By Patricia Vermeulen*
Last month, the world’s largest global conference on the health, rights, and wellbeing of girls and women in the last decade took place in Copenhagen, Denmark. This year’s focus was on how to implement the Sustainable Development Goals (SDG’s) so they matter most for girls and women. Specific emphasis was put into health – in particular maternal, sexual, and reproductive health and rights – and on gender equality, education, environment, and economic empowerment.
As an organisation that is very active in the field of women and girls’ health and rights, Amref Flying Doctors was present as well. We support reproductive health and rights for women through ensuring access to effective contraceptives, skilled obstetric services, assisted delivery, ante-natal and post-natal care and care of new-borns.
Women Deliver conference
As one of the leading, global advocate for girls’ and women’s health, rights, and wellbeing, Women Deliver brings together diverse voices and interests to drive progress in maternal, sexual, and reproductive health and rights. The conference has become an important platform that brings together world leaders, advocates, policymakers, journalists, researchers, and leaders of corporate companies and civil society. The Women Deliver conference in Copenhagen was one of the first major global conferences following the launch of the Structural Development Goals and attended by more than 5,000 people. Among those present were representatives of 2,000 organizations from over 150 countries. For example representatives from United Nations Agencies and governments, including ministers and parliamentarians from over 25 countries.
There is still very much that has to be done to improve women and girl’s health and rights worldwide. In the Netherlands, the risk of a mother not surviving childbirth is 1 in 10,200 births. In Africa this rate is much higher; during 1 in every 39 childbirths the mother does not survive. According to the World Health Organisation (WHO), the biggest risk to the lives of teenage girls and women in the developing world is pregnancy and childbirth. Too many young girls become pregnant with devastating and long-term effects on their reproductive health. The risk of complications during pregnancy is much higher for young girls. Fistula can develop due to long and difficult deliveries. Pregnancy at a young age also increases risks for the baby, premature birth, low birth weight and infant mortality during pregnancy or shortly after birth frequently occur. Every year 162,000 women in Africa die during their pregnancy or delivery. A large part of these maternal deaths is caused by complications during childbirth, for example bleedings, infections, or obstruction. Malaria, anaemia and aids also cause a high number of fatalities during pregnancy. Africa accounts for 20 percent of the world’s births but contributes to 40 percent of maternal deaths globally, many of which would be preventable if proper and accessible healthcare was in place.
Structural Development Goals
A lot of progress already has been made in the fight against the high maternal deaths since the Millennium Development Goals (MDG’s). Unfortunately, in Africa this positive development is lagging behind. The maternal death rate is still 14 times higher in developing countries and only half the women in developing countries receive the healthcare they need. As part of the Sustainable Development Goals (SDG’s) the international community aims to decrease the worldwide maternal death rate to 70 per 100,000 births. It is currently estimated that one midwife can look after 500 mothers every year and safely deliver at least 100 babies. When educated to international standards and within a fully functional health system, midwives can provide about 90% of the essential care to women and new-borns and can potentially reduce maternal and new-born deaths by two thirds. There is an urgent need to do more, it is simply unacceptable that in the 21st century so many women suffer and die when simple affordable solutions are at hand. Most of the deaths can be prevented by affordable training and equipment saves lives.
Key areas for improvement
We recognise three crucial environments for pregnant women in which we can make improvements: in the village, during their journey from the village to the health clinic or in the health clinic. In the villages, the presence of traditional birth attendants can make an important difference. They are trusted by the local community and can help with relatively simple problems. Traditional birth attendants offer advice to women during their pregnancy and refer them to a health clinic for medical treatment if necessary. Many pregnant women are not able to reach a health clinic in time, because of poor infrastructure, or lack of transport or money. A solution for this problem is the construction of special houses where pregnant women can spent the last period of their pregnancy. Pregnant women with possible complications often choose to stay in these houses. In case complications occur during their pregnancy or childbirth, the women can reach the health clinic fast. In many health clinics in Africa there is a shortage of skilled health workers. The clinics are often not well equipped and they lack medicines, therefore it is often difficult to diagnose and treat their patients efficiently. Increasing the number of skilled midwives to provide basic and comprehensive emergency and obstetric services is therefore key to preventing maternal deaths. Just as important is the provision of basic medical supplies to health clinics and hospitals.
