Banning traditional birth attendants improve safe motherhood?

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Malawi has one of the highest maternal mortality rates in Sub-Saharan Africa, estimated at 984/100,000. The statistics can be compared to war ravaged nations such as Afghanistan in Asia or the politically unstable French Caribbean nation of Haiti.

Most of Malawi’s health facilities suffer from brain drain, where health workers migrate to developed countries in Europe, especially Britain, in search for better working conditions.

To better understand this, one of the country’s civil society groups, Malawi Health Equity Network (MHEN) in conjunction with VSO International, are embarking on research on the migration of health workers to the United Kingdom (UK) and the impact on Malawi’s health sector. The research is still in its infancy, but when complete, will help the nation know the true impact of brain drain.

Even without research, it seems obvious that brain drain leads to heavy understaffing in health facilities. This scenario forces mothers in labour to seek services of traditional birth attendants (TBAs). TBAs have capitalised on the human resource shortage in the maternal health care service to provide services of poor quality, often subjecting expectant mothers to unhygienic operations. Many mothers of child bearing age are dying as a result.

On the contrary, the Global Peace Index (GPI) ranks the country the second safest place to live in Africa after Botswana. Under these circumstances, mothers should therefore live longer.

In most countries in Africa and Asia, maternal mortality is inversely proportional to women’s status, broader strategies, such as poverty reduction and women’s empowerment are needed.

Another interesting fact is that mother and child outcomes are closely linked. In Nepal for example, infants of mothers who died during child birth were six times more likely to die in the first week of life. It is a worrisome development that maternal, newborn and child health have not been given financial priority at international level and received much less support than malaria, tuberculosis and HIV.

Over half a million women die in pregnancy or child birth each year. Women in the poorest countries, such as Malawi, and other parts of the world are over 1000 times more likely to die from maternal causes than those in developed countries. For every 30,000 women in Sweden, one will die from pregnancy-related complications. In Sub-Saharan Africa the average figure is a staggering one in 16 and in South Asia one in 43 - the regions with the greatest burden of maternal deaths world wide.

Yet, banning traditional attendants is unlikely to solve the problem in itself. In an article exploring maternal health in the UK-based Lancet Journal, several pro-active measures are called for:

· Donors and government need to formulate a clear strategic vision of what it takes to reduce maternal mortality.

· Strategies to help women during labour and delivery should be the priority.

· All women should deliver in health facilities with midwives working in team.

· Poor women in rural areas and Sub-Saharan Africa and South Asia should be prioritised.

· Long-term financial support from the international community is needed.

· Countries need to adopt policies to protect the poorest families from the catastrophic consequences of unaffordable delivery.

· An estimated extra US$1 billion from 2006, increasing to US$ 6.1 billion in 2015 is needed to increase coverage to desired levels.

· Governments need to start planning now for the deployment of health workers, especially midwives.

· Investment in community health workers should not be at the expense of funds for skilled attendants.

· Governments need to invest in efforts to retain existing staff.

· Better monitoring systems are needed to keep track of progress made in improving maternal health.

The banning of traditional attendants will not improve the situation of mothers, unless this is coupled with greater access to health facilities.

Without political commitment and investment in maternal health service delivery, declines in maternal deaths are unlikely in the next 10-20 years. It is also doubtful if the fifth Millennium Development Goal- to reduce maternal mortality by 75% by 2015 will be met.

Dingaan Mithi is program officer for Journalists Association Against AIDS in Malawi. This article is part of the Gender Links Opinion and Commentary Service which offers fresh news on every day news.

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Assayed Hummad says:

I have found it interesting area and is relevant to my study. Great article!

09 July 11

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