Introduction
Maternal mortality is defined as death that follows due to complications from pregnancy or childbirth. It remains one of the most unaddressed public health issues. UNICEF has mentioned that when it comes to maternal mortality, every region has advanced, although levels of maternal mortality remain unacceptably high in sub-Saharan Africa. Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries.
The aim of this paper is to attempt to bring to light key factors that public health professionals might unconsciously be overlooking. Considering all social determinant factors, there is compelling evidence that the lack of education and access to resources is at the root of this public health issue. It is crucial to identify the leading social determinants of health that relate to education and socio-economic status, and that are contributing also to this issue, in order assess the risk factors, and plan and carry out an intervention for prevention and control of the problem.
Background on Health Situation of sub-Saharan Africa
All maternal deaths (99%) happen in developing nations. Specifically, the greater part of these deaths happen in sub-Saharan Africa and right around 33% happen in South Asia. It has been noted that the geographical context plays a major part in the issue as the mortality rate is higher among women living in rural areas and poorer communities. In a recent report the World Health Organization (2018) stated that poor women in remote areas are the least likely to receive adequate health care. This is specially factual for regions with low numbers of professional health workers, such as sub-Saharan Africa. This signifies that tens of millions of births are not assisted with the aid of a midwife, a health practitioner or a skilled nurse. Unfortunately, failure of adequate medical care can only be influenced by the government who has an important role to play in this ongoing problem. They don’t have the means to provide communities in the region with adequate services (i.e. transportation to health clinics) or even adequate information for prevention (i.e. education). In high-income countries, surely all women have at least four antenatal care visits, and are attended by a health care professional at some point of childbirth and acquire care after birth. In 2015, only 40% of all pregnant women in low-income countries had the recommended antenatal care visits (WHO).
Synthesis of the literature
Although the issue at hand doesn’t have any health impacts other than death, many professionals have taken it upon them to identify who is at most risk. Doctor, Nkhana-Salimu, and Abdulsalam-Anibilowo ( 2018), found that women with hemorrhage, hypertension, sepsis, and obstructed labor combined account for 64% of all maternal deaths. Pneumonia and HIV/AIDS account for 23%, and unsafe abortion accounts for 4% of maternal deaths in Africa (Doctor et al, 2018). Conditions such as hypertension could be avoided with knowledge about adequate nutrition or simple methods to avoid being stressed, thus raising high blood pressure. Mothers more than likely unknowingly go through their pregnancy and into labor with those fatal signs that end up costing their lives because they don’t have any prenatal care.
Upon gathering more information, I noticed the emphasis that was put on education. Alvarez, Hernandez and Gil (2009) concluded that education and an effective and efficient health system, especially during pregnancy and delivery, are strongly related to maternal death. Also, macro-economic factors are related and could be influencing the others (Alvarez et al, 2009). Hemorrhage, hypertension, and so forth—all previously mentioned—are a result of either lack of education or economic hardships. Both authors did mention a certain fluctuation between women who live in urban areas and women who live in rural areas. Those of urban regions tend to have much more access to health services, education and also tend to live in more comfortable settings. All these data are compelling evidence that prove that education and economic status are dominant factors determining maternal mortality and how they are all interrelated.
Tlou (2018) is convinced that women who are more comfortable economically have higher chances of attending prenatal visits and visits following birth as opposed to mothers who can’t afford these visits. Furthermore, household or individual wealth often correlates with the choice of a proper hospital or clinic for delivery. That is due to the fact that usage of antenatal care services is influenced by the cost of the service and medication as well as other indirect costs like transport (Tlou, 2018). Merdad and Ali (2018) further supported Tlou’s (2018) statement in an ecological analysis which showed that antenatal care coverage was significantly associated with low antepartum mortality, whereas the presence of a skilled attendant at childbirth was significantly associated with low postpartum mortality. In sub-Saharan Africa, maternal deaths occur at high rates, and vary substantially by country and region. The provision of maternal care is a predictor of time-specific maternal mortality. These results confirm the need for country-specific interventions during the continuum of care to achieve the global commitment to eliminating preventable maternal mortality (Merdad et al 2018).
Although the mortality rate in the region is still relatively high, there are existing strategies in place that are addressing the problem. The Journal of Global Health (2016) formed the Alliance for Maternal and Newborn Health Improvement mortality study centrally coordinated by the department of Maternal, Newborn Child and Adolescent Health of the World Health Organization (WHO/MCA), and makes use of harmonized tools, teaching and implementation strategies throughout participating emplacements to collect records from a large cohort of women of reproductive age, their pregnancies and the effect of these pregnancies for both mothers and their newborns. Principal investigators from each site, together with the WHO/MCA coordinating team, built up a table of center factors to be gathered across sites for all deaths. This harmonized statistics series device will also facilitate pooling of information throughout sites and subsequently extend statistical strength for evaluation on rarer outcomes (Journal of Global Health, 2016).
Others have taken a different approach when it comes to reducing maternal mortality in sub-Saharan Africa. Wijeratne and Weeks (2017) are more concerned with “ethical consumerism” which includes the modification of obtaining instances to advance a specific arrangement of moral values. Ethical consumerism provides an opportunity by which people and advocacy groups worried about maternal mortality can effectively draw in with these issues. This approach, employed in conjunction with sanctions and international legal prosecutions has also been endorsed by the UN as a powerful means by which the international community can contribute toward creating an environment of sustainable, basic security in sub–Saharan Africa where improved health infrastructure can continue to develop and save mothers lives (Wijeratne et al, 2017).
Conclusion
The purpose of this paper was to give a true insight of what it’s like for many pregnant women in countries of sub-Saharan Africa. Although the fertility rate is abundant in that region, it is not something that can be celebrated as chances of mothers dying during birth or shortly after birth are really high. While there are many strategies in place to attempt to reduce the rate of maternal mortality in sub-Saharan Africa, they are not effective enough as the causes behind the issue remain unchanged and completely avoidable. In many of the literatures reviewed there are several mentions about programs put in place by international organizations such as WHO and the UN. Perhaps, it might be more effective for local governments to implement strategies instead of outsiders because they are best placed to understand the underlying issues that international organizations might not. No one will understand the true hardships that these mothers face more than local jurisdictions. In this case, perhaps it’s not best to look at the problem as a whole, but to scrutinize every country of the region. Prevention programs implemented by the regional governments should be tailored to specific countries with specific needs.