On further reducing maternal deaths, HIV
It is gratifying to learn that the rate of new HIV infections (incidence) in Malawi is decreasing. The country is among seven African countries where incidence of HIV among babies has gone down; it is estimated that such drop is currently at 50 percent. The desire that we can move towards zero HIV infection among babies is becoming closer to be realised.
Malawi’s maternal mortality ratio is among the highest in the world. Very few countries in the world, notably Sierra Leone and Afghanistan have ever had a maternal mortality ratio as of Malawi at some point which was over 1 000 deaths per 100 000 live births. The current maternal mortality ratio for the country is estimated at 460, which is a huge drop from what it used to be not a long time ago. There is still a long way to go but it appears success is possible if we put our hands together.
The current approach that the country has taken is such that there is a huge drive to ensure that all pregnant women deliver at a health facility to be supervised by trained midwives and other health cadres. But what is a maternal death? The World Health Organisation (WHO), defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” This definition is a mouthful but until we agree as to the definition, then it is possible that each one of us will be talking a totally different thing.
A maternal death is the death of a woman who is pregnant or six weeks after the end of the pregnant. However, for such deaths to be considered maternal deaths, the cause must be related to the pregnancy or the care of the pregnancy. A pregnant woman, who dies from a road crash, although this is death of a pregnant woman, is strictly speaking, not a maternal death. Similarly, a death of a woman or a girl who suffers complications of abortions (both spontaneous miscarriage and induced abortions) contributes to maternal mortality. It is estimated that between 20 percent and 25 percent of all maternal deaths in this country are related to abortions.
This, therefore, means that until we start tackling the burden of unsafe abortions, most of the efforts being exerted on maternal deaths will still leave a lot of other women out of reach.
What are the possible ways that unsafe abortions may be prevented? A starting point is to prevent unwanted pregnancies, defined loosely here as pregnancies whose “owners” do not want them. Most of the induced abortions are a result of unwanted pregnancies. Some of the unwanted pregnancies are among young people who, as society, we believe they are not having sex. Because we think they are not having sex, we decide that they cannot have pregnancy protections. But because they do not have pregnancy protection and they are having sex, more often than we would like, pregnancy results. It is these pregnancies we should have avoided in the first place. Our effort to stem maternal mortality cannot achieve the full-intended goals by just facilitating women to deliver at a health facility. Women must have the capacity to decide when and whether they should be pregnant in the first place. By saying “women”, this should not be construed as absolved the men from responsibility.
Let me finish off by talking about the reducing incidence of HIV in Malawi. Certainly this is good news.
But let us also remember that while incidence (new cases) have gone down, the prevalence (the total number of people infected) may be increasing. Prevalence is the sum total of people who have the infection.
As more and more Malawians access highly effective antiretrovirals (ARVs) and low numbers die from Aids, the HIV prevalence will increase. This calls for proper planning and re-orientation of the HIV and Aids strategy which not only invests in prevention and treatment to save life, but also how HIV infected persons live high quality lives.
