Maternal mortality rates in developing countries

Dr Ruth Jackson returns from her field trip in Ethiopia with some harrowing revelations.

"It makes no sense to me to cut funding to maternal and neonatal health programs." - Dr Ruth Jackson
"It makes no sense to me to cut funding to maternal and neonatal health programs." - Dr Ruth Jackson

Following her last communications from abroad, Dr Ruth Jackson shares with us the touching and harrowing story of one of her research subjects, Abenet and her baby:

One of the tasks for world leaders at the United Nations General Assembly will be to review progress toward the Millennium Development Goals (MDGs) and debate the next global development agenda. MDG 5 proposed a 75 percent reduction in the maternal mortality ratio in developing countries. In Ethiopia, the 2011 Demographic and Health Survey (EDHS) estimated the MMR to be 676 maternal deaths per 100,000 live births - the target is to reduce the MMR to 267 deaths per 100,000 live births by 2015.

The next UN framework will have a critical bearing on whether, and by how much, maternal mortality will be reduced in the coming years in countries such as Ethiopia. While the priority that maternal health and other health issues receive in the global framework will influence health policy and programming around the world, I want to share Abenet's story as her baby was born a month ago just in time to celebrate Ethiopian New Year.

Abenet lives in Kafa Zone in Ethiopia's southwest, an area dominated by steep hills, gorges and streams with large areas of natural forest that are the habitat of wild Ethiopian coffee and has been described as one of the 'biodiversity hotspots' of the world.

Abenet is now a mother of four and has not had the opportunity to finish school (I sponsor her to go to school - and only learnt of Abenet's pregnancy about six weeks ago…). Abenet did not attend antenatal care (ANC) once during this pregnancy (34 percent of women in Ethiopia receive ANC from a skilled provider). Four ANC visits are recommended to ensure that both mother and baby are doing well during the pregnancy. Abenet's baby was born at home in the night, with her aunt assisting (only 10 percent of Ethiopian women give birth with a skilled birth attendant to assist). Abenet's sister Genet, who lives next door and has done nursing training came to visit and saw that Abenet had retained placenta/postpartum haemhorrhage (one of the direct causes of obstetric death). Genet called the ambulance.

Bonga, the capital of Kafa Zone, is a town of about 20,000 and now has a functioning ambulance - when I did my PhD research there in 2007 the ambulance was not working. The ambulance took Abenet to the closest health centre but they couldn't help her so she was taken to the hospital (it's about 45 minutes' walk to the hospital). Finally, at the hospital, they managed to get an IV inserted (after nine attempts) and to stop the haemhorrhage and remove the placenta. There is no possibility of blood transfusion at the hospital. The only reason Abenet is alive I would guess, is that Genet acted quickly and that they were close to medical care!!

I know Abenet's husband wanted her to produce a son which she has now done so my hope is that she won’t have any more children. But with the new school year starting, Abenet must decide if she can go back to school to start Grade 10. I suggested she think about waiting another year - but she must make the decision herself…

Abenet's youngest sister, Tigist, is expecting a baby any day now too. As I've known about this pregnancy for awhile, I insisted that she have four antenatal visits and that she have her baby in the hospital. Tigist has an intellectual disability (the pregnancy was 'unplanned' and we believe she was raped) so she will need everyone to assist her with raising the child which she says she wants to keep. In the short term, she will get fresh milk every day and some money to contribute to the costs of the delivery in the hospital.

It's easy to get bogged down in studying statistics around maternal and neonatal mortality. Because I did my PhD research in Kafa Zone, I can put names to faces of women I've met who've lost babies in childbirth because they didn't reach health facilities on time, or because the health facility could not assist them. I was given a list of 154 names of women who died in childbirth in a 25 year period from one small rural area. It makes no sense to me to cut funding to maternal and neonatal health programs. That means, that possibly, the next time a woman arrives at Bonga Hospital to have her baby, she will die because there is no doctor, no midwife, no gloves, no blood, no IV fluid, nothing there to assist her.

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