Maternal mortality rate has declined, but still way too high

The South African Medical Journal released an article in 2018 confirming that there has been a general decline in maternal mortality rates in the South African public sector.

The numbers still remain high, especially because the Journal also confirms that 60 % of these deaths are potentially preventable.

So what exactly is contributing to the current Maternal Mortality Ratio (MMR) in the South African healthcare system?

Maternal deaths owing to obstetric haemorrhage and complications related to hypertension still remain high. The two main contributors to deaths related to hypertension were due to two main causes;

i) The woman did not attend regular antenatal appointments
ii) The primary healthcare clinic failed to refer mothers with hypertension

The first reason was not due to the failure of the woman to attend the appointment. The clinic’s schedule would limit the number of times the ‘non-high risk’ pregnant women can attend these appointments. The clinic would just require them to attend 6 weekly appointments from when they hit 20 weeks. A woman should attend at least 8 appointments from week 20, whether or not they have high-risk pregnancies.

Issues like preeclampsia, which is characterized by high blood pressure, can occur very late in the pregnancy and can mature even quicker, thus endangering both the mother and child. The clinic’s schedule, therefore, would make it hard for such a condition to be detected in its earlier onset.

The Department of Health is making a great effort in ensuring that they are training healthcare professionals accordingly. The Department has adopted the National Committee for Confidential Enquiry into Maternal Deaths. The committee is committed to the reduction of maternal deaths in South Africa. It is made up of independent assessors that look at individual maternal deaths as soon as they are reported to the committee. It is made up of obstetricians, midwives, anaesthetists, and medical officers.

The decline of mortality rates is due to the increased distribution of antiretroviral drugs for HIV positive women.

Nonpregnancy related infections still accounted for 60 deaths in every 100 000 live births. These infections include malaria, tuberculosis, meningitis, and pneumonia. 95% of these women were HIV positive.

This means that as much as the government is rolling out more treatment for HIV positive women, these women are still at risk of losing their lives before, during or post birth.

Let us look at the stats:

Around 1800 women died in 2009, and this has decreased to about 1600 in 2010, 1300 in 2013 and 2014 and in 2016 the number was around 1200. This does not seem like much right, considering that Statistics SA indicates that there were about 456 612 deaths in 2016. For me, this number is ridiculous, especially because 100 assessors tasked with assessing maternal mortality rates agree that 60 % of these were potentially preventable.

What this means is that poor treatment significantly contributed to the death of these women.

Poor treatment in our healthcare system, particularly relating to maternity, is no new subject.

If you are fortunate enough to afford medical aid, you probably have no idea how it feels like to be ridiculed and insulted when you are struggling through labour. I have heard too many young girls and women talking about how they got pinched in-between their thighs to coerce them to push the baby out. Or how they get told “we did not impregnate you” when they scream a little too loud during contractions.

The number of articles I have read about lawsuits being filed over negligence in public hospitals is beyond me. On the 28th of June 2017, a woman sat outside the theatre room from 12:00 PM for a C-Section, but was not attended to until 17:15 PM. By that time, her baby’s heartbeat had stopped, and they had to remove the lifeless body from inside her. Two hours before she was attended to, a nurse wheeled her into the nurse’s tearoom to ask for assistance, but they turned her away because she was a ‘non-risk’ pregnancy.

Nompumelelo Sibiya did not get to see her twins after they were taken away from her after birth and incinerated without her permission. The hospital claims she had signed a form giving them permission to incinerate the twins, but she claims to have not done such a thing. Was evidence of this negligence cremated along with the two children?

In June 2019, a woman* was bleeding at 28 weeks’ gestation and was subsequently taken to Edenvale Hospital at 3:00 AM in the morning. She was taken into the ward alone and the family left her there. At 6:30 AM they went to go check on her and she has still not been seen by a nurse or doctor. When her family threatened to speak to the Head of Department (HOD), they allowed her mom to enter the ward to check on her and they did her checkup. At 7:00 AM the doctors decided that she has to have C-section. The porter came to collect her 2 hours later, and the C-Section was reverted. She was now to deliver vaginally.

What happened next is even more ridiculous than not prioritizing a bleeding pregnant lady.

The nurses started arguing that she should not birth on the bed she was sleeping on. This back and forth is happening while the baby’s head was crowning. She had to walk to another room with the baby’s head in between her legs, and the baby immediately arrived when she got on the next bed.

Sithembile Shabane is a 23-year-old KZN woman who passed away in 2019, along with her baby. The family and the community has attributed her death to medical negligence and transportation delays. Shabane stays 34 km away from the hospital, but the ambulance took too long to arrive at her residence. The mother and her baby, unfortunately, both died on arrival to the hospital.

These are sad stories that keep seeing families burying their children, not getting the opportunity to take their little ones home, or children never getting to know their mothers.

We hope such stories encourage our public administrators to re-look the overall management of a public health system that caters to millions of South Africans. South Africans that run to the polls hoping for some form of change. Healthcare is one such change that is desperately needed.

*The woman requested to remain anonymous

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