Develop(ing) V: Maternal Health

Inspired by my time in Ghana.

A year ago, I attended a Child and Maternal Health seminar run by the Global Health Society at Uni.  We were overwhelmed by statistics and stories of tuberculosis and preventable maternal deaths. Amongst the emotions, we also found ourselves questioning the state of maternal health here. In a country with most treatments at its disposal, there are numerous maternal deaths that get swept under the rug. And then we realised...childbirth is a dangerous endeavour.

Pregnancy and childbirth carry high risks - gestational diabetes, pre-eclampsia and eclampsia, infection, vaginal tearing during birth, fistulas, post-partum haemorrhage... The list goes on.  These risks are to any woman, anywhere in the world, who is pregnant, giving birth or who has very recently given birth. For all that we've managed to control risks in many areas, this particular part of being a woman is one of the riskiest in life. In countries where health services are not adequately equipped, utilised or staffed, these risks increase.

Sub-Saharan Africa has a particularly poor track record in maternal health and many reforms have been undertaken by governments in an effort to reach MDG 5.  Ghana introduced free maternal healthcare in 2008. The nation is implementing a number of preventative health care campaigns around malaria treatment during pregnancy and antenatal check ups, but these are poorly taken up due to sociocultural factors.

I remember walking through Kumasi and seeing a sign for the local Marie Stopes Centre and being so excited to see an institute I've often associated with doing great things for women across the world. I asked one of the nurses with whom we were working if many women accessed the service. She shook her head sadly. No, it was inappropriate for a woman to go there. She would be shunned by her family. Only women who had nothing else, who were desperate would visit. Do these women visit other services, I asked. Not normally... Sometimes if they are rich. Most women do it themselves. That's the way it's been for so long.

One day, I saw a billboard plastered with a government campaign for getting a primary physician.  Everyone should have one. I wondered where one would find this primary physician. I asked how it worked. It doesn't, was the response I got. So how do you deliver healthcare? Ineffectively. The answers I was getting were short, pessimistic. No one wants a bar of what the government is doing. Anti-government sentiment abounds.

Yet it seems like the government is really trying. Free maternal healthcare, health campaigns, increasing health-care professional numbers, especially in district hospitals, a quasi-ambulance system. While the government seems to be putting in a lot of effort, there are bigger challenges at hand. Overcoming years of tradition, gender inequality and national attitudes takes a lot more than some well-meaning governmental policies.  It not just a matter of convincing women and their partners that it is okay to attend antenatal clinics, it is also convincing a nation to donate blood so that transfusions can occur after post-partum haemorrhage. It is having the services available to process this blood to reduce infection spread.  It is being able to distribute it and store it at appropriate temperatures.  It is having adequate room available to put patients and health professionals. It is having enough spaces in the education system to train these professionals.  It is making hospitals welcoming.

Having visited the hospital in this very informative study, I saw how many people were waiting for health assistance. How many patients needed consultations. The facilities available. The sense of chaos as we sat an waited patiently for a friend to see a doctor. There is still so far to go.

Changing maternal health outcomes does not sit solely in the hands of the health professionals, nor solely in the hands of the women. It is a collaborative effort between government, society, transportation and roads, the environment and global innovators. We are all in this together.  From creating home birthing kits in a lecture hall in Sydney to the workers in Ghana, we can all make an impact.


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