Julie Marsaban is an Independent Health Promotion Consultant with over 20 years experience in the field of maternal and child health. She was the Communications and Gender Advisor to the Special Presidential Envoy on Millennium Development Goals (MDGs) for the President of the Republic of Indonesia until her recent relocation to Hobart, Tasmania where she has transferred her membership from SIJakarta to SI Hobart. Julie joined SI Jakarta as a founding member in 1992 and now she is one of SISWP Programme Coordinators. In this article she explains the global state of the maternal mortality ratio (MMR), the progress in reaching the fifth MDG, i.e. reducing MMR and how we can help.
Although the latest UN Statistics reported a trend that there are fewer women dying from complicationsof pregnancy and childbirth, globally there are still 1,000 women dying a day due to pregnancy and childbirth complications. That is like two giant jumbo jets full of women crashing down daily or 41 women dying every hour and yet no one hears about this. It’s not breaking news. But if a small 12-passenger plane crashes the news is featured on TV around the globe. It is a sad fact and that is why I am here raising awareness of this issue.
There are 8 MDGs and MDG 5 is to reduce the maternal mortality rate by three-quarters, between 1990 and 2015. Although the progress is notable, the annual rate of decline is half of what is needed to reach the MDG target by 2015.
The majority of these deaths are in the developing countries with more than half occurring in the Sub-Saharan African countries, about one third in South Asia and five in developed countries. The main causes of death are severe bleeding after childbirth, infections, hypertensive disorders and unsafe abortions. The risk of dying is 36 times higher for a woman living in a developing country compared to a woman living in a developed country. Many of these deaths are preventable and it mainly hinges on having access to trained medical birth attendants (a doctor or midwife), adequate antenatal-care, access to family planning and obstetric emergency care. Let me give two illustrations from close personal experiences. The first one is about a woman in a small district hospital in Indonesia and the second is my own experience.
“She’s just as good as dead.” Thirty-two-year old Siti was lying barely conscious in a bed in a third class district hospital ward, her eyes fluttering and rolling upwards.She was surrounded by her husband, mother and siblings who were all wailing pitifully after the hospital doctor gave them her prognosis and left the ward. Her seventh baby is now only just over one day old, was swaddled and left sleeping, unattended on a padded side-board in the corner of the ward. Siti was brought to the hospital by her husbandand family, and arrived at the hospital about 2 hours previously. She had a long difficult labor at home, attended by a traditional birth attendant. After the baby was born she started bleeding. Her husband was away and the family waited for his return. When the husband returned and made the decision to take Siti to hospital it was already more than 6 hours after the birth. Their village had no paved roads. It took them 4 hours to find transport and another 3 hours to reach the hospital. At the hospital they waited another 2 hours for the doctor at which time he pronounced flatly “It’s too late, she’s lost a lot of blood. Nothing can be done. She’sjust as good as dead.” And a few minutes later she died and her seven children are left motherless.
“I would’ve died… twice.” I was 30 years old, in the labor room of a private maternity clinic in Jakarta and after 14 hours of noprogress and some loss of blood, the birth was aided with a vacuum extractor. It was later apparent that the umbilical cord was entangled around my baby’s neck. She spent a week in an incubator to recover from her ordeal. A prolonged labor could be fatal for both mother and baby. Three years later on my third ante-natal care for the second pregnancy the USG revealed that my placenta was located low in the womb and blocking the ‘exit’. I was told by the doctor that normal delivery was not an option… “You would bleed to death” he added, so a C-section was scheduled a few days before the due date. The outcome was another healthy baby girl. I thought there and then “Two is enough.” If I were poor and lived in a remote village I would’ve died – not once – but twice, if that is even possible!
So what do these two stories show? They reiterate the important factors that dictate the childbirth outcomes as mentioned before and it shows that there is still a lot to be done if we are to reduce maternal deaths. What can we do to help accelerate the rate of reduction? The measures that are proven effective are: training more midwives, strengthening hospitals and health care and health centers and improve access to family planning and to pregnancy and delivery care.
SISWP’sFederation project, ‘Birthing in the Pacific’ in Papua New Guinea is one such effort. See Di Lockwood’s blog from April 28th for more information about this, or click here. Another example is the support SI Jakarta gave to a small non-profit clinic for low-income communities in the outskirts of Jakarta. This clinic provided free sterilizations for men and women who already have 5 or more children, and do not want anymore, thus preventing the risk of complications from subsequent pregnancies. There are many such projects in other developing countries that could benefit from support from SI Clubs throughout the world. Let’s try and stop these ‘jumbo jets’ from falling.
Julie Marsaban
SI SWP
Photo: Acehnese village women listening intently to Julie Marsaban
explaining the woman’s reproductive anatomy after the Boxing Day Tsunami of
December 2004.
Statistics from the UN:
Maternal Mortality Ratio
(Selected countries
for comparison)
Australia: 8
Chad: 1,200
Congo: 530
Fiji: 6
Indonesia: 240
Malaysia: 31
New Zealand: 14
PNG: 250
Singapore: 9
UK: 12
USA: 24
MMR: maternal deaths
per 100,000 live births.