Making Motherhood Safe

Some Tragic Incidences

Ferdousi a village teen was married to Shahed Ali 16. When married the adolescent girl Ferdousi was just 14. Their first child was born two years after marriage. Delivery was done at home. During pregnancy Ferdousi was administered tetanus Toxoid. Two years after the birth of first child another boy child was born but he died soon after. Again a son, the third one, was born, two years after the birth of the second one. Ferdousi became pregnant again for the fourth time when she was still nursing the neonat. This time the couple decided to terminate pregnancy. Accordingly they went to the district town and saw a doctor who performed menstrual regulation procedure and released Ferdousi after a few hours with advise and a prescription for medication. The doctors asked them to come back next day for follow up.

As this would cost money and as Shahed Ali was a day labour, having money for bare daily living, decided not to go to the district town next day to see the doctor for follow up. Instead Shahed Ali went for his daily work. Around noon, Ferdousi s bleeding became profuse. Her mother-in-law was perplexed and went to the local doctors for help. She was advised by them to call in a lady doctor. The gynae and obstetric trained lady doctor was unavailable as she was on call else-where. Ferdousi's husband was informed. He came and went for the lady doctor. However, before he could comeback with the lady doctor, Ferdousi expired.

In another incident, Rubia Begum, a rural girl was married at 22. After two years she became pregnant. During the confinement period she never went to any doctor for check up nor took tetanus toxoid injections. Though local health assistant and family welfare assistant advised her to get the shots, she didn't bother because of misconception and fear. However, Rubia delivered twins in the end phase of her pregnancy. Delivery was conducted by local birth attendant. Immediately after delivery Rubia had convulsions and at one stage, she died.

In yet another case, Dolly Mondol, married at the age of 16, gave birth to two girl child consecutively. She became pregnant for the third time with the hope of getting a boy child - a son. During all these days of pregnancy she did not see a doctor nor had any check up. One day at 3 am in the early morning she felt labour pain. Local birth attendant was called in. At 5 am a child was born but the placenta didn't come out. Village doctor was called who decided that he was unable to take care of this emergency. Dolly was bleeding profusely. At around 8 am she was taken to the nearest city hospital where blood transfusion could not be done as the party could not make prior blood collection. Dolly could not be saved.

I take the opportunity of quoting another story from the Population Reference Burean's report, "Making Motherhood Safer".

The story of Tahera, a young woman in, (14, when interviewed), illustrates how many factors can contribute to poor decision making: inability to recognise, danger signs of life-threatening complications; poor knowledge of where to receive care for complications; inability of the husband to decide what to do because of his lack of knowledge; inefficient decision making process due to community power structure; initial reliance on ineffective local remedies; fears about the potential costs involved in emergency maternity care; community opposition; and transportation problems.

Yet the story had a happy ending, in part because the traditional birth attendant who helped get the young women to the hospital had received education about the importance of emergency obstetric care. Yet another story from the South East Asian region depicts the need of adolescent girl's need for access to reproductive health services including family planning, and antenatal delivery and postpartum care.

A few months after Aziza turned 15, she was married and went to her husband's home. Her mother had prayed fervently before she departed that, inshal Allah-Arabic for "God-willing" Aziza would present her husband with a son to make her position secure in the household. When, a few months later, Aziza began to feel sick in the mornings, there was much in trouble in both the families. As Aziza's pregnancy progressed, her husband noted she looked pale and was con-stantly tried. The doctor confirmed that Aziza was severely anaemic and was not gaining enough weight. She was too young to be having a baby, the doctor said.

The doctor warned the family about possible complications during the pregnancy and delivery, as Aziza was scarcely more than a child herself and her body had not yet developed sufficiently. During , antenatal checkups, the doctor warned against a home delivery, but when Aziza's contractions began some three weeks early, Aziza's mother-in-law tried conventional home delivery. When 14 hours passed Aziza was put into a cycle rickshaw and wheeled to the hospital at a distance. As Aziza's water had burst before she reached hospital and as by this time 20 hours had passed, labour became rather complicated, Aziza was exhausted and weak. Doctors opted for Caesarean section. She suffered life threatening haemorrhage, but she and her new born survived. The doctor counseled Aziza's husband against the hazard of another pregnancy too soon. Aziza's husband realised how fortunate they had been. While Aziza wanted to have a baby, many adolescents get pregnant unintentionally. The health risks of pregnancy for young women are complicated by their lack of access to information about contraception.

