At first take, a pregnant Motswana woman and a condemned man on death row have nothing in common. But look closer and a chilling parallel emerges: Pregnancy is a death sentence for hundreds of pregnant Batswana women mostly in rural areas.
The latest UNFPA report has In fact revealed that Botswana is one of the most dangerous places in the middle income world to give birth.
Dozens of Batswana women die each year giving birth, and indications are that hospitals across the country aren’t routinely following practices that would save lives during childbirth.
Sunday Standard has turned up information suggesting that the country’s maternal death has become a full-blown public health problem that has finally begun to garner mainstream attention. At a cursory glance, the deaths of mothers are devastating, private tragedies. But delve deeper and a picture emerges of a public health crisis that’s been hiding in plain sight for years. Most of these deaths and near deaths are from preventable causes.
Boago Makatane, a UNFPA Strategic Information Specialist says, “Botswana has the 9th highest maternal mortality ratio among upper middle income countries. These deaths are attributed to preventable causes, 28% haemorrhage, 17% hypertensive disorders and 17% are HIV related. Maternal mortality ratio declined from 188.9 maternal deaths in 2011 to 182.6 in 2013 down to 127 in 2015 but has risen to 156.6 in 2016 and decreased again to 143.2 in 2017. At 143 deaths per 100 000 live births, Botswana’s maternal mortality remains persistently high. The sad thing about this is these deaths are totally preventable. There is a lot that isn’t being done to curb maternal mortalities in the country.”
At 143 deaths per 100 000 live birth, Botswana which is an upper middle income country compares badly with developed countries which have an average maternal mortality ratio of 12 per 100 000 live births.
While Botswana prides itself with one of the best primary health care regimes in the developing world, the numbers suggests that the country’s health care has been falling hundreds of pregnant women for years.
The numbers reveal much about the disparities that cause high rates of maternal death in poorer countries and low rates in affluent countries. Resources are scarce in developing countries, and those that are available in the form of medical expertise, facilities and supplies are distributed unevenly.
As one of sub-Saharan countries with a high HIV prevalence among women of reproductive age Botswana finds itself in an especially difficult position. Pregnant women with HIV/AIDS are six to eight times more likely to die during pregnancy and childbirth than other women. Although there has been some reduction in HIV‐related maternal deaths in the country since the scale‐up of antiretroviral therapy, HIV infection still contributes significantly to maternal deaths in Botswana, with almost a third of deaths in 2015 estimated to be AIDS‐related
Ministry of Health Public Relations Officer, Keemenao Sampisi says “the maternal mortality ratio as well as numbers of maternal deaths in Botswana is fluctuating. According to the numbers provided by Statistics Botswana, maternal deaths were 91 in the year 2013, 72 in 2014, 73 in 2015, 85 in 2016 and 75 in 2017. Botswana’s maternal mortality ration is 143.2 deaths per 100 000 live births. Although having decreased in compared to the year 2013 this information shows that maternal deaths are still high in the country.”
WHO defines maternal deaths as those that occur during pregnancy or within 42 days of termination of pregnancy from either direct or indirect causes.
Once a baby is born, they become the focus of medical attention. Mothers are monitored less, their concerns are often dismissed, and they tend to be sent home without adequate information about potentially concerning symptoms. A healthy pregnancy begins before conception and continues with prenatal care, along with early recognition and management of complications if they arise. Health care providers can help women prepare for pregnancy and for any potential problems during pregnancy. Early initiation of prenatal care by pregnant women, and continuous monitoring of pregnancy by health providers, is key to helping to prevent and treat severe pregnancy-related complications. Many women each year need emergency treatment to save their lives while they deliver their babies, or immediately after. Mothers are dying needlessly before, during and up to a year after giving birth from pregnancy related complications and health conditions aggravated by childbirth. The majority of deaths are from conditions that could have been prevented had women received the right medical care throughout their pregnancies and during birth. Severe bleeding and infections after childbirth are the biggest killers, but high blood pressure, obstructed labour and unsafe abortions all contribute.
Information from UNFPA reports reveals that throughout pregnancy, women in rural areas are less likely to receive the eight antenatal appointments. These appointments are crucial in identifying problems or underlying issues that could cause difficulties in childbirth. The leading causes of maternal deaths are haemorrhage (bleeding), in particular post-partum haemorrhage, infections, unsafe abortions, high blood pressure leading to seizures, and obstructed labour. These complications occur predominantly at childbirth and are highly treatable if adequate care, supplies and medicines are available. Young women aged 15-20 are twice as likely to die in childbirth as those in their twenties. Adolescent girls have a particularly high risk of death in childbirth. Complications in pregnancy and childbirth, together with unsafe abortion, are the biggest killers of girls aged 15 to 19.
Hypertension and obstructed labour are among the main causes, since their bodies are not fully developed and ready to give birth. About half of all pregnancies among this cohort are unplanned. Babies born to very young mothers are much more likely to die in the first year of life. Young adolescents do not yet have a fully developed pelvis. Pregnancy for them can result in serious consequences, such as eclampsia, premature labour, prolonged labour, obstructed labour, fistula, anaemia (thin blood) or infant and/or maternal death. Barriers to access to health services go beyond the lack of hospitals and doctors. Furthermore, women are vulnerable to complicated pregnancies through the practices of child marriage (and adolescent pregnancy), high fertility rates (which increases the potential for obstructed labour) and patriarchal customs that make women’s health, nutrition and education unimportant.