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Maternal health risks - Family health doctors say more funding required for improvement
published: Sunday | April 27, 2008

Avia Collinder, Sunday Gleaner Writer

MORE FUNDING and urgent supporting legis-lation are needed in order to reduce deaths and improve maternal health in Jamaica, family health practitioners disclose.

According to Dr Karen Lewis-Bell, director of family-health services in the Ministry of Health - with more money, her unit could do more for reproductive health. Additional funding is needed for the establishment of intensive-care units, specialist clinics and public education for women, she said.

Caribbean maternal mortality rates range between 60-170/ 100,000 live births. In Jamaica, there are 45 deaths for every 50,000 live births annually.

"Many of these deaths could be prevented if every woman had access to reproductive-health services," a recent United Nations Population Fund (UNFPA) release in Kingston claimed.

According to UNFPA, "The loss of a mother shatters a family and threatens the well-being of surviving children.

"Research shows that for every woman who dies, 20 or more experience serious complications ranging from chronic infections to disabling injuries."

Maternal death and disabilities, UNFPA states, are often the result of poverty and inadequate state support.

Primary causes of maternal death

Commenting on the local death rate, Lewis-Bell pointed out that the figure was much better than 15 years ago. She admitted, however, that there remained some areas of concern, including the need for specialist units for maternal care.

"Persons may need intensive-care facilities, which not all hospitals have," she stated.

The figures for maternal death were more than 45 as "we are having a fair number of our deaths related to violence, motor-vehicle accidents and homicides". These, however, are not included in maternal mortality figures.

Primary causes of maternal death include haemorrhage, complications of abortions, hypertensive disease or disorders, embolisms, and com-plications of chronic diseases such as diabetes.

While protocols have been introduced to reduce and manage the leading cause of death in Jamaica, hypertension, little can be done about the botched abortions - the fifth-leading cause of maternal deaths - as long as legislation on the matter remained out of place, Lewis-Bell said.

Need a change

"We need a change in the law to facilitate the Ministry of Health taking an adequate public-health approach to the management and regulation of abortions," said Dr Olivia McDonald, executive director of the National Family Planning Board (NFPB) - an entity which also contributes to the Safe Motherhood initiative of the Ministry of Health.

Last week, the international Partnership for Maternal, Newborn and Child Health, meeting in Cape Town, South Africa, called on G8 leaders to fulfil previous commitments to global health and commit to new, long-term fi-nancing for essential interventions that can avert the deaths of over six million mothers, newborns and children every year.

The statement called for an additional $10.2 billion annually, the estimated cost to ensure universal coverage of basic services needed to achieve Millennium Development Goals on reducing child death and improving maternal health by 2015, respectively.

The United Nations Millennium Development Goals call for a 75 per cent reduction in maternal mortality between 1990 and 2015. The three-pronged strategy to accomplish this goal is access by all women to contraception to avoid unintended pregnancies; the availa-bility to all of skilled care at the time of birth; and, timely access to quality emergency obstetric care for those suffering complications.

McDonald told The Sunday Gleaner that the NFPB "never, ever gets what we ask for".

The NFPB has an operational budget of some $60 million. If they got more, she stated, the main focus would be more mass media messages as, "education was the most important thing".

Family planning, she stated, contributed to proper prenatal care and proper spacing in between each birth. "When people do not plan, the quality of prenatal care is compromised," McDonald said.

Indirect causes of maternal death are chronic disease, previously existing conditions like diabetes, obesity, asthma, cardiac problems, HIV and sickle-cell disease. Public education, family-health practitioners assert, would do much to reduce the impact of such factors.

Maternal mortality

Lewis-Bell disclosed that reducing maternal mortality was also the responsibility of the woman. Some females, she said, often failed to comply with the instructions of the doctor or midwife, or did not pursue regular and early visits once they had missed two periods.

The timing of pregnancy, she added, was also an issue. "If she has pregnancies too quickly in succession, the body does not get an opportunity to recover and there is risk of haemorrhage. Practising healthy lifestyle in terms of diet and exercise and ensuring a normal weight for her height is also important."

One new public-education initiative has been the transforming of the old maternity card used at local hospitals into a booklet "which captures the health information on individual pregnancies, but also educational messages for women," the family-services director said.

The ministry, she added, was also in the process of developing video and radio announcements for general public education with support from the Pan American Health Organisation, UNICEF and others.

More could be done, she said, if there was more money: "Unfortunately, funds are limited. Everybody needs more."

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