Ninety percent give birth to babies at home aided by untrained attendants. That situation, created problems for both mother and child.

Around the world, people celebrate the birth of a new baby. Societies expect women to bear children, and honour women for their role as mothers. Yet in most of the world, pregnancy and child birth is a perilous journey. In less developed countries, more than half a million mothers die each year from causes related to this life-giving event.

These deaths are only part of this tragic picture: For every women who dies, about 30 suffer from devastating health problems such as infertility and damage to their reproductive organs. Ninety-nine percent of these deaths occur in less developed regions, and most are due to inadequate medical care at the time of child birth. This tragedy need not continue Evidence shows that motherhood can be safer for all women.

Over the past decade, experts have largely come to agree on a set of lifesaving strategies that can work even in low-resource set things. What remains is for governments to commit to making safe motherhood a priority.

Research shows that women's lives can be saved and their suffering reduced if health system could be addressed seriously and life threatening complications of pregnancy and child birth when they occur.

One of the best ways to do this is to make sure that women receive skilled care at delivery. Providing skilled care means ensuring that health professionals such as doctors, nurses or midwives can manage normal deliveries and treat the life-threatening complications of pregnancy and childbirth. With support from functioning health and transportation systems, these professionals can treat or stabilize women and refer them for appropriate care. Ensuring that women receives skilled care at delivery is an essential part of safe motherhood pro-grammes. Skilled care can only be effective in the context of health systems make obstetric care avail-able to all women, including surgical and technical interventions required to treat life threatening conditions during pregnancy, delivery, and after childbirth. Antenatal care, among other services, can play a role in detecting and treating some complications of pregnancy. The existence of skilled care, however, does not guarantee its use. Women face multiple delays in seeking and receiving life saving care when they need it.

Women miss the opportunity to receive life saving care when they do not recognise the signs of life threatening complications (Delay No 1); when they postpone deciding to seek care (Delay No 2); when it takes too long to reach appropriate care (Delay No. 3); and when they receive substandard or slow care at health facilities (Delay No 4).

Diminishing these delays requires policy commitment and actions at the local and national levels, but is feasible even in low -income settings. Reducing maternal deaths requires well-coordinated and sustained efforts. To make motherhood suffer, maternal health experts recommend the following policy options. Decision makers should choose options relevant to their countries.

Delay One: Help Women and Their Families Recognize Danger Signs By:

  1. Raising awareness in communities about the signs of life-threatening complications; and .
  2. Educating women, their partners, and their families about when and where to seek care for complications.

Delay Two: Help Women and Their Families Decide to Seek Care By:

  1. Encouraging families and communities to develop plans of action in case of obstetric emergencies;
  2. Raising women's status so that they are empowered to make critical health decision;
  3. Enhancing links between communities and health care providers;
  4. Improving relationships between traditional healers and skilled health care providers;
  5. Improving the interpersonal skills of health care providers by using information about how the community defines quality of care;
  6. Educating women and their families about where to seek care for complications;
  7. Encouraging communities to excrete insurance scheme to pool the costs associated with emergency care; and
  8. Encouraging the use of health care facilities by adolescents, single or unmarried women, and ethnic and linguistic groups who are reluctant to use services because of socio-ctiltural barriers.

Delay Three: Help Women Reach Appropriate Care By Encouraging Communities to Create Emergency Transportation Plans

  1. Upgrading roads and other transportation systems;
  2. Enhancing referral systems between communities and health care providers; and
  3. Establishing maternity waiting homes.

Delay Four: Make Sure Women Receive Care at Health Facilities By

  1. Upgrading the quality of care at Health Facilities, including improving providers' technical and inter-personal skills, motivation and performance;
  2. Establishing national protocols for treating obstetric complications;
  3. Training health facility staff to recognise and admit patients with life-threatening complications;
  4. Ensuring adequate and sustainable supplies of emergency medicines, essential equipment, blood and staffing levels at Health Facilities;
  5. Providing 24-hour service at, facilities that provide emergency obstetric care;
  6. Enhancing referral systems between communities and health facilities;
  7. Improving communication between the units that provide care in order to generate more referrals; and
  8. Ensuring that the national curricula for health providers include practical components about treating obstetrical emergencies.

"Motherhood and childhood are entitled to special care and assistance.

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