[procaare] Battling to Take Death out of Birth in Africa

["Reuters" <procaare@healthnet.org>]

Battling to take death out of birth in Africa
Reuters: May 20, 2008
By Skye Wheeler
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JUBA, Sudan (Reuters) - Lying on a sagging mattress and wincing 
slightly, Anna Lado laughs at the idea that she should have been 
afraid of giving birth to her first child, now lying in a crib near 
her in a hospital in south Sudan.

"It's natural," she smiles.

But in fact, she received a life-saving caesarean in the capital 
Juba's teaching hospital: a relatively rare operation in south 
Sudan where one in 50 women die in childbirth, the world's highest 
maternal mortality rate.

In this vast expanse of dusty scrubland where around 10 million 
people live, the return of peace after Africa's longest civil war 
has exposed the dire state of the healthcare system.

A 2005 peace deal ended two decades of conflict between the south 
and the north that claimed around 2 million lives and was fought 
over ethnicity, religion and oil. The conflict is separate from the 
continuing violence in Darfur in the west.

Under the deal, the semi-autonomous south will have a chance to 
vote for independence in 2011. Meanwhile, authorities must try to 
rebuild a devastated land that has few paved roads, chaotic laws, 
rudimentary services but large oil fields.

Last June, the United Nations Population Fund (UNFPA) said south 
Sudan had the highest rate of pregnancy-related deaths in the 
world, at 2,030 per 100,000 births. That compares to a rate of 509 
deaths per 100,000 births in the north.

U.N. officials say at the last count there were nine fully trained 
midwives in south Sudan, seven of those in the capital. The UNFPA 
says only around 5 per cent of women in south Sudan deliver in an 
institution.

At the Juba teaching hospital, wide-eyed babies are weighed in a 
harness and then passed through a jostling sea of mothers.

"It's shocking because most of those women just represent those who 
get to facilities, how many more did not reach them?" said Magda 
Armah, who works for UNFPA.

Festo Juma, the hospital's chief administrator and only 
obstetrician, looks exhausted as he describes his caseload. He is 
between operations and is wearing white Wellington boots and green 
scrubs, with a facemask dangling around his neck.

"In the rural areas, the situation is very much worse. The main 
cause (of the high death rate) is the complete absence of obstetric 
services in three-quarters of the south," he said.

South Sudan is by no means unique in Africa, but the severity of 
its situation stands out: Until recently, there was only one 
delivery bed in Juba hospital. A new theatre with four delivery 
beds, a blood bank and beds for 150 patients, plus a nursery, are 
about to open.

In April, a new report by the U.N. children's agency UNICEF said 
African countries had made the least progress among developing 
nations towards a U.N. goal of cutting infant and maternal 
mortality by two-thirds by 2015.

MALAWI'S EXAMPLE

The White Ribbon Alliance -- an international organization to 
promote safe motherhood with members in 91 countries -- says 
African women have a 1 in 16 chance of dying from a pregnancy, 
compared with 1 in 1,400 in Europe.

"These are needless and preventable deaths. This is not a strange 
illness that requires science to find a cure. We know what to do 
but the political will to put resources into this and to prioritize 
it is missing," said Brigid McConville, the director of White 
Ribbon Alliance in London.

Armah agrees on the need for investment.

"There needs to be a massive injection of funds into the training 
of skilled birth attendants and we need the infrastructure," she 
said. UNFPA is working with the Juba hospital to open a blood bank 
and mini-lab.

UNFPA also plans to inform women about pregnancy care.

"People don't know that women have a right to reproductive 
healthcare," Armah said.

Thousands of miles to the south of Sudan, in the sliver-like 
country of Malawi, the importance of grassroots education to fight 
maternal mortality has been recognized.

UNFPA says that nearly 2 percent of live births in Malawi result in 
the death of the mother: that's 16 deaths a day from pregnancy or 
childbirth complications.

But a community in Dedza district, just outside the capital 
Lilongwe, is trying to change that.

In under two years, Chitowo community, working with UNFPA, has 
reduced maternal deaths to seven from 33.

"This has been possible because as a village we formed committees 
to encourage pregnant mothers to go for antenatal (care), monitor 
newborns, distribute bed nets and set up rules to follow on 
hygiene," said village chief Adamson Mwangwazu.

"We also fine those who deliver at home instead of in a health 
centre ... We no longer lose a child or a mother like we used to."

This example is being copied in other communities in what is being 
dubbed Malawi's health revolution -- albeit a revolution that is 
limited in scope because of the stranglehold that HIV/AIDS has on 
the country.

YOUNG ARE DYING

Through its local partners in Malawi, White Ribbon Alliance has 
enlisted the police's help in picking up pregnant women who are 
walking long distances to try to get to a clinic.

The group is also working with the ministry of health to find ways 
of retaining health staff in rural communities, by providing 
housing, power, schools and security.

McConville says cutting the maternal mortality rate will benefit 
everyone, and not only because women hold communities together and, 
in many places, do much of the farming work.

"If you get it right for mothers, you've got the health staff in 
place in the community, you've got the referral system to the next 
level, you've got the operating theatre, the anesthetist, the 
electricity and communications."

"All of this will benefit a man with a broken leg or a child with a 
respiratory illness."

In south Sudan, Festo Juma's biggest immediate problem is lack of 
supplies and staff. He says he has been unable to persuade southern 
doctors working in Khartoum to return.

"Even here (in Juba), three-quarters of the midwives are village 
midwives, with no proper sense of emergency or knowledge of how to 
deal with problems," he said.

In the hospital, about 40 women die in labor each year, mostly 
because they arrive in a perilous state.

The babies who survive face their own battles: 135 out of 1,000 
children in south Sudan die before they reach five years old, 
according to a government and U.N. survey.

And early marriage and pregnancy means teenagers are among those 
dying in childbirth.

"Of every 1,000 pregnancies, 200 are adolescents," Armah said. "The 
young are dying."

(Additional reporting by Mabvuto Banda in Malawi)

(For full Reuters Africa coverage and to have your say on the top 
issues, visit http://www.africa.reuters.com/)

Cross-posted from AFRO-Nets