Maternal mortality: Africa's burden
Toolkit on Gender, transport and maternal mortality. Vs4 -04-2005
Margaret Grieco, Professor of Transport and Society,
Transport Research Institute, Napier University and Visiting Full Professor, Institute for African Development,
Cornell University
and
Jeff Turner, Independent Consultant,
United Kingdom - email: jeffreymturner@hotmail.com
This web site is
dedicated to the memory of Vera Nyarko, a talented student of the University of Ghana, who died in childbirth.
Contents:
Basic argument
Introduction:
Why gender and transport?
Why Africa?
Expert
evidence
Map of maternal mortality,
Africa
Overview of African data
Problems
and solutions:
networking in Africa
The
transport issue
Best Practice - Specific transport
and maternal mortality projects
Suggested
interventions
Policy
discussion
Conclusion
References and on line resources on transport
and maternal mortality
Safe
motherhood galleries of images
Contact
email address
The basic
argument is found at:
http://www.geocities.com/transport_and_society/classnotes10.html
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to Contents
Introduction: Why gender and transport?
There is a relationship between mobility,
power and well being. The differences between male and female travel patterns
and the cultural rules and roles associated with these differences are undercharted in the policy environment. The impact of constrained
mobility on bargaining also has its impact on what comes to be available as
resource and service within local constraints. No better demonstration of
these constraints can be found than in Africa's portrait of maternal mortality:
constraints on mobility and on the resources for mobility and accessibility
have devastating consequences for women's health on the African continent.
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to Contents
Why Africa?
There is a need for a re-examination
of 'the politics of priority': health or wealth? Many of the heated policy
discussions around growth versus poverty reduction as the priority are had
without reference to the scale of the crisis in maternal well being. Maternal
mortality is not simply fatal but is often a cruel and harsh lived experience
for Africa's women. And yet OECD's evaluation
of the costs of drastically reducing maternal mortality in Africa indicates
that this can be done without the need for significant increases in the wealth
of the continent. It is a matter of organisation and part of that organisation
is the provision of transport facilities and hostel provision for those in
need of, or likely to need, emergency obstetric care.
- Ironically, maternal mortality - death because of distance from health
facilities - is increasing in Africa at the same point as there is a global discourse
on the 'death of distance'.
- The mapping of mobility entitlements and accessibility patterns against
gender, and the consequences of these patterns, is not adequate.
- Similarly the measurement of maternal mortality and women’s health
has been under-resourced with the consequence that current overviews are
inadequate and operational and evaluative knowledge on best practice interventions
is weak.
- There does seem to be a strong relationship between poor transport
organization and high levels of maternal mortality.
- There is a clear ground in which improvements in information technology
could help reduce rates of maternal mortality.
- A set of mobility and empowerment factors need to be considered and
addressed in any campaign to reduce maternal mortality.
- The reduction of maternal mortality is a Millennium
Development Goal.
- The policy discussion is short on suggestions on how to realise this
goal - and the contribution that safe motherhood transport plans could make
to this reduction is under-operationalised.
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Rough journeys at best
- rural transport in Africa
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When a large tree falls on a rural
road, walking comes back into use: Ghana. Photo and description by Phil
Bartle sourced @ http://www.scn.org/cmp/
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Expert evidence
The expert advice is clear: maternal mortality in Africa is a crisis and it is a crisis which is likely to worsen.
'Africa has the highest
maternal mortality rate in the world.
Experts on reproductive health have painted a grim
picture of maternal and child health in the region and warned that the situation
could worsen in the next decade if no immediate remedial actions were taken
by Africa's governments and development partners. Many African
countries have been hit by an exodus of medical personnel to overseas destinations
in recent years.
"Only 42% of
births in the African region are attended by skilled personnel," an expert
at the regional conference on maternal and new-born health in Zimbabwe emphasised. Unsafe abortions
are also high among adolescents, according to him. Experts, who are drawn
from various international organisations, are examining
the extent of the problem on the continent and will suggest ways of reducing
the death rates among mothers and infants. African governments' health budgets
were also identified as inadequate to deal with obstetric cases.
