA representative in northern Ghana, says that because the majority of women here marry and give birth before their 20th birthdays, premature pregnancy is more common and can pose considerable health risks to the young women and their babies. The younger a girl is when she becomes pregnant, the greater the health risk for her and her baby, Tenyi says.
Tenyi says that obstetric fistulas, a hole in the vagina or rectum caused by obstructed labor, especially affect young mothers, whose pelvises aren’t fully formed. Fistulas, which affect more than 2 million women in Africa, usually result in the death of the babies and chronic incontinence for mothers, which typically leads to social isolation, depression and chronic medical problems, according to UNFPA.
Anemia, a condition in which the blood is deficient in red blood cells and hemoglobin, is also preventable, according to UNICEF. But severe anemia leads to maternal deaths during childbirth here in Ghana, especially among teens, as anemic women can’t handle much blood loss.
Blood loss is also tied to unsafe abortions, the second most common cause of maternal death in Ghana. More than one in 10 maternal deaths here are due to unsafe abortions, according to the Guttmacher Institute, a U.S.-based agency that promotes sexual and reproductive health around the world. Kansuk estimates that 600,000 women die annually in Ghana because of abortions. And many of these women are young, as Kansuk attributed 23 percent of all maternal deaths in Ghana to illegal abortions among women ages 15 to 17 – either by untrained personnel or self-induced, when women try to abort their babies themselves.
Kansuk says that about 300 to 400 youth visit the center every month to learn about sexual and reproductive health. But he says they are in the minority as most young people do not come to the center for counseling or testing.
Even when teens visit the center, they can still take drastic measures, Kansuk says. Last year, one girl in junior high school who used to come to the center died after she tried to abort her baby on her own.
“When she came to the center for weekly meetings, the nurse noticed a change in her and realized she was pregnant,” he says. “So she asked the girl to go and come back on a scheduled date for a guided advice, only for them to hear that she had died while trying to abort the pregnancy illegally with grounded bottles and herbs.”
Kansuk, who has been working at the center since 2001, says that older women sometimes try to abort their babies by themselves, too.
“Unfortunately, it does not only happen to adolescent girls who are not married,” he says. “There was another case involving a married woman who also lost her life due to illegal abortion.”
Kansuk says her husband had advised her not to abort the pregnancy, but she secretly did it anyway by inserting certain herbs in her vagina.
“When the midwife found out after examining her, it was too late to save her,” he says.
Kansuk says the region needs more blood banks in its general hospitals and clinics in order to reduce maternal deaths from hemorrhaging. But spiritual and cultural concerns with blood transfusion often prevent this treatment.
Cultural beliefs also sometimes prevent pregnant women from coming to the hospital on time or at all. Some believe that a husband must perform a special set of rights when women go into labor before taking them to a hospital, GBC reported. Other myths say that delivering at home proves that wives are brave and faithful to their husbands.
Tenyi says that many women even prefer home deliveries, mostly because of understaffing at hospitals.
“Most of the pregnant women prefer going to the midwives because they have time for them and are ready to explain the various ways of taking care of themselves and their unborn babies as compared to the trained nurses at the hospitals,” Tenyi says.
But Tenyi says it’s not the nurses’ faults.
“They cannot be blamed because they are understaffed with very few facilities and resources to work with,” he says.
One expecting mother, Maa Adwoa, 20, says that hospital staff members have treated her well but she still plans to deliver at home with the help of a midwife. She says her mother and grandmother both gave birth at home and that there have been no casualties.
Because of this preference for midwives, Kansuk says that traditional birth attendants, TBAs, should be trained and empowered instead of criticized in order to promote maternal health. Kansuk says TBAs are also needed at various health centers, in addition to other skilled health personnel, such as doctors and nurses.
The government here legalized abortion in 1985 for cases of rape, incest and in which the delivery might cause the mother mental or physical harm, according to the Guttmacher Institute. But as of 2007, only 4 percent of women reportedly knew of the law, according to the government’s latest statistics. That year, a group of international and domestic organizations launched a program to reduce maternal mortality – especially because of unsafe abortions – and promote contraceptives in Ghana, according to the Guttmacher Institute.
Ghana’s government has also signed onto the Millennium Development Goals, a global action plan to achieve eight anti-poverty goals by 2015 and one of UNFPA’s focuses. Goal five, to improve maternal health, aims to reduce the maternal health ratio – deaths from pregnancy complications or childbirth – by 75 percent.
To address this goal, the government declared maternal mortality a national emergency in 2008. It also set up a free health care program for pregnant women, among other initiatives, such as increased training of midwives. It also announced plans to set up a special task force to address the issue. The reach and impact of these new projects is not yet clear.
The national progress report released last year, based on a 2008 survey, showed that although Ghana’s maternal mortality rate has slowed, it was not on track to meet the goal.
The main challenge is inadequate access to maternal health care services, according to the 2010 report. Another challenge is an unavailable data set on maternal health care, as many deliveries take place at home and the numbers and causes of deaths are unreliable. This makes it difficult for the government to monitor and evaluate progress being made.
Evelyn Fia Kwofie, a student here, urges people to keep in mind that any figures and statistics represent real girls and women who are losing their lives for preventable reasons.