Why Dar makes ‘insufficient progress’ in maternal health

Tuesday September 9 2014

Young Kibiti mother Fatuma Maulidi holds her

Young Kibiti mother Fatuma Maulidi holds her newly born baby she safely delivered at Kibiti Health Centre in Refiji District, Coast Region recently. Fatuma believes, she was lucky to deliver safely at hospital because up to 50 per cent of mothers like her deliver at home in Tanzania. PHOTOS /SYRIACUS BUGUZI 

By Syriacus Buguzi, The Citizen Correspondent

Dar es Salaam. Amid reports of increasing deaths resulting from teen pregnancy, Fatuma Maulidi, her husband and other family members were worrisome when she conceived aged 17. But they kept their fingers crossed and prayed to God that nothing bad happens to her and the child during delivery.

This made Fatuma attend clinics regularly and when she was in labour, she arrived at Kibiti Health Centre early and nurses took over. Fortunately, she safely delivered a healthy baby.

Being pregnant is not a disease, but in Tanzania, like in most other developing countries today, many pregnant women still die from maternal complications, just like other diseases would kill them. What is dejecting is that some of the pregnancy related problems which lead to death can be prevented with little cost.

It is now estimated that more than 8,000 pregnant women in Tanzania die from pregnancy-related complications each year. This has forced maternal health experts ask themselves questions how preventable problems can lead to increasing deaths. Efforts are being made by the government as well to curb maternal deaths.

This year, Tanzania was ranked by the 2015 MDGs Countdown Report as one of the countries making ‘insufficient progress’ in dealing with maternal mortality and morbidity, which is being covered in MDG Number 5. However, the report notes, significant progress has been made in achieving MGD Number 4 of reducing child mortality.

With less than a year to the UN’s Millennium Development Goals deadline, stakeholders are devising new ways of reducing the menacing deaths. But the latest count-down report says that much is still desired in rural African settings where more women are known to die from preventable causes.

For some rural women, like Fatuma, conceiving aged 17 is very risky. Though she delivered safely, most other teens do not survive to tell their stories.

Fatuma’s success story of safe motherhood is pegged on the role of non-governmental organisations that have invested in healthcare delivery in the country.

Despite the role of NGOs and heavy government investment in addressing maternal mortality, rural women, such as Fatuma in Rufiji District, Coastal Region, still see giving birth as frightening. And she now believes it was by sheer luck that she is alive now and her baby is healthy.

Fatuma’s cause for fear is indeed justified. Her home is located in Mbuchi Ward, about 30 kilometres from Kibiti Health Centre. Health experts say she would be taking chances to deliver at home - an option that many women in her locality are opting for - not knowing that it would cost them life, in case of emergency.

But still, Fatuma thinks she is lucky, thanks to her aunt, Ms Zackia Mohammed, who offered her the required moral and financial support.

“My life would have been at stake if it was not for my aunt who advised me to come to the hospital early… and not take chances to deliver at home,” Fatuma said, as she narrated her story to The Citizen on Sunday last week about her experience of giving birth for the first time.

“I was not sure if I would come out of the labour room alive,’’ she said, noting: “I have always heard most women die in such circumstances and I was so scared.’’

Fatuma’s story curtain-raises a real-life experience of women who happen to give birth at hospital under the care of skilled health workers.

However, most women who fail to reach health facilities for whatever reason, have different stories. Most of them give birth while going to hospital due to delays. And when they are lucky to reach there, others don’t get the attention of health workers. Researchers refer to this kind of delays to as ‘Ds—3 delays’.

According to the medical officer in charge of Kibiti Health Centre, Mr Chagi Lymo, 130 expectant mothers report to the centre each month for delivery.

But, he says many more, whose number he could not ascertain, take the risk of delivering at home under the care of unskilled traditional birth attendants or even ‘experienced’ close relatives.

“There is still a large section of women who prefer to deliver at home and this puts their lives in danger,” said Mr Lyamo. He was briefing reporters on how his health centre has improved maternal and child health, thanks to support from an NGO, World Lung Foundation (WLF).

WLF is an international initiative that has invested in curbing maternal deaths in Tanzania by adopting a new model that aims at decentralisation of emergency maternal health care services during child-birth to rural settings.

However, concerns that many women do not take heed of the health experts’ advice on taking advantage of such services are growing, adding to the reasons why maternal deaths is still a big health challenge in the country.

Statistics from the latest Tanzania Demographic Health Survey show that 90 per cent of the women who become pregnant in the country, make an effort to visit a health facility for antenatal clinic assessment.

However, when it comes to child-birth, up to 50 per cent of them prefer to give birth in their homes, a tendency that experts say contribute greatly to the increase in maternal deaths countrywide.

“The dangers related to pregnancy are unpredictable… it would be dangerous if a woman takes her condition for granted and deliver at home where she is not under the care of an experienced or skilled health worker,” says Dr Sunday Dominico, WLF Director of Clinical Services.

WLF is banking on journalists to spread educative information to all women across the country about the value of safe motherhood and raise awareness about the urgent need to tame maternal deaths.

During a three-day workshop held in Dar es Salaam, which aimed at, among other things, equipping journalists with new skills on presenting stories on maternal health, Dr Dominico, himself a specialist in maternal health, emphasised on the need to sensitise rural communities on the importance of giving birth at hospital.

In the wake of the unabated maternal mortality, WLF is planning mass campaigns in three regions of Morogoro, Kigoma, Coast and Dar es Salaam, scheduled to begin sometime this month with ambitious plans of sensitising all women on pregnancy preparedness.

In Tanzania, the maternal mortality ratio is still at 454 per 100,000 live births - accounting for 8,500 actual maternal deaths per year and the estimated lifetime risk of maternal death is now 1 woman out of 38.

The estimated risk of dying because of pregnancy and child birth complications is, according to experts, 60 times more in Tanzania than in the US, one of the most developed settings of the world.

Although it would be unfair to compare the Tanzanian situation to countries that have the most developed healthcare systems like the US whose maternal mortality ratio stands at 21 per 100,000 live births, some Sub-Saharan African countries have managed to curb the deaths substantially. They include Algeria at 97 per 100,000 live births, Egypt at 66, and Libya at 58.

Statistics show, nearly 99 per cent of maternal deaths occur in countries with less economic resources, mostly in Africa and Asia, according to this year’s Millennium Development Goals Report.