Maternal mortality: What if Africa didn’t care?

The ordinary African woman, generally closer to death than to life whenever performing her natural duty of giving life, will be hoping for tangible results from the deliberations of the 15th African Union Summit (19-27 July 2010), convened in Kampala under the lovely theme, “Maternal, infant and child health and development in Africa”.

The choice of this theme is a good step in the AU’s Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA), launched in 2009 under the key message, “Africa Cares: No woman should die while giving life”.


Since its launch, the CARMMA campaign has tried to bring the issue of high maternal mortality in Africa on the table. By the end of 2009, some eight countries had had their respective Ministries of Health launch the campaign at country level, and another nine were expected to launch by the Kampala Summit.

The campaign went global in March 2009, when a new international leadership group to lead the fight against high maternal mortality was launched on the in London, with Bience Gawanas (African Union) and Sarah Brown as the co-chairs.

Until now, health hadn’t explicitly featured in the themes of AU summits, following its predecessor’s (OAU’s) declaration committing member countries to allocating 15% of their national budgets to health.

Unfortunately, the experience of the several years since 2001, when this famous (but now as we know, hollow) declaration was hot air, after all. The latest available data shows that by 2007 only four countries had about met the goal of spending 15% the budgets on health: Burkina Faso (14.8%), Botswana (17.3%), Djibouti (15.1%) and Rwanda (18.8%).

Liberia and Malawi had exceeded the target in 2006 at 16.4% and 18%, respectively, but then dropped to 6.4% and 12.1% in 2007. Uganda has remained average, at around 10%, and the mid-term budget framework indicates that this will be reducing to about 9%. Seven countries allocated less than 5% in 2007, with oil-rich Nigeria particularly a sore eye with a paltry 3.5%, which above all, was nearly a 2%-point from its 1999 allocation!

With this embarrassing performance of our governments on their own commitments, one may be forced to ask: what has been the value of the Abuja declaration to us? And what will be the value of deliberating the problem of high maternal deaths and coming up with new declarations to address it, or even to address health financing (which has a separate session at the Kampala summit on the 24th July)?

Ensuring the survival of mothers is crucial and urgent: it is their human rights; it is important for the socio-economic well-being of women, households and nations; and it is a commitment that African countries have made in their national laws, reproductive health policies, the Programme of Action of the 1994 UN International Conference on Population and Development (ICPD), and in the UN Millennium Development Goals (MDGs), among others.

In spite of all these commitments, the maternal health situation remains appalling, especially in sub-Saharan countries. In 2005, almost 11 million children under five years of age died from causes that were largely preventable. Among them were 4 million babies who did not survive the first month of life. At the same time, more than half a million women died in pregnancy, childbirth or soon after. Most of these were in Africa, where maternal mortality is highest, with the lifetime risk of maternal death being one in 16 (compared to one in 2800 in rich countries).

WHO has stated that reducing unnecessary maternal and child deaths toll in line with MDG’s will depend largely on every mother and every child having the right to access to health care from pregnancy through childbirth, the neonatal period and childhood. In many sub-Saharan countries, this is not happening.

In Uganda for instance, only about 42% of expectant deliver in health facilities under professional supervision; and 58% at home. Most of those few that deliver at health centres (74%) don’t receive postpartum care, contributing to a fatal situation where nearly 4 out of every 10 infant deaths occur during the first month of life.

Perinatal and maternal conditions account for 20.4% all deaths in Uganda. It is a sad situation. Overall, Uganda’s maternal mortality rate stands at 435 mothers out of every 100,000 live births; equivalent to 6000 deaths per year. And for each of these women who die, another 100 survive with serious illness or disability. It is estimated that at least 45,000 newborn deaths occur each year and an equal number are stillborn.

With this kind of situation, we are definitely running behind time to achieve the MDG’s on maternal and child health. MDG 5 targets to reduce maternal mortality rates by three quarters and to achieve universal access to reproductive health by 2015. Progress has been slow on this goal, given that only five years remain (out of the 25 years that we allocated ourselves).

But if we can’t achieve the MDG targets, the Kampala summit is the right opportunity to assess what went wrong, and what strategies need to be put in place – and implemented now, now.

We know that over 70% of maternal deaths could be prevented if expectant mothers received proper care during pregnancy and delivery; and that nearly three quarters of all neonatal deaths could be prevented if women were adequately nourished and received appropriate care during pregnancy, child-birth and the postnatal period.

"Today, maternal mortality is the slowest moving target of all the Millennium Development Goals – and that is an outrage. Together, let us make maternal health the priority it must be. In the 21st century, no woman should have to give her life to give life." –Ban Ki-moon, United Nations Secretary-General

Africa has declared that it cares about maternal and child health, but the situation is that bad. What if it did not care? The time and opportunity to end the hollow declarations and convert national and multinational commitments into visible progress is now.