Healthy mothers and healthy babies
One of the directors from the before mentioned ngo in Kenya, explains why so many women die during childbirth and he emphasises the differences between Africa and the developed world. “Women in the developed world take for granted, for example skilled midwives, an obstetrician and operating theatre if needed, antibiotics and medicines to ensure that potential complications can be treated rapidly. All these apparently basic things are regarded as great luxury in large parts of Africa.” Common complications like obstructed labour, severe bleeding and infections can be treated effectively when there are trained health workers with basic medicines and equipment. But these complications can be life threatening elsewhere. “In Africa there are simply not enough health workers or basic services; the continent has just three per cent of the world’s health workforce. So mothers and babies die, even if they do eventually reach a hospital or clinic.”
Women in poor and remote communities, far from the nearest health services are most at risk, and young women and girls are in the most danger. “In many communities girls still marry young and contraceptive advice is poor. Many of the worst complications in pregnancy are suffered by teenage mothers; giving birth is a physically traumatic experience for a girl whose body is still developing.” Diseases like HIV/AIDS and malaria are a threat to mothers of all ages and their new-born babies across the continent and people who are desperate for help turn to traditional healers. “Very few of those healers have been trained in modern standards of hygiene, and most are just as poorly educated as the people who come to see them. While their intentions are good they can unwittingly make problems worse and might even add new complications.” There is still great need for the improvement of women and girl’s health and rights. With this conference there is hope that the international community can make considerable steps to implement consistent policy to achieve the objectives of the SDG’s in 2030.
The story of Stella Vitari
At about 4pm one afternoon Stella Vitari felt contractions; her third child was on the way. It was already late and the journey to the health centre was long, so Stella laboured at home. “When the baby refused to come, the traditional birth attendant said I should go, but it was late, and I had to wait until the following day.” Stella lives in a poor part of Tanzania with basic roads and infrastructure. In the morning four men carried Stella on a bed to Mpanda hospital, miles away. By the time Stella reached the hospital she was unconscious. “My mother was told that my uterus had ruptured and the baby was dead.”
The case of Stella is typical for many women living in Africa. What should be a time of joy, turned to fear and pain. Stella lived to tell her story but many mothers do not. In most of Africa, having a child is one of the most dangerous things for a woman, while in Europe the risk is considerably lower. This is the most dramatic health inequality in the world today.
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The story of Seitat Sarika
“My name is Seitat Sarika. I live near the Entasoopia Health Centre in Magadi District, south-western Kenya. My daughter, Nodam, came to stay with me a month ago because she was pregnant with twins, and wanted to be near the health centre when her time came. At 9pm on April 27, just as Nodam was about to cook the evening meal, she felt a very sharp pain. And then she began to bleed heavily. I have never seen anything like that.”
Seitat is a traditional birth attendant, who has helped many women to have their babies. “I have been taught the importance of referring women to the health centre so they can be attended by skilled workers. I immediately sent some young boys to look for a vehicle to take my daughter there. They found that one vehicle had broken down, so they went looking for another.” In the mean time she called her neighbour to see if he could help. “He is a strong man. He tried to carry my daughter in his shuka (a traditional shawl) but she was too heavy. Soon his shuka was soaked in blood. Then my daughter collapsed. At 10 pm, one hour after the pain started, she died. I was shocked and distressed. It all happened too fast. The babies died too.”
Now Seitat is left with Nodam’s two other children to look after. “Nodam had done everything right”, she says. “She had attended the ante-natal clinic regularly, and she moved here so that she could give birth at the health centre. If it had been a normal birth, she would not have died. But there was a complication, and we were not able to get her to the health centre on time.”
*Patricia Vermeulen is CEO of Amref Flying Doctors in the Netherlands