"The percentage
of GDP (gross domestic product) devoted to health in sub-Saharan Africa remains at between one percent and 3,7% compared
to the large percentage spent on arms," they conveyed. "If nothing
is done to arrest the trend (of high and growing maternal and child deaths),
it is estimated that there will be 2.5 million maternal deaths, 2.5 million
child deaths and 49 million maternal disabilities in the region over the next
10 years", Prof. Joseph Kasonde noted. He states
that more than half of the 600,000 women who die every year from pregnancy-related
causes were in the African region which constitutes only 12% of the world's
population and 17% of its births. Maternal mortality ratio in Africa remains the highest in the world with the average actually increasing
from 870 per 100,000 live births in 1990 to 1,000 per 100,000 live births
in 2001.
According to a WHO-sponsored
study made available at the regional workshop on improving maternal and neonatal
health in Zimbabwe, neonatal morbidity and mortality rates is currently estimated
at 45 deaths per 1,000 live births and contribute about 50% of the infant
mortality rate in the region. The findings of the study, presented by Dr Office
Chidede, a Consultant Neonatologist at the University of Zimbabwe, also show that
stillbirths and deaths within the first seven days of life in the Region was
estimated at 76 per 1,000 live births.
He also indicated
that 70% of deliveries take place in the community where maternal and newborn
births are usually not recorded. Eight countries were covered by the study
conducted between February 2001 and August 2002. Its goal was to develop or
recommend evidence-based strategic interventions and establish sustainability
in the institutionalization and implementation of identified remedial measures.
The study documents some of the causes of death as provided by health providers
and facility records. These include: birth asphyxia (suffocation during birth),
40%; prematurity and low birth weight, 25%; infections,
20%; congenital defects, 10%, and acute surgical conditions, 3%. Other findings
relate to unavailability of basic supplies and equipment, staff shortages
and low morale, bad roads and long distances between
referral points, continued use of traditional birth attendants (who
are still popular and highly regarded) and preference of mothers to deliver
in health facilities, although these are still largely perceived as not user-friendly.
Pregnancy in adolescence
presents a unique and frightening picture," he highlighted, adding that
13% of all maternal deaths occurred in adolescents, 14 million of whom gave
birth annually worldwide. Prof. Kasonde conveyed
that in spite of the somber picture, two major initiatives launched in the
past two decades had helped to stem the tide of maternal and child deaths
in Africa. These include the Safe Motherhood Initiative launched in 1987 which
drew attention to the multifaceted nature of the problem and the need to invest
in five key critical areas: human rights, empowerment of women, education,
socio-economic development and the improvement of health systems. The Making
Pregnancy Safer Initiative, launched in 2000, focused on the health sector
and its crucial role in accelerating maternal maternity reduction. The aim
of the Initiative was to ensure that women and their newborns have access
to the care they need through the strengthening of health systems and appropriate
community-level actions."
He stated that in
spite of the harsh economic environment prevailing in Africa, the application of appropriate policies by governments would lead to
improvements in the outcome of pregnancies irrespective of the economic status
of countries. According to him, it was now time for African governments to
focus on the availability of and accessibility to
emergency obstetric care because emergencies constituted a major risk for
maternal mortality in Africa. Other essential
interventions, he said, were the reorganization of health systems, the strengthening
of midwifery skills, and increasing the number of skilled birth attendants.
He further concluded his presentation with a four-pronged call for action:
action to place maternal and newborn health high on the agenda of governments
and partners; to review policies, guidelines and programmes; to allocate and release resources and action to
harness resources from communities and partners." http://www.sahims.net/regional/exec-review/2004/02_feb'/reg_review_04_02_20.htm
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Twelve post-operative women at the
Addis Ababa Fistula Hospital in Ethiopia are ready to go home. They
have had their obstetricfistulae repaired, and they have been given
new dresses (the constant leakage of body waste, caused by fistulae,
ruins clothing). Only a few have live babies. Most have given birth
to stillborn babies.
309-16 Addis Ababa, Ethiopia
Credit: © Ruth C. Kennedy, Courtesy of Photoshare @ http://www.photoshare.org/
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Women from the Akpamanya hamlet in the
Nimbo community of Nigeria engage in a health situation analysis activity
as a way to express their perceptions and experiences related to women's
health. This activity took place as part of the formative research component
of the Ndukaka Project (Female Genital Cutting - FGC) in the Enugu State.
In this photo, a participant draws her idea of a healthy woman.
529-11 Akpamanya, Nigeria
Credit: © 2002 Serena Williams/CCP, Courtesy of Photoshare @ http://www.photoshare.org/
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Back to Contents
Map of maternal mortality,
Africa:
Click on the link below for the map of maternal mortality
for Africa:
http://www.overpopulation.com/faq/Health/mortality/maternal_mortality/maps/africa.html
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to Contents
Overview of African data:
Click
on the link below for an overview of maternal mortality data for Africa:
http://www.overpopulation.com/faq/Health/mortality/maternal_mortality/africa.html
Back to Contents
Problems and solutions: networking in Africa.
This section draws attention to forms of
networking around the problem of rising maternal mortality rates: there has
been local, regional and web-based data base construction as well as the development
of safe motherhood action networks within localities historically afflicted
by high maternal mortality rates. The links below provide an insight into
some of this activity.
- There is a rising maternal mortality rate in Africa. http://www.gfmer.ch/Endo/Course2003/Maternal_mortality.htm
This link provides access to information
on the sisterhood methodology for collecting
data on maternal mortality - this is a network methodology which is useful
in contexts where traditional data collection provisions have been inadequate
and under-resourced.
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A
women's ward at the Buwenge Health Center in the Jinja District of Uganda;
woman lying in bed.
426-17
Uganda Credit: © 2001 Harvey Nelson, Courtesy of Photoshare @ http://www.photoshare.org/
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A health worker examines a pregnant
client in the DISH Project video "Caring Completely," set
in Uganda.
77-74 Uganda Credit: © 1996 CCP, Courtesy
of Photoshare @http://www.photoshare.org/
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- The evidence is that maternal and child health care is deteriorating:
and regional networks are forming to combat the crisis.
"It
is estimated that 585,000 women die each year as result of pregnancy and childbirth.
Almost all of these deaths (99%) occur in developing countries, particularly
Africa. Therefore there is an urgent need to address the problem
of maternal mortality with effective programs to reduce the unacceptable number
of deaths that occur in the world's poorest countries."
"From 1988 to 1996
a Network of eleven multi-disciplinary teams in West Africa, (Ghana, Nigeria, Sierra Leone) the Prevention of Maternal Mortality (PMM) Network,
collaborated with a team at Columbia University,
New York ."
"In June 1996, the
PMM Network presented the results of eight (8) years of research at an International
Conference in Accra.
This marked the end of the 1st Phase of the Network and the beginning of
the 2nd Phase. The Network
has now become a complete African entity with its regional headquarters
in Accra - Ghana. It is now known
as the Regional Prevention of Maternal Mortality (RPMM) Network.
Five disciplines form the
RPMM Network, namely Community Physicians, Nurse-Midwives, Obstetricians,
Social Scientists, and Anaesthetists. Their projects
focus on interventions that improve the availability, quality and utilization
of emergency obstetric care. Activities range from improving services at
health facilities to improving access to care."
@ http://www.rpmm.org/ (site presently
under reconstruction) Regional prevention of maternal mortality network.
- Policy goals, mortal failure: displaying the scale of the
gap.
Despite the various
policy calls to action and international networking amongst development agencies
on the topic, in Africa the situation is worsening. In addition to displaying the
scale of the gap there is a need for a rapid identification of
immediate operational measures which can be taken to redress this glaring
inequity.
"The
complications of pregnancy and childbirth are the leading cause of death and
disability among women of reproductive age in developing countries. It is
estimated that around 515,000 women die each year from maternal causes. And
for every woman who dies, approximately 30 more suffer injuries, infection
and disabilities in pregnancy or childbirth. This means that at least 15 million
women a year incur this type of damage. The cumulative total of those affected
has been estimated at 300 million, or more than a quarter of adult women in
the developing world…..
Though much has
been learned during the past decade about the causes of maternal death, there
is little evidence of significant progress towards the ambitious goal of halving
maternal mortality. Every year, over half a million women continue to lose
their own lives to the hope of creating life. Women
in Sub-Saharan Africa continue to face a 1 in 13 chance of dying from pregnancy
and childbirth, when the risk for women in the industrialized world is only
1 in 4,085." http://www.childinfo.org/eddb/mat_mortal/
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Women in Zambia meet twice a week on Tuesdays and Fridays at a referral
center to learn about family planning, reproductive health, and birth
spacing, in order to reduce the dangers of child-bearing, STIs, and
poverty.
2004-416
Zambia Credit: © 2004 Yesaya Banda, Courtesy of Photoshare @http://www.photoshare.org/
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Health educators in Nigeria use a large
flip chart to speak to a group of women about women's health issues.
58-36 Nigeria Credit: © 1990 CCP, Courtesy
of Photoshare @
http://www.photoshare.org/
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- Mali, an important case study: the social organisation of local women around reproductive health/
best practice http://allafrica.com/stories/200408130726.html (link no
longer working on a free basis):
"The small Malian town of Zegoua - population 22,000 - doesn't have a great many "claims
to fame". In one respect, however, it has achieved something remarkable.
"Since
January 2002, there's not been one case of neonatal or maternal mortality
in Zegoua or any other nearby village," Yaya Coulibaly, director of the
Zegoua Community Health Centre, told a group of local and
international journalists recently. The centre caters for nine villages,
which are divided into 16 zones. Zegoua is located
almost 500 kilometres south of the Malian capital,
Bamako - near the country's border with the Ivory Coast.
According to Coulibaly,
the secret of the area's success in reducing neonatal and maternal mortality
lies in the determination of its women to tackle these problems. They have
organized themselves into teams for taking charge of their health care.
"In spite of their meager financial
resources, these women pay the fees for postnatal consultations, vaccinations
and family planning," Coulibaly said.
According to the United Nations Children's
Fund (UNICEF), an average of 1,530 women fall pregnant
every day in Mali. Of these, 230 experience complications during pregnancy, while 20 die.
About 100 of the children they deliver also die. In addition, several women
develop serious postnatal conditions such as fistulas and descended uteruses.
Before the women of Zegoua
and its surroundings started grouping together to address these problems,
the approach that some had to healthcare was a little haphazard."
"We never thought
about our health problems," says Mariam Ouatara, from the village of Katele, adding that scarce funds were sometimes spent on entertainment.
"After these big parties, some of us couldn't even afford to pay the
100 CFA francs (about 18 cents) it costs for a simple vaccination card."
The women have now formed groups that plant
cotton, peanuts and rice. A share of the revenues generated by these crops
is used to pay for consultations to check on the health of babies and new
mothers, and to discuss family planning issues. The funds also extend to
vaccinations, and buying drugs for treating malaria.
In the event
that severe problems develop during a pregnancy, the coordinator of each
village team must ensure that the woman concerned is transferred to a clinic
that is equipped to deal with such emergencies."
Click here for map
giving location of Zegoua
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The transport issue:
Disciplinary divides have prevented the transport
profession's explicit focus on maternal mortality as a measure of transport
failure. An inventory or toolkit of transport measures, and associated measures,
aimed at reducing maternal mortality could usefully be developed by international
agencies such as the World
Bank (click on link for access to World Bank embryonic site on maternal
mortality and transport).
"In addition to contraception, women
need access to a broad range of services. The primary
means of preventing maternal deaths is to provide rapid access to emergency
obstetrical care, including treatment of hemorrhages, infections, hypertension,
and obstructed labor. It is also important to ensure that a midwife, or doctor is present at every delivery.
In developing countries only about half of deliveries
are attended by professional health staff. Skilled attendants must be supported
by the right environment. Life-saving interventions – such as antibiotics,
surgery, and transportation to medical centers – are unavailable to many
women, especially in rural areas. These women may lack the money for health
care and transport, or they may simply lack their husbands’ permission to
seek care. " http://www.developmentgoals.org/Maternal_Health.htm
In order to appreciate the
importance of transport and accessibility interventions in the reduction of
maternal mortality, only one statistic is necessary - there is an accessibility
time of 30 minutes to services which is crucial for women's health and survival.
The reason the maternal mortality fell
in the US this century was because of the advent of antibiotics and blood
transfusion more than anything else. There is simply no scientific evidence
to prove the falling mortality was because birth was moved into the hospital.(1)
The evidence does show that as long as there is
a system in place to transport women in labor to a facility within 30 minutes
where there are antibiotics, blood transfusion and cesarean section capacity,
there should be very little maternal mortality.
Maternal mortality is quite different from perinatal mortality and infant
mortality. The latter two are much influenced by socioeconomic factors while
maternal mortality is much more directly a function of the quality of the
health care available. If midwives (traditional, direct entry, or nurse-midwives)
are trained to know the signs of serious complications and have the means
of transport, there is no need for a doctor at the site of primary care
of pregnant and birthing women who have had no complications. But at the site of the place where the woman is transported, there
is need for a doctor who has surgical skills and, ideally, obstetrical skills,
to manage the complications. Wagner, M @ http://www.geocities.com/Wellesley/5510/wagner.html
(link no longer working)
Measuring women's access to maternal health
services in Africa using this figure has not yet been undertaken but there
seem to be good planning reasons why it should. And the use of new information
communication technologies can make both planning and service delivery more
timely.
The transport lessons around the reduction
of maternal mortality in Africa clearly involve communication and organisation issues
as well-
- fast information links can save lives,
- rendering services locally can reduce the need for mobility, and
- operating hostels for those at risk can temporarily
reduce distance within critical windows of care.
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Best Practice
- Specific transport and
maternal mortality projects:
The specific
projects identified here all have explicit transport dimensions which can
be replicated elsewhere. Currently, there is an institutional vacuum in respect
of the transport arrangements required for safe motherhood.
The evaluation of the projects identified below and their systematic emulation
and replication within a "Safe motherhood transport planning" framework
is clearly an activity which can be undertaken within the remit of the development
agencies in alignment with meeting the Millenium Development Goals.
'A government-backed
Safe Motherhood programme has reportedly established village committees on
safe motherhood, organized
transportation plans and provided training to traditional birth attendants
so that they can recognize signs of obstructed labour and act efficiently
to get a woman to a facility. Telephones and radios have been installed in
some health centres to communicate with the referral
hospital and request ambulance transport for women in distress...........Pervasive
gender inequities sometimes prevent women’s access to transportation and emergency
obstetric care. Decisions about when and where to seek care are usually made
by an uncle (or, occasionally, by the husband); without their input, a woman
would be unlikely to seek care on her own.'
- Transport
within Safe motherhood unions - Zegoua, Mali (link no longer working
on free basis but see above and below text on topic)
'The small Malian town of Zegoua - population 22,000 - doesn't have a great many
"claims to fame". In one respect, however, it has achieved something
remarkable.
"Since January 2002,
there's not been one case of neonatal or maternal mortality in Zegoua or any other nearby village," Yaya Coulibaly, director of the
Zegoua Community Health Centre, told a group of local and
international journalists recently. The centre caters for nine villages,
which are divided into 16 zones. Zegoua is located
almost 500 kilometres south of the Malian capital,
Bamako - near the country's border with the Ivory Coast.
According to Coulibaly,
