By Paul Okediji
According to the MDG 2012 report, Egypt, Morocco, Tunisia, Ethiopia and Rwanda recorded significant declines in maternal mortality (more than 50%) between 1990 and 2008. However, the overall continental progress is insufficient to meet the goal of improving maternal mortality.
Of all the MDGs, the fifth goal is still a grave concern for the most part of the continent as progress in achieving this goal is just too slow. As at 2008, the average maternal mortality rate for Africa was 590 deaths per 100,000 live births. This translates to the death of a woman every 2.5 minutes or 576 every day (UN 2011). Recent reports have shown that “maternal mortality still remains disproportionately high, and has decreased by an average of only 1.6 percent a year across the continent” (MDG 2012).
Data from the UN have revealed that some African countries are close to achieving this fifth goal. Nations such as Egypt, Morocco, Tunisia, Ethiopia and Rwanda recorded significant declines in maternal mortality (more than 50%) between 1990 and 2008. The major rationale behind this success was the improvement of the proportion of women giving birth with a skilled birth attendant. This they did by improving access to referral health institutions, increased dissemination of information about contraception and better supply of health attendants. Also, it has been observed that these high performers also share high economic growth rates, reiterating the relationship between goals 1 and 5.
An instance of the importance of political commitment and well-planned interventions in achieving significant progress towards MDG 5 is the case of Rwanda. As at 1994 post-genocide, the country had the highest MMR of 1400 deaths per 100,000 live births in Africa. However, through strong political will and solid planning of maternal health financing and intervention, Rwanda drastically reduced its MMR to 540 and 383 in 2010 and 2012 respectively, about three-quarter reduction since 1995. It this can be replicated in other countries, the progress of the continent would be fast-tracked.
Countries such as Gabon, Namibia, Botswana and Zimbabwe have made no progress at all, or have in fact retrogressed. Common factors to these countries include the high prevalence of HIV/AIDS and the presence of conflict or political instability. These is illustrative of the importance of testing womenof reproductive age group (in order to secure the proper treatment) and functional infrastructure and services as roads, transport and communication are crucial for expectant mothers to access life-saving care.
One of the best ways to ensure the survival of mother and child is delivering with the assistance of a skilled health attendant. According to the MDGs 2012 report, a 1% increase in the proportion of births with a skilled health attendant is associated with a 0.21% decline in maternal mortality. For instance, Equatorial Guinea increased the proportion of women delivering with skilled attendants from 5% to 64.6% in 6 years, translating to a significant decline in MMR.
Despite the successes of some countries, the continent as a whole is moving sluggishly along despite a lot of initiatives aimed at improving maternal health. The relationship with other MDGs point to the fact that efforts to decrease MMR cannot be taken in isolation. Improving access to and use of skilled birth attendants and health equity would help in making significant progress. Furthermore, reducing poverty, improvingeducation, boosting employment and empowering women, as well as fighting HIV/AIDS, TB andmalaria will all have positive effects on maternal mortality.