Taking care of mums: Making strides to reduce maternal mortality

Although the country may not succeed in reaching its fifth Millennium Development Goal (MDG) of reducing its maternal mortality ratio (MMR) to 185 per 100,000 live births, Ghana has nonetheless made noteworthy strides in improving maternal health over the last 15 years. Indeed, between 1990 and 2007, the MMR has fallen from 740 per 100,000 live births to 451 per 100,000 live births, according to the Maternal Health Survey conducted in 2007.

Data from the Ministry of Health (MoH) indicate that the primary causes of maternal death are excessive bleeding, hypertension-related disorders, infection and anaemia. Other contributing factors include a pervasive lack of family planning, malaria, complications resulting from unsafe abortions and malnutrition.

ROOM FOR IMPROVEMENT: Though MMR had fallen to 350 per 100,000 by 2010, according to the MoH’s Health Sector Medium Term Development Plan ( HSMTDP) 2010-13, MMR will only fall to 340 per 100,000 by 2015 – a far cry from the MDG target of 185. According to Gilbert Buckle, the executive director of the Christian Health Association of Ghana, despite the many years of falling MMR, it is possible the ratio worsened between 2010 and 2011, likely due to the rise in reporting as more women are giving birth within the health care system. He said the need for minimum equipment and supplies was one of the biggest challenges in overcoming problems relating to maternal health.

Edem K Hiadzi, the CEO of the Lister Hospital and Fertility Centre in Accra, affirmed this, telling OBG, “Like other facets of health care, the availability of infrastructure, equipment and facilities is one of the primary obstacles to providing effective maternal health care in rural areas.” As Hiadzi explained, the issue is not just about constructing hospitals and clinics, but also one of establishing road infrastructure and bringing ambulances to rural areas to treat women who cannot reach clinics in time due to transportation problems.

FINANCING: In May 2012 the government announced that it was in the process of securing a €52m loan from the EU to help fight maternal mortality. Much of the funding will be used to provide essential equipment and supplies, such as portable ultra-sound machines, as well as to train nurses in rural areas to scan and detect for minor pregnancy complication that could then be referred to major health centres.

Government funding itself has also been focused on maternal health care to a great extent; in fact, 30% of funding (GHS1.97bn, $1.16bn) for the HSMTDP will be funnelled to maternal and adolescent health care, the largest amount contributed to any of the plan’s five objectives. Community health service centres are being established nationwide to improve awareness and education regarding family planning and maternal health care, among other basic services, such as vaccinations and first aid. The government will also send 161 ambulances to rural districts to improve connectivity, especially crucial in obstetric emergencies.

MIDWIFERY: Yet another challenge preventing Ghana from meeting its maternal health goals is the shortage of midwives. Buckle said that in five years roughly half of the country’s midwives will retire, and the current rate of graduates coming out of training programmes will not be enough to replace outgoing birthing facilitators. To address this, the MoH has reformed the midwifery training course by eliminating the requirement that midwives train as state-registered nurses before taking a sub-specialisation to enter the home birthing field. Hospitals and universities may now graduate midwives straight away without the additional requirement of first attaining a general nursing degree.

From 2000 to 2010, Ghana’s MMR ratio fell by an average of 3.3%, significantly below the 5.5% required to achieve its fifth MDG in 2015. It also currently faces shortages of equipment and supplies, as well as the future shortage of midwives. As a result, the country is not likely to drastically accelerate the reduction in the MMR in time to realise its fifth MDG. However, that should not diminish the advances made over the past decade in any way, or vastly alter plans for the future.