Monday,26 August 2024
Author: Oliyer Abwooli Kabagenyi Country: Uganda
SUMMARY
Juliet was just 23 years old, a young woman with big dreams and aspirations, " I am going to take care of your education till you are all responsible people, I want to give you the best in life I never had growing up" she used to tell her siblings. Born into a humble background, she devoted herself to caring for her four younger siblings after her father passed away. Her mother, a single parent, relied heavily on her. Despite the hardships, Juliet found consolation in agriculture where her career was beginning to blossom. However, her journey was unfortunately cut short. Just five hours after undergoing a C-section at a local hospital, Juliet succumbed to severe postpartum hemorrhage. Her story, just like so many others, some untold, is a painful reminder of the unnecessary maternal and perinatal deaths that continue to happen in our society. These stories demand our attention and immediate action.
BACKGROUND
Maternal and perinatal mortality continues to be significant public health challenges, particularly in low- and middle-income countries like Uganda. According to recent data, the global maternal mortality ratio is approximately 211 deaths per 100,000 live births, with excessive bleeding before, during, and after childbirth being the leading cause of death (WHO, 2023). In Uganda, the maternal mortality ratio remains high, at around 336 deaths per 100,000 live births (UNICEF, 2023), there is urgent need for interventions. Several factors contribute to the high rates of maternal and perinatal mortality, including reproductive, socioeconomic, cultural, and healthcare-related issues. However, there are also effective strategies to mitigate these risks. Reproductive Factors such as Parity and Age: High parity (having many children) and extremes of maternal age, particularly adolescent pregnancies or pregnancies in women over 35, are associated with higher risks of complications. Comprehensive sexual and reproductive health education, along with access to contraceptive services, can help women plan and space pregnancies, reducing these risks (Chou et al., 2021).
Main Factors that Contribute to Maternal and Perinatal Mortality
Complications During Pregnancy Hemorrhage, both antepartum (before birth) and postpartum (after birth), remains the leading cause of maternal mortality, contributing to nearly 30% of maternal deaths globally (WHO, 2023). Improving access to quality antenatal care, equipping healthcare facilities with necessary supplies, and ensuring timely management of obstetric emergencies are crucial steps to reduce these deaths. Community education on recognizing and responding to danger signs during pregnancy is also essential (Say et al., 2021).
Socioeconomic Factors
Poverty is a critical determinant of maternal and perinatal health outcomes. Women from low-income households often lack access to essential maternal health services. Addressing this requires government and nongovernmental organizations to invest in making maternal healthcare services affordable and accessible. Innovations such as community health insurance schemes and mobile health clinics have been shown to improve access in low-resource settings (Bauserman et al., 2022). In addition, increasing education and awareness about maternal health is another key strategy. Community-based health education programs that focus on the importance of antenatal care, skilled birth attendance, and emergency obstetric care have been effective in improving maternal health outcomes (Campbell et al., 2021).
Cultural Factors
Cultural beliefs and practices such as the celebration of the 10th born in the family can significantly influence maternal health outcomes. Engaging community leaders and traditional birth attendants in health promotion efforts can help align traditional practices with modern healthcare. Training and collaboration with traditional birth attendants have been shown to reduce maternal mortality in some settings (Kyomuhendo, 2022).
Health Care Workers
The shortage of skilled healthcare workers is also a significant barrier to reducing maternal and perinatal mortality. Governments should focus on training and retaining healthcare workers, particularly in rural areas. Strategies such as task shifting, where non-physician health workers are trained to perform specific medical tasks, have shown promise in addressing workforce shortages (Fleming et al., 2022). Improving the attitude of healthcare workers towards patients is crucial. Regular training in respectful maternity care, alongside accountability mechanisms, can improve patient experiences and encourage more women to seek care in formal health settings (Bohren et al., 2022). These and many more strategies have the potential to significantly reduce maternal and perinatal mortality, saving countless lives and improving the well-being of mothers and newborns, if effectively implemented.
Stigma and Gender Inequality
Addressing gender inequality is crucial for improving maternal health outcomes. Empowering women to make decisions about their reproductive health and challenging harmful gender norms can reduce delays in seeking care and improve maternal outcomes (UNFPA, 2023). Healthcare Factors: Many healthcare facilities in Uganda lack the infrastructure and equipment needed to manage obstetric emergencies effectively. Strengthening health systems by investing in infrastructure, ensuring the availability of essential supplies, and enhancing the capacity of healthcare workers is critical (WHO, 2023).
Juliet’s story is not just a statistic; it is a call to action. Behind every maternal and perinatal death is a life cut short, a family left in mourning, and a community deeply affected. We must urge nongovernmental organizations, the government of Uganda, community leaders, and healthcare workers to work together to address these preventable deaths. It is time to confront these tragedies head-on, ensuring that no more mothers or newborns are lost due to preventable causes. The world cannot afford to turn a blind eye any longer. The time to act is now, let's put a stop to the loss of future parents, leaders, and important people in our society.
REFERENCES
Bauserman, M., Lokangaka, A., Thorsten, V., Tshefu, A., Goudar, S. S., Esamai, F., … & Bose, C. (2022). Risk factors for maternal death and trends in maternal mortality in low-income and middle-income countries: a prospective longitudinal cohort analysis.https://pubmed.ncbi.nlm.nih.gov/26062992/
Bohren, M. A., Vogel, J. P., Hunter, E. C., Lutsiv, O., Makh, S. K., Souza, J. P., … & Gülmezoglu, A. M. (2022). The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. https://journals.plos.org/plosmedicine/article%3Fid%3D10.1371/journal.pmed.1001847%26fullSite
Campbell, O. M., Graham, W. J., & Lancet Maternal Survival Series Steering Group. (2021). Strategies for reducing maternal mortality: getting on with what works. https://pubmed.ncbi.nlm.nih.gov/17027735/
Chou, D., Daelmans, B., Jolivet, R. R., Kinney, M., & Say, L. (2021). Ending preventable maternal and newborn mortality and stillbirths. https://pubmed.ncbi.nlm.nih.gov/26371222/
Fleming, N. S., Culler, S. D., McCorkle, R., Becker, E. R., & Ballard, D. J. (2022). Improving patient safety: Lessons learned in large-scale improvement initiatives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10656601/
Kyomuhendo, G. B. (2022). Low use of rural maternity services in Uganda: impact of women's status, traditional beliefs, and limited resources. https://pubmed.ncbi.nlm.nih.gov/12800700/
Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A. B., Daniels, J. D., … & Alkema, L. (2021). Global causes of maternal death: a WHO systematic analysis. https://pubmed.ncbi.nlm.nih.gov/25103301/
UNFPA. (2023). Gender Equality: Ending Gender-Based Violence and Harmful Practices. https://uganda.unfpa.org/en/topics/ending-gender-based-violence-and-harmful-practices
UNICEF. (2023). Maternal mortality ratio (modeled estimate, per 100,000 live births). https://data.unicef.org/topic/maternal-health/maternal-mortality/
World Health Organization. (2023). Strategies toward ending preventable maternal mortality (EPMM). Geneva: WHO. https://platform.who.int/docs/default-source/mca-documents/qoc/qualityof-care/strategies-toward-ending-preventable-maternal-mortality-(epmm).pdf?sfvrsn=a31dedb6_4
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