We've come a long way Mom

...but we still have miles to go:

by Husna Inayathullah

The Sri Lanka College of Obstetricians and Gynaecologists has played a major role in providing maternal healthcare in Sri Lanka. Professor Hemantha Senanayake, Past President of the Sri Lanka College of Obstetricians and Gynaecologists, and the Perinatal Society of Sri Lank and Professor in Obstetrics and Gynaecology, Faculty of Medicine at the University of Colombo, deciphers the State of the World's Mothers Report 2015 and explains the difference between being 'healthiest mother' in South Asia and being ranked 99th in the world.

Excerpts:

Question: A recent global assessment on World's Mothers ranked Sri Lanka 99 among 179 countries in the world. Sri Lankan mothers were ranked among the healthiest in South Asia, but in a global context it appears Sri Lanka has to improve a lot more. What can you say about this?

Answer: I agree with the angle of your question. For too long we have been patting ourselves on our backs saying we are the best in South Asia but we have a long way to go. Look at our other achievements - 92 percent of our mothers will book with their midwives before the completion of the 12th week of pregnancy and 99 percent of our births take place in health facilities.

These are major achievements for a developing country and none of the other countries in South Asia can even come close to this. So I agree with your assertion that we could do better than what we are doing. However, in fairness to ourselves, we have to consider that in the latest report on maternal deaths (for the year 2013) the main cause of maternal deaths was heart disease complicating pregnancy.

We review every single maternal death that happens in Sri Lanka and what we saw in these was that some of these mothers who died had such severe heart conditions that they should never have become pregnant. Some of them had in fact defied medical advice not to get pregnant. Also, some of them are patients who survived to adulthood thanks to modern medicine. The second commonest category was respiratory disease complicating pregnancy, many of whom were victims of the H1N1 virus.

To put things in perspective in 2013, 32 women died due to heart disease complication pregnancy as against 10 dying of hypertensive disease and 9 due to haemorrhage. So the low number of women dying due to direct causes is a compliment to the quality of care we provide. In most parts of the world haemorrhage is the main killer.

Q: According to the MDG's country report it states that the Maternal Mortality Ratio (MMR) was 39.3 per 100,000 live births in 2006. It seems to be good, but don't mothers and babies die after delivery in remote areas which have fewer facilities? Have the situation improved, in not what can be done to improve the situation?

A: The latest available MMR is 32.5 per 100,000 live births. We are concerned that the decline is not what it could be - we have been in the thirties for too long.

Obviously conditions such as heart disease are things we are directing our attention now. The maternity care service is having a good reach in Sri Lanka and in 2011, 93 percent of our mothers had their babies in a hospital that had the services of a specialist obstetrician. However, we can't deny that we have a district wise disparity. Some of these causes go beyond what we are providing in the field and hospitals.

Q: The MMR rates in certain districts in the war-affected areas and in the Nuwara Eliya Districts are comparatively low. What's the secret to this?

A: I think this is a great success story. For example in 1999, the MMR in Nuwara Eliya was 213 per 100, 000 live births, way above the national average. We then introduced major changes in the way maternity care was provided in the area and in some of the recent years the district has had below national average figures. I know that in 2013 the North did extremely well, thanks to improvements in infrastructure and dedicated staff.

Q: Does Urbanisation affect the health conditions of mothers and babies in Sri Lanka?

A: Not particularly in the Sri Lankan context. Perhaps some of the other factors related to urbanisation may contribute.

Q: What can be done to further improve the mother's health condition that could lead us to be ranked higher in the perceivable future?

A: I have already alluded to heart disease. Mothers must follow medical advice and make it a point to mention or reveal their medical histories. Pregnancy is a serious matter and care must be given to scrupulously following clinics and advice given in them.

Q: Is there any special diets that should be taken by pregnant women?

A: Our traditional diets are very healthy. We don't need to fall prey to marketing gimmick and buy expensive milk powders that claim unproven benefits.

An egg a day is plenty to get the proteins the mother needs and small fish, sprats and the small shrimps are a good source of calcium. Even dry fish provides good quality protein.

I like to see families being encouraged to grow their own vegetables - our soil is very fertile and it is not difficult to grow beans and other healthy foods at home. What is more, you are sure they will come without dreaded chemicals.

Q: Apart from diets are there any other factors that contribute to the health of a mother?

A: I like to emphasise the importance of birth spacing here. Lack of spacing can result in drastically poorer outcomes for the mother and the baby.

Also very importantly, lack of spacing limits the time a mother can breast feed a child. We now know how important breastfeeding is - it even improves cognitive development of the baby. So lack of spacing is bad for the mother, the infant or toddler and even the unborn baby.

A mother could conceive any time from six weeks from the delivery onwards, despite her not having her menses and despite her breastfeeding. There is a popular myth that a mother will not conceive until the return of menses. This is furthest from the truth. There are many safe, convenient contraceptive methods for breastfeeding mothers.