Attaining Social Justice Through Safe Motherhood
The World Health Organization celebrated its 50th. Anniversary on April 7 1998. The date coincides with the annual World Health Day. One of the most important objective of WHO is striving for the betterment of the health of women and children. Thus, this year the theme “Safe Motherhood” has been chosen.
According to WHO figures, 1,600 women die from the complication of pregnancy and childbirth daily. The annual fatality rate stands at a staggering half million! Almost 90% of these deaths take place in countries of Asia and sub-Saharan Africa. The remainder 10% involve mostly developing nations.
In fact, complications of pregnancy and childbirth is one of the major causes of death of women of reproductive age in many developing countries. On top of this, more than 50 million others suffer from maternal morbidity, or acute complications from pregnancy.
For some 30% of these women, the illnesses are long-term and often debilitating. These include irreversible damage of the uterus, incontinence and infertility. Major complications during delivery may result in permanent nerve damage and loss of sensation, wasting of leg muscles and, finally paralysis. Infections may also lead to persistent pain and damage of the reproductive system.
The highest maternal mortality rate is found in Eastern and Western African countries. There are nations which have recorded 10 deaths for every 1000 live births. The reasons for this are inadequate maternity care, poor hygiene and inappropriate management of delivery.
These issues was recently addressed at an international conference in Washington D.C. in America, called “World Health Day – Safe Motherhood and Reducing Maternal Death”. The participants to the conference include U.S. First Lady, Hillary Clinton and World Bank President, James Wolfensohn.
At the conference, Malaysia was represented by Datin Seri Dr. Siti Hasmah Mohammad Ali, wife of the Prime Minister and a strong proponent of family health care. We hope that ample recommendations and implementable plans of action would come out from this seemingly high¬powered gathering.
In Malaysia, it is estimated that, between 1991-1995, there were half a million births annually. The maternal mortality, or death which occurs during pregnancy or within 42 days after childbirth from causes arising from pregnancy or its complications, rate recorded for the peninsular during the period was 0.2 per 1000 births, or approximately 100 per year. This figure is relatively low, compared to other developing countries, where the average maternal deaths for every 1000 live births is 4.8.
Experts believe that the majority of deaths related to pregnancy and delivery can be prevented. Most occur either during or shortly after delivery. Some of the major causes of maternal death are severe bleeding (25%), infection (15%) and unsafe abortion (13%).
The provision of basic medical care during and shortly after delivery is crucial. Therefore, the availability of a commendable health-care infrastructure and professional support are vital in ensuring a safe, hygienic, non-traumatic and well-monitored childbirth.
Prior to delivery, an appropriate ante-natal care service is required to help the expecting mother and foetus survive the 38-week or so gestation period. Malaysian expecting mothers are lucky as the Ministry of Health has a comprehensive ante-natal programme. Mothers-to-be need only follow the guidelines and advice given by the ever helpful medical personnel.
Regular check-up s with reliable referral possibilities are widely available throughout the nation. Rural clinic ratio to population has improved from 1:5320 in 1990 to 1:4580 in 1995.
These facilities and supports have become one of the mainstay of the national health agenda. There have also contributed tremendously to the significant reduction in the number of pregnancy and delivery-related mortality and morbidity.
Beginning in 1995, the National Plan of Action on Nutrition (NPAN) of the Ministry of Health, has an on-going program to reduce severe anaemia, or the reduction of the red blood cells, among pregnant women to 1.9% by the year 2000. Many women become mildly anaemic during pregnancy.
In severe anaemia, an expecting mother may become very tired and weak. She may also suffer from dizziness. As reduction in red blood cells means a less availability of the oxygen-carrier haemoglobin, the baby may also be affected as they receive less oxygen. This may lead to premature labour.
Apart from the backing of a solid ante-natal health care programme, pregnant women need also put in a lot of effort to ensure safe motherhood. They should observe a good pregnancy practice. This inc1ude eating good food, getting enough rest and avoiding unhealthy lifestyle.
Smoking, drinking alcohol and the use of illegal drugs during pregnancy would only increase the possibility of miscarriage, stillbirth and having babies with low birth weight and reduced mental capacity. These can also complicate delivery and post-natal care. Thus, these hazardous activities should strongly be prohibited, especially so among pregnant women.
However fit and healthy you are at the beginning of pregnancy, carrying another body and soul in your womb is bound to gradually put a strain on your physical resources. Though taking good care of yourself cannot guarantee a problem-free pregnancy, but it will certainly give your baby the best possible chance and leave you in a better shape at the end of the pregnancy.
A pregnant woman is a special individual. Physiologically she is different in the sense that she is sharing her body with another human being or beings. She is sharing blood, food, air, hormones and many other things. Mentally, too, she may not be as much the person she used to be. Thus, in these moments, her psychological needs should be perfectly read and understood by those around her, especially, the husband. Indirectly, husbands can also contribute to the success of the pregnancy.
The care given to child-bearing women does not stop after delivery, but actually continues, especially for the newborn. A rather exhaustive immunisation package is prepared to ensure that the child grows into a healthy and strong individual. Thus, we are able to achieve a great improvement in post-natal survival rate as we progress.
The infant mortality, or the death of babies within the first year of life, rate had gone down from 24 in 1980 to 10.5 in 1995, for every 1000 babies. During the same period, toddler (1-2 year old) death rate was more than halved from 2 to 0.8 per 1000. In addition, only 0.67% neonates (premature babies) died in 1995. These figures augur well for the status of health-care in this country.
Pregnancy is a unique experience, reserved only for the majority of women. However, the experience can be a painful one. Although pregnancy and childbirth are special events in a woman’s life, and in the life of her family, there is always a possibility of it turning out to be a time of fear, suffering and even death.
Pregnancy is not a disease. It is a normal physiological happening. Nevertheless, each pregnancy is associated with certain risks to health and survival, both to the woman and for the baby she bears. These risks are invariably present in every society and in every setting. But at the present moment they affect mostly pregnant women living in poor and underdeveloped countries.
We know now how to reduce these risks. We actually have the resources and the will to do it. It has been said that reducing maternal mortality is one of the most cost-effective strategies available in the area of public health. Access to information related to pregnancy and contraception can help reduce risky and unwanted pregnancies.
Access to health care facilities, especially at the critical time of birth, can help ensure that childbirth is a memorable and joyful event. The quest for safe motherhood is not merely an health-care strategy, but it also tantamount to the fulfilment of social justice.
The risk that a woman faces in bringing life into this world are not mere misfortunes or unavoidable natural disadvantages , but are injustices that civilised societies have a duty to rectify through political, economical, legal and religious will.
“We have enjoined on man, kindness to his parents, in pain did his mother bear him, and in pain did she give him birth.”