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DEVELOPMENT-AFRICA: Better Education Improves Health of Mothers and Children

Zahira Kharsany

JOHANNESBURG, Jan 15 2009 (IPS) - A new UNICEF report reveals there is still much to be done to reduce infant and maternal mortality in sub-Saharan Africa. Failure to improve care for pregnant women and newborns threatens to undermine progress on all health-related development goals.

"Newborn deaths account for up to 40 percent of all under-five deaths around the world," UNICEF Chief of Health Peter Salama told IPS in Johannesburg.

"With 9.2 million deaths across the world, half of them are in Sub-Saharan Africa, and 40 percent are of newborn infants in the first 28 days of life. We now know that without addressing the issue of newborn care, we can't actually achieve the health-related Millennium Development Goals."

UNICEF's "State of the World’s Children 2009: Maternal and Newborn Health" – launched in Johannesburg on Jan. 15 – is one of the first comprehensive reports that UNICEF has released on maternal and newborn health. It complements a report on child survival released last year.

Each year, more than four million babies die within four weeks of birth; 500,000 women die from complications in childbirth. Women in developing countries are also 300 times more likely to die in childbirth or from pregnancy related complications than those in a developed, industrialised country.

"If you look at some of the statistics in those terms, they are absolutely striking. If you look at Niger, which is the riskiest place to be a woman of reproductive age in the world, the lifetime risk is 1 in 7," says Salama.

"You compare that with one of the safest places in the world, Ireland, where 1 in 47,600 has a chance of dying. This is a really important way of portraying the extraordinary disparities between the developed and developing worlds."

Maternal mortality is as a result of five major causes, haemorrhage being the most common one, and the others being complications with unsafe abortions, infection, obstructive labour and hypertension and hypertensive disorders.

Salama adds that these medical problems are closely related to the social status of women.

"What is really important about maternal health is the recognition that underlying those medical issues is a whole series of nutritional, water and sanitation, HIV related issues," Salama says.

"And underlying that even further, are what we call the basic issues of maternal and child deaths: issues around education, poverty, the state of the women and their rights to basic things such as the financing to get to a hospital, the transport costs to get to a health facility."

Risk factors

A key factor that increases maternal mortality is the number of pregnancies a woman goes through in her lifetime. Education is also vital – education of women and girls is closely correlated with enhanced power over decision-making over finances and reproductive health questions like condom use or seeking treatment for sexually-transmitted diseases.

According to Salama, a woman who is better educated is also more likely to delay marriage and therefore have their first child later in her life.

"We know that women that have earlier child birth are at much higher risk of dying themselves and their infants have much higher risks as well. We also know that women who are educated make better decisions about health care for themselves and their family."

Akhil Iyer, UNICEF's representative in Niger, explains that Niger has the lowest age of marriage in the world. "It also has the highest illiteracy rate among women and the lowest rate in secondary schools. The educational situation at the moment, compounded by a very inadequate health infrastructure and an inadequate health care facility you have essentially a lethal combination."

UNICEF and the government of Niger are trying to solve the problem of infant mortality through the education system. "We are putting more girls through the primary and secondary schools. There is a big push on primary but we are also pushing to keep the girls in the education system because Niger has one of the highest drop-out rates between primary school and secondary school."

Yet another factor pointed out in the report is a shortage of health-care professionals. Fifty-seven countries across the globe fail to meet the World Health Organisations recommendation of 2.28 health-care professionals per 1,000 people, among them 36 countries in Sub-Saharan Africa.

Niger's health care system is under-resourced, says Iyer. "You have some of the lowest ratios in the world in terms of doctors to number of inhabitants and mid-wives to number of inhabitants are particularly bad in rural areas."

Some African countries have seen doctors and nurses leave the country for Europe, where health care professionals are paid better and have better facilities. In many countries, such as Zimbabwe or Somalia, there has also been a complete break down in health care facilities due to conflict situations, with inadequate facilities or shortages of medicine preventing doctors and nurses from carrying out even basic testing or care.

In studying overall care, UNICEF considers two axes. The first follows the life cycle from pre-pregnancy, pregnancy, the delivery and the newborn and child care. This is important according to Salama, if health care is to avoid successful intervention at one point in a woman and her child's life, only to lose them for lack of follow-up.

The other axis follows care from the family and community level to the first level of health care through the referral system to the higher levels of health care. In other words, it follows the idea that people and families as well as communities can help to educate and inform those in vulnerable situations.

In both cases, the role of health workers is critical, says Salama. "Without the right level of health workers, with the right training, with the right skills, with the right equipment, with the right linkages to further referrals, we can't get access to community care rights."

He stressed that is was not only doctors who are required. "The critical health worker shortage is not only about medical professionals. Certainly medical professionals are needed, particularly at the higher end of emergency care, but it's not the whole story. There is a lot of recognition of the important role of mid-level workers including mid-wives."

Mid-level workers are a vital link between women and families to a clinics and a referral system to higher levels of care.

There are several programmes to address maternal health within the continuum of care in Niger. Iyer says that programmes looking at health in mothers and pregnancy and care of the newborn have been introduced.

"Niger in fact has done quite well relatively speaking in improving care for the newborn child and reducing the newborn mortality rate. The interventions are well established, and the challenge in Niger is to move them along more quickly. With interventions within this continuum of care are well established and we know what we have to do."