Why do mothers die at childbirth?

By Carol Aloysius

Every 90 seconds, somewhere in the world a woman dies giving birth. Multiply that by the days of the year and the number will undoubtedly shock you out of your comfort zone: 358,000 - no less and probably much more if the unofficial numbers are counted.

These figures which Amnesty International (AI) has painstakingly chalked after years of research in many countries are meant to shock. The initial reaction would be disbelief as readers try to understand how a natural process like giving birth to a child could cause so many premature deaths of women both married and unmarried.

But this sense of shock, soon gives way to resignation and acceptance since the vast majority of women who die from childbirth (80 percent) are from poor developing South Asian countries and Sub Sahara African nations. They die for trivial preventable causes: Many die even before they reach the nearest medical facility to which they have to walk several miles, or hitch a ride from a cattle truck, or a wagon carrying farm produce or even getting a ‘lift’ on a camel or pony. In neighbouring India and Pakistan it would more likely by a three wheeler.

Fortunately for us in Sri Lanka, our free health care system has provided mothers to be a hospital within every three or four miles from their homes except in very remote areas, making such births while in transit to a hospital extremely remote and unlikely, health sources note.

Impact of maternal deaths

Mothers who die prematurely in our part of the world are usually young; in fact very young and that is largely one of the main reasons why they die in the first place while giving birth. Many of them are still in their teens, 18 and under and their bodies are still growing. They are in fact, still children themselves totally unprepared for the demanding challenges of motherhood.

It is the realisation that something should be done to prevent mothers from dying prematurely, and leaving thousands of motherless children likely to suffer from emotional loss, physical abuse and neglect, that the Safe Motherhood concept was conceived and accepted by several member countries of the United Nations including Sri Lanka..

The risk of becoming pregnant at too early an age not only poses risks to the mother but the child as well. It is a proven fact that babies born to women still in their teens are likely to be born too early (prematurely) and weigh too little at birth. Health experts have warned that underweight (less than 2.5 kgs) babies have little chance of fighting off diseases and infections than children who are born with normal weight. Repeated infections can easily lead to death in the first year of their life.

The key then to child survival among other things is spacing a birth. To quote a recent WHO report, the risk for young children is increased by fifty percent if the interval between birth is less than two years. Our own health officials, to whom this writer spoke, agreed.

“Children born too close together do not develop physically or mentally as children birth 2-3 years apart,” a spokesperson from the Family Health Bureau which is overlooks maternal welfare said. “Why?” we asked. “How does timing make a difference in child survival and the child’s quality of life?

“For one thing when a woman who is still breastfeeding her child gets pregnant, she may decide to stop breastfeeding her child, and switch to formula milk or commence complementary feeding early. This will prevent the child from getting the optimum benefits of breast feeding.

In addition, the mother will also have less time to prepare nutritionally balanced foods her child needs once the new baby arrives.

Since most of her attention will be on the needs of new baby, the other child may not get the care and attention he/she needs especially during illness. Hence the child will fail to grow and develop well,” the health official explained.

“Breastfeeding is the key to child survival,” points out an expert on the health of new born children. “Immediate skin to skin contact and early initiation of breast feeding within an hour following birth, could reduce neo natal mortality significantly”.

How?

“By placing a new born directly to the mother’s bare chest (skin to skin contact) it helps the new born to ‘adapt and adjust’ to the new environment which is different to what he was used to while in his mother’s womb. It regulates the new baby’s temperature, helps establish breast feeding as a regular practice and forges mother and child bonding which is important to both mother and child.”

Breast milk also helps new born babies to fight infections. A nutritionist underlined this fact when she told us, “Colustrum (first milk) that the new born receives from his mother, is rich in nutrients and anti bodies and helps fight infections. It is all the baby requires in the first few days of life.

Feeding colostrums also stimulates the mother to produce more milk”. In countries, where the rate of infant mortality was high, and the rate of literacy was low among women, wrong myths that this rich source of nutrients is bad for the child, had led many mothers to throw away the milk.

“Fortunately”, she adds, “in Sri Lanka, because of high literacy among women and raised awareness about breast feeding benefits, the majority of our mothers including working mothers now breast feed their babies for at least the first three months prior to their returning to work.

Our studies show that nearly 80 percent of mothers now exclusively breast feed their infants for 3-6 months. Our target is that all mothers do this for the first six months of their child’s life, so that their child can have the best possible start in life, and continue to breast feed even when the child is receiving complementary foods, for as long as is possible”.

National campaign

To this end, a national campaign is being conducted islandwide with the Health Ministry now banning all advertisements on formula milk foods in hospitals, and encouraging mothers to initiate breastfeeding before leaving the hospital after a delivery.

According to the WHO report of 2013, optimal breastfeeding of children under two years, has the potential preventing 800,000 deaths of children under five years who die of low weight, malnutrition and diarrhoea every year, while thousands of under aged mothers will die of anaemia and birth complications caused by illegal abortions.

Even in Sri Lanka which has one of the lowest if not the lowest number of maternal and infant mortality rates in the South Asian region, it is said that from 750 to 1,500 illegal abortions occur daily.

Ensuring safe motherhood for all pregnant women with improved obstetric care, giving women more control over their reproductive health, improving the quality of family planning services and preventing illegal abortions by encouraging young women to make informed choices before they assume the responsibilities of motherhood, can prevent these needless deaths.

In just three months it will be 2015. Before the dawn of the next year, another 358,000 more women worldwide and in Sri Lanka will die because of unplanned childbirth, and botched illegal abortions leaving thousands of motherless children.

Are we ready to avert this looming crisis?