Giving birth, losing life

To Leonard Chikumbu, the two graves he passes each morning remain a painful reminder of how much he has lost in his 29 years on earth. The graves, one smaller in size flanking a much bigger one, bear the bodies of Chikumbu’s dead child and that of his deceased first wife, Grace.

Chikumbu and Grace got traditionally married two years ago, in a lavish ceremony by local standards. Grace soon conceived the pair’s first child, to the delight of a proud Chikumbu.
“It was the happiest time in my life,” Chikumbu recalls in a tone dripping with sadness. “She became pregnant two months after we’re traditionally declared man and wife. Everything seemed to be proceeding the way it’s meant to.”

As Grace’s belly grew in size, so did the excitement in the Chikumbu household. “By her seventh month, I had already started wondering about names. I wanted it to be a boy and I had already resolved to name it Joash Chikumbu, after my father. But I also had my options open if it was a girl. I was torn between Charity and Christine.”

Grace carried the pregnancy into its full term without any undue complications. So, when her time to deliver arrived, Chikumbu and the local Traditional Birth Attendant expected no problems.However, all that changed when Grace’s uterus ruptured.

Panicked, the locals tried to rush Grace to the nearest hospital, 15 miles away. But it was too late. The child died at the start of the journey, taking with it Grace’s will to live.

“She died on arrival at the hospital. Losing the child on the way was painful. But by the time we arrived at the hospital, I had forgotten about that tragedy and was instead praying that Grace would live. At least with her alive, we would have had another chance to try for another baby.”
Over a year has elapsed since the double deaths but not a day passes without Chikumbu mourning the departed pair.

Relatives have put him under increasing pressure to remarry, claiming that he has mourned enough and it’s time to move on.

But Chikumbu can’t help but fear going through the same experience again. Chikumbu’s is a fear shared by a number of Malawian widowers who have lost their wives to the rampant rates of maternal mortality in this landlocked southern African nation.

A damning study recently concluded that Malawi, with 807 deaths per 100,000 live births, possesses the worst maternal mortality rate of any non-conflict country in the world.
With poorly-paid and under-motivated nurses deserting the country for better opportunities abroad, conservative but still grim statistics indicate that roughly between 3,100 and 6,000 women and girls perish each year due to pregnancy-related complications, at a rate of 16 per day. Furthermore, another 62,000 to 180,000 women and girls suffer from disabilities caused by complications during pregnancy and childbirth each year.

The nurse to mother ratio in rural areas where the likes of Grace are expected to give birth is alarming and the midwives in attendance are normally over-stretched.

The World Health Organisation (WHO) recommends that health services employ a minimum of 100 nurses and 20 doctors per 100,000 people.

Malawi, with its population of over 15 million people, boasts of only 200 doctors and 3,000 nurses. The workload is immense and the healthcare system is cracking under the strain.
In a bid to put the spotlight jupon the problem, one Malawian daily last month raised an SOS plea directed towards the government, on behalf of nurses and midwives.

Quoted in the press, Dorothy Ngoma, the Executive Director of the National Organisation of Nurses and Midwives, revealed just how desperate the situation had become.

“We’re losing mothers because of our acute shortage of doctors, midwives and nurses,” Ngoma lamented. “At Bwaila Hospital in the capital Lilongwe, for example, it is common for a single midwife to be attending to three or four deliveries in one go. In rural areas where 70% of the population lives, it’s even worse. I have visited nurses on night duty working alone and taking care of over 100 patients for a shift of 16 hours. It is not humanly possible to have quality care that can save lives with this.”

Studies have proven that most maternal health problems experienced in Malawi stem from anaemia (87%), malaria (80%), retained placenta (77%), obstructed labour (76%), malpresentation (71%), antepartum and postpartum haemorrhage (70% each), and pre-eclampsia (56%).

These, according to Ngoma, are problems that are compounded both during delivery because surgery is not performed early enough when complications arise and thereafter because of lack of antibiotics and adequate follow-up care.

Malawi’s high maternal mortality rate has been worsened by the increasing number of teenagers indulging actively in sex.

Teenage sex has inevitably inspired a wave of unwanted pregnancies. And in a country where abortion remains a crime punishable by a prison sentence of up to 14 years for both the provider and the woman seeking it, this has simply worsened the crisis.

Statistics early this year showed that 40% of all maternal deaths, especially in urban areas, were down to induced terminations by medically untrained, trial-and-error providers.

With such abortions often carried out in unhygienic conditions, using unsterilised equipment and dangerous objects, women and young girls are aware of the risks.

But the risks continue appearing more appealing in comparison to the prospect of having an unplanned and unwanted dependant abruptly thrust into one’s life.

According to the disseminated findings of Strategic Assessment, Magnitude and Consequences on Unsafe Abortion in Malawi, 32, 094 women were treated for induced abortion complications in the country’s health facilities last year alone.

The research also revealed that 112,008 women procured abortions and most of them feared to seek medical services for the fear of stigma, discrimination and legal repercussions.
It’s a harsh reality the government readily acknowledges.

No sooner had the recently-appointed Health Minister, David Mphande, assumed office than he admitted that Malawi’s fight to achieve the fifth Millennium Development Goal of reducing maternal mortality rate remains indecisive unless the issue of unsafe abortions was resolved.
“It is obvious that we cannot achieve our MDG 5 target of 155 per100,000 if abortion deaths alone are responsible for 200 deaths per 100,000 live births on our current maternal mortality rate of 807 per 100,000,” Mphande confesses.

The fifth MDG commits the Malawian government to reducing maternal mortality by three quarters by 2015. But while Malawi has tried to galvanise its health system to meet the needs of mothers and newborns, the country’s present abortion rate of about 35 per 1,000 women is one of the highest in sub Saharan region.

“I am also informed that a significant proportion of these abortions are unsafely procured,” continues Mphande, “and that half of the women who suffer complications are below the age of 25 years. Many of these women are disabled for life.”

Efforts to relax Malawi’s restrictive anti-abortion law, which is enshrined in section 149 of the Penal Code, have been met by stiff resistance from the country’s religious leaders, both Christian and Muslim.

The UN deadline is just five years away. But for Malawi to even have the finish line in sight as far as maternal mortality is concerned, many hurdles have to be skipped between now and then.
It’s the proverbial race against time. And sadly, it’s one Malawi seems to be losing for now.
Source: http://www.streetnewsservice.org/news/2011/january/feed-264/giving-birth,-losing-life.aspx

Photo: Sharon Wibabara