As we celebrate Mother’s Day we should give a thought to our sisters in Africa. For today, like every day, almost 1,500 of them will die doing what we took for granted: giving birth. The statistics are sobering. Half of the worldwide 600,000 maternal deaths occur in Africa, a continent with 12% of the population. The lifetime risk of maternal death is 1 in 36 in Africa (1 in 26 in West and Central Africa). Here in the United States that risk is 1 in 2,100. In Sweden that risk is 1 in 11,400.
More women die from pregnancy and childbirth related complications in Africa than from AIDS, traffic accidents, and tuberculosis combined.
Why do so many die?
When labor goes awry there are often delays, maybe even days, before a woman seeks care. For some, it is not recognizing that there is a problem until it is too late, because in Africa more than 50% of deliveries occur without a skilled birth attendant. Even if a problem is recognized, many women cannot get to the closest hospital. In the rainy season the roads may be impassable, there may be no car available, or the family may not be able to afford the $2 ride to the hospital. Consequently, many women walk in labor and hope for the best. They have infections or are bleeding, but there is no other option. Thousands die on the road side every year.
For those women who do manage to get to a medial facility, the treatment and services that we take for granted often do not exist. Oxytocin, a drug which costs 33 cents and can stop excessive bleeding, is frequently unavailable. Or the power may be out in the operating room, so no c-section can be performed for an obstructed labor. Or there may be no sutures to repair a bleeding laceration. 25% of African women who die in pregnancy, die from blood loss. As infections are often so advanced after 4 days of labor at home, or antibiotics may simply be unavailable, another 15% die from infection. Another 13% die from unsafe abortions.
The death of a mother is a double tragedy, because an orphan in Africa has twice the risk of dying before the age of five.
If you want to save the children, you have to save the mothers.
But the root of the problem isn’t the number of midwives or lack of access to a particular medication, it is the whole infrastructure. The best hospital is of no value if no one recognizes the early warning signs. And state of the art medications cannot save a bleeding mother who cannot get to the hospital.
That is where Save The Mothers comes in, a non-profit with the mission of making childbirth safer for women in developing countries. The brainchild of Dr. Jean Chamberlain Froese, an OB/GYN who realized that extra vials of medication would only go so far, and that the real problem was the social infrastructure for women. In addition to providing obstetrical care, she has spearheaded a Masters Program in Public Health Leadership in Uganda. Students are diverse, including journalists, members of parliament, clergy, and even members of the military. These graduates become a sustainable network of advocates.
On a personal note, Jean and I trained together in Canada. She is an incredible doctor and full of passion and I am privileged to count her among my friends.
To save the lives of mothers, you have to change attitudes about the worth of women. Today, instead of picking up a latte, donate the $3.50 to Save the Mothers or buy Jean’s book, Where have all the mothers gone? If you can get through each story without crying you are made of stronger stuff than I am.
And remember, even though our maternal mortality rate is not as desperate as Africa, we lag far behind almost every industrialized country. Our failure to provide maternal care to 25% of pregnant women ensures that giving birth in America will always be more dangerous than having a baby in Canada, Japan, or Europe. Even women in Poland is safer. If our politicians valued women and the health of the next generation, like all these other countries, we would have universal prenatal care.