Maternal health is one of the most pressing issues in developing countries, with hundreds of millions of women struggling on a daily basis to get access to basic health care for themselves and their children. According to the World Health Organization, almost all maternal deaths (99%) occur in developing countries; more than half of these deaths occur in sub-Saharan Africa.
The Central African Republic (CAR) has one of the world’s highest maternal mortality ratios – the number of women who die during pregnancy or child birth – at 890 deaths per 100,000 live births. A woman’s lifetime risk of maternal death in CAR is 1 in 27, compared to 1 in 3,800 in developed countries.
It is important that all births are attended by a skilled health professional, as timely management and treatment can be the difference between life and death. However, only 53% of births in CAR are attended by skilled health professionals. Women outside the capital often give birth at home in unsanitary conditions, relying on untrained traditional birth attendants. According to Olga, an International Medical Corps midwife:
“Traditional birth attendants have a lot of power and influence with the communities and pregnant women, but they often have little or no formal training. They will encourage the mother to give birth at home. They wait until they can’t deal with a problem anymore and only then will they bring the woman to the clinic, but it can often be too late and the mother or the baby will die.”
But maternal care is more than just delivering babies. Says Olga:
“We have to do a lot of community awareness and health education. The biggest challenge is actually getting women to come to the health facility and use the services. In one village the health facility is only 3 miles away, but the women weren’t using the services. We have to educate the women and the communities about the importance of ante and postnatal consultations, and the benefits of giving birth at a health facility with a skilled midwife.”
Many women die as a result of complications that have developed during pregnancy. Regular antenatal consultations allow midwives to monitor the progress of mother and baby, and to identify and treat women who are ‘at risk’. Mothers also receive immunizations against tetanus, de-worming and anti-malaria medication, and iron supplements.
Postnatal care begins immediately after the birth, with close observation for 48 hours for detection of complications such as postpartum hemorrhage and eclampsia. Postnatal care continues for about 6 weeks when the major focus is ensuring that the mother is healthy and capable of taking care of her newborn, and equipped with all the information she needs about breastfeeding, immunizations for her baby, and family planning.
Indeed, to reduce the risk of maternal death, it is vital to prevent pregnancies that are too early in the woman’s life or are too close together. Olga adds: “There is a poor level of education amongst women, particularly in the rural areas where we work. That is why you will see women with so many children; one woman in the village of Kagabando has 15 children!” International Medical Corps provides family planning services as part of its reproductive health program, which includes information about the benefits of spacing pregnancies and the provision of contraceptives.
A slowly improving and expanding reproductive health service in CAR is making a difference – the maternal mortality ratio has reduced from 1,570 deaths per 100,000 live births in 2008 to 890 in 2011. International Medical Corps and our teams of dedicated midwives and trained birth attendants will continue to strive towards better health care for pregnant women, mothers and their babies.