tragedy of our time
Opinion
The most neglected tragedy of our time
Each year in the Pacific, hundreds of women die in childbirth. Unlike other health killers, this one takes women in their prime - in their teens, 20s and 30s.
The tragedy for the family concerned is immense, especially for children who will have to grow up without a mother and for the woman’s husband who will have to shoulder the burden of parenthood alone.
For the woman concerned, death, whether it be from haemorrhage, infection, obstructed labour or other causes, is often an excruciating and drawn-out affair.
Many of these deaths are preventable yet there has been little public debate on this terrible toll or on measures that could be taken to reduce it.
The United Nations Children’s Fund (UNICEF) is hoping to be the catalyst which changes that. It has made maternal mortality the focus of its 1996 edition of its Progress of Nations report. New esti mates produced by UNICEF show that worldwide, 600,000 women die each year giving birth, almost 20 per cent more than
previously thought.
More sobering is the fact that for every woman who dies, approximately 30 more “incur injuries, infections and disabilities which are usually untreated and unspoken of, and which are often humiliating and
painful, debilitating and lifelong”.
According to UNICEF, the toll of injury and disability from pregnancy related causes is “arguably the most neglected health problem in the world”.
The Pacific makes its contribution to these figures. Papua New Guinea has by far the highest maternal death rate. There, 930 women die for every 100,000 live births - the third-highest rate in the entire Asia-Pacific region, exceeded only in Nepal and Bhutan.
In other Island nations, the death rate is also too high. In Solomon Islands, official figures put the maternal death rate at 549 deaths per 100,000 live births or around 77 women per year. Vanuatu, Kiribati, Marshall Islands and Tuvalu also have maternal death rates of over 100 per one hundred thousand births. When one com pares that with a rate of nine in Australia,
the enormity of the tragedy is more obvi ous.
The only area in the region in which maternal death rates come close to what women might expect from their govern ments is Polynesia. Cook Islands, with its hitherto generously funded health system, has the lowest rate with 46. Next comes Western Samoa with 50.
Fiji has 68 and Tonga between 70 and 80 per 100,000 births. Behind these fig ures are complex causes.
According to UNICEF, the facts that women are having many children close together, that they are having babies both younger and older, that in some areas women are forced - whether by necessity or by unsympathetic husbands - to work hard right up until they go into labour and that they are not able to make it to a clin ic soon enough all add to the problem.
In many countries with fast-growing urban centres, the number of pregnancies among unmarried teenagers is booming.
Married or otherwise, young women have always had babies but statistics reveal that when they do so before the age of 20, they double their chances of dying in child birth.
In Melanesia, malaria is a particular danger to pregnant women.
It reduces a woman’s haemoglobin, causing anaemia which weakens her abil ity to withstand or recover from haemor
rhages.
In other places, the increasingly poor diet of junk food, tinned fish and rice is also contributing to the number of women
who develop pregnancy-related diabetes
and hypertension.
Despite these myriad of causes, there is one predictor above all others which gives a good idea of a woman’s risk of maternal death, and that is access to a clinic with trained staff during pregnancy, at the time of birth and afterwards.
Many of the problems which kill can be minimised if women go for check-ups during pregnancy. For malaria, for instance, women can be given prophylax is while they are pregnant and iron tablets if they develop anaemia. Simple urine tests can warn of diabetes and other risk factors such as previous problems in preg
nancy or an unusual presentation of the baby can be assessed and the woman referred to a better equipped health centre
before problems develop.
At the time of birth, a clinic (or even well-trained traditional birth attendants or low-level health workers) can offer antibi otics, which drastically reduce the risk of infection, and administer drugs which reduce another big killer - haemorrhage.
Five percent of all women having babies will require Caesarean birth - the only area in which measures to reduce maternal mortality will cost the health budget relatively dearly, particularly if transport is required from remote areas.
Still, the benefits in terms of better sur vival and fewer disabilities for children as well as mothers has got to compensate to some extent.
One of the most fruitful areas for gov ernments seeking to reduce maternal mor tality is in the provision of high-quality family planning services to all who need them.
According to UNICEF, “meeting only the existing demand for family planning would reduce pregnancies in the develop ing world by a fifth, bringing at least an equivalent reduction in maternal deaths
and injuries”.
While Pacific governments have improved their family planning services over the past decade, more is still needed.
Many of those who currently do no have access to contraception, whether it be for reasons of remoteness from health ser vices, traditional cultural or embarrass ment, are those most at risk - older women who have many children and do not want more and young women would
gain added protection against the increas
ing incidence of sexually transmitted dis eases in the region.
Better access to family planning will .reduce the toll taken by repeated pregnan cies close together and reduce the number of dangerous illegal abortions.
Dealing with maternal mortality will
require breaking the silence surrounding
many taboo subjects but perhaps it has been just this reluctance in the past which has allowed this problem to go almost unremarked. ■