Maternal deaths mainly caused by delays
Maternal mortality is still a problem in Jamaica, and this is still due, in large part, to the three delays. This was the feedback to a presentation done by maternal, neonatal and infant health (MNIH) rights advocate Linnette Vassell at a workshop themed 'Respectful Maternity Care: Midwives Do Care', hosted by The University of The West Indies School of Nursing, Mona (UWISON), and the WHO/PAHO Collaborating Centre for Nurses and Midwives in the Caribbean last month.
Attended mainly by midwives and nursing practitioners, the seminar's aim was to examine barriers to respectful care and identify ways to improve the quality of care given to pregnant families. This focus was partially influenced by the WHO, whose mandate is for policymakers to acknowledge the sometimes poor quality of care experienced by women during facility-based childbirth, evidenced in disrespectful and abusive behaviours from healthcare providers and other staff to the pregnant women and girls.
In her presentation on Respectful Care As A Human Rights Issue, Vassell highlighted the fact that most maternal mortality deaths are preventable and then went on to identify the three delays to which the United Nations attributes maternal, neonatal and infant deaths:
1. "Delay in seeking appropriate medical help for obstetric emergencies due to costs, poor education, gender inequality [or] poor access to information.
2. "Delay in reaching an appropriate medical facility due to distance, poor infrastructure [or] transport challenges, and
3. "Delay in receiving adequate care due to staff shortage [or] unavailability of adequate facilities and supplies."
The session took an interesting turn when attendees began to highlight real-life situations reflecting the impact of these delays locally. Reference was made to the 2017 death of a baby in Mavis Bank, St Andrew, after the mother went into premature labour and the father was unable to secure help from the police.
Nurses also referenced cases they had witnessed of women who had undergone C-sections and were afraid to do so again, delaying seeking prenatal care until they were in labour, not understanding that they faced an increased risk of the uterus rupturing. They also spoke of women in dependent relationships who may be afraid to ask their partners for money to seek the medical attention they need.
According to the World Health Organization, Jamaica's newborn mortality ratio was 11.6 per 1,000 live births in 2015, while the maternal mortality ratio was 89 per 100,000 live births. In the same year, the infant mortality ratio was 13.8 per 1,000 live births, and the children-under-five mortality ratio was 15.7 per 1,000 live births.
Vassell, who currently works as advocacy specialist in the EU-funded Partnership for the Promotion of Patients' Rights in MNIH project (spearheaded by a multidisciplinary team from the University of the West Indies, Mona, and the Women's Research and Outreach Centre noted the importance of educating women and other stakeholders on reproductive health and rights, addressing employment and sustainable livelihoods for women and their families, and putting in place the infrastructure necessary to help reduce mortalities resulting from the three delays.
She also commended UWISON for hosting the workshop to address important barriers to healthcare in the island, stating that it was good that they, as professionals, were practising self-criticism and exploring ways to improve care.