“When I grow up, I will be rich. I will have a successful career. I will own a really nice car. I will be happy. I will have three kids and a dog.”
As children, we dream about what’s possible. As we age, we realize our dreams are not entitlements...we have to work hard to make them reality. But what about all that’s out of our control? Should we have to worry about some of our dreams being squashed because our human rights are not realized?
Lately, I’ve been reflecting on this a lot as I’ve been attending many baby showers in Kampala, where I live and work. These are mostly exciting and upbeat events, but in a country where maternal mortality rates are declining but still remain high, I can’t help but worry about what the next few months have in store for the expectant mothers.
I was recently at a friend’s baby shower, and she was so happy we had taken the time to surprise her. After the festivities, however, she mentioned that she always feared and dreaded baby showers. “I would be more comfortable if we had done a baby welcome party,” she said. We laughed this off and told her not to worry. We told her to be positive and have faith that it would all go well. Two months later, she had the cutest bouncing baby boy, and both mother and baby are healthy and happy.
Sadly this is not always the case. Another friend of mine was not as fortunate. Agnes was one of the most hardworking, ambitious, lively, upbeat, and intelligent people I have ever met. With her dream of graduating at the top of her class with her Masters in Business from Makerere University recently achieved and another dream of having a child about to manifest, she tragically lost her life to preeclampsia in her third trimester.
Agnes’ story is not unique. In Uganda, 336 mothers die for every 100,000 deliveries. My friend who worried about her baby’s delivery was not being hormonal or emotional, terms we often use to label pregnant women. Her worries were completely valid and supported by information and evidence.
Surely every single person alive represents a missed opportunity for the world to master the art of safe child delivery. In many developed countries, and even in the United States, the numbers clearly tell us we’ve missed the mark. In the 2005 WHO annual report, it was estimated that 80% of maternal deaths during delivery are preventable. Globally, maternal and neonatal deaths are primarily the result of direct causes, including hemorrhage, obstructed labor, eclampsia, and sepsis. In developing countries, indirect causes play a bigger role. These causes may include the existing burden of preventable communicable diseases — such as malaria, tuberculosis, HIV/AIDs — and the crippled healthcare systems that face challenges such as lack of medical equipment at health facilities, lack of medical training for staff, and lack of information for mothers, among other factors.
During my Global Health Corps fellowship, I have had the chance to work as a monitoring and evaluation fellow at LifeNet International, an organization that builds the capacity of local health centers and hospitals through nurse training (primarily focused on maternal and neonatal health, infection prevention, and noncommunicable diseases), management training (growth financing), and medicine supply in rural Uganda, the Democratic Republic of the Congo, and Burundi. Throughout this fellowship, I have gotten to assess the impact that LifeNet trainings are having on several health outcomes including maternal deaths.
Recently, while doing my routine report creation, using data obtained from the Uganda HMIS collected at facilities, I realized something odd. According to the Ministry of Health, one maternal death is expected for every 300 births in Uganda, but this particular health facility partner was reporting a maternal death every single month for seven months in a row. Each month had about 30 deliveries, while a year prior to this seven months’ period, there was none. Other health facility partners reported one or two maternal deaths a year.
This was truly concerning. I alerted the medical team that something peculiar was going on and asked them to identify what could have been the cause. Did the health facility hire new staff that weren’t properly trained? Was there particular equipment they needed that they did not have? Was there a particular clinical skill they lacked? Was there no electricity at the facility?
Upon following up, we learned that funding had been cut for an ambulance at the facility to transport mothers in case they needed referral. When the mother needed to be referred and couldn’t afford the transport money, she would die at the facility.
This was a simple gap that we were able to identify, and we were reassured that the facility had found a new source of funding for their ambulance. We were told to expect that the maternal mortality numbers would go down. However, this is a systemic issue! What is alarming is that women are at the mercy of this broken system, risking their lives just to deliver children — something that should be just another life event. Every once in a while we have a “Band-Aid solution,” such as the funding for the ambulance, but we need to address this problem systemically.
I do not have all the answers. Here’s what I believe we need to do to make more progress, though:
- Advocate for more funding for the health sector.
- Coordinate training and skill building opportunities for our medical practitioners.
- Demand that our taxes are directed to providing health facilities with the equipment they need.
- Direct significant funding towards blood donation in order to prevent a blood shortage crisis.
- Empower the public with the information that they need in order to have healthy, safe deliveries.
- Support health workers and celebrate their contributions.
I would love to see a day when no mothers died during child delivery, and I am sure you would, too. Let’s work together to get there more quickly.
Note from the author: Special credit to my awesome co-fellow, Nicole, who helped me edit and select the photos for this post.
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