Zero Tolerance for Maternal Mortality

Dr. Abdelhadi Eltahir

Availability of emergency blood, often needed by women in labor, is not commonly practiced in the developing world due to cultural, physical, and/or resource barriers.

Maternal and newborn care is
one of the biggest challenges in international health. Women and infants
die every day in the developing world from preventable causes – most
of which are virtually nonexistent in the Western hemisphere. It is
tragic when you hear about an 18-year-old girl who dies due to eclampsia,
or a mother of two who dies from postpartum hemorrhage (excessive bleeding
after birth). It’s unacceptable – and in many ways shameful for the
international health and development community – for women to die from
preventable and manageable illnesses and conditions. 

Deji, a Nigerian nurse-midwife,
shared some of her experiences with me during my recent trip to Pathfinder International project sites in Nigeria. At Murtala
Muhammad Specialist Hospital, which has a maternity ward that conducts
around 13,000 deliveries a year, Deji did not have immediate access
to a blood bank if one of her patients needed blood. If a woman was
suffering from severe bleeding post-childbirth (25 percent of maternal
deaths are caused by postpartum hemorrhage) she would have to take a
blood sample from the woman, wait for the results (usually 20-30 minutes),
then look for donors. Deji said husbands would often have to pay someone
to donate blood to save their wives. Such commercial blood is not only
more expensive, but usually has a higher risk for transmitting HIV than
blood donated by a volunteer. Imagine the difficulties involved in finding
a donor that not only matches you wife’s blood type, but is screened
for HIV – all while under the duress that her life is at risk. By the
time a woman receives a transfusion it could be more than five hours-and
that’s a modest estimate. Deji would see women die for no other reason
but that they lacked access to a blood supply.  

Unfortunately availability
of emergency blood is not commonly practiced in the developing world – and
sub-Saharan Africa in particular – due to cultural, physical, and/or
resource barriers. But with the right systems and training, many of
these barriers are addressed and emergency blood made available. For
instance, at Murtala Muhammad, Deji was extremely enthusiastic that
the hospital saw the opening of a new blood bank which will provide
much needed blood supplies for the maternity ward. Opened this past
January at the impetus of a Pathfinder maternal care project, the new
blood bank was named in honor of a longstanding, dedicated OB/GYN Dr. Habib Sadauki (who also directs Pathfinder International’s Continuum of
Care: Addressing Postpartum Hemorrhage

project). The blood bank will address one of the critical delays in
ensuring maternal survival and care. 

In addition, at another Pathfinder project site in rural Nigeria I noticed
an interesting change. Immediately after a local hospital received training
and support to maintain an emergency blood supply, the Medical Officer
in charge initiated a system for emergency blood. He set aside at least
four pints to be available for maternal emergencies at all times. This
may seem a small amount, but it is a big achievement for this rural
hospital. If every rural hospital adopts such a strategic intervention,
then women who arrive at a hospital with postpartum hemorrhage could
be saved much more quickly during this most critical of times.  

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For the past twenty years,
I have seen little change in worldwide statistics for maternal and newborn
care. But it’s time to put our collective foot down and call for zero
tolerance to maternal death. No longer should women die during a time
that should be one of celebration and hope. It is imperative that we
rededicate ourselves to ending maternal mortality.  

Putting zero tolerance for
maternal death into place – or to put it more positively – ensuring
maternal and newborn survival, requires broad-ranging and innovative
approaches. These include helping women access family planning to prevent
unwanted and early pregnancies, managing emergency obstetric care, and
involving communities in identifying and addressing their own community
health needs. Already there are organizations – like Pathfinder – that
are pursuing these changes. But it is going to take more.  

More attention needs to be
paid to emergency obstetric and neonatal care. More funding is required
in order to provide quality health services and change the dire circumstances
many women face. And more pressure needs to be brought to bear on leaders
to highlight this as a major issue going forward. But together I look
forward to a new time of zero tolerance and more women being saved through
such simple, yet vital, acts as accessible blood.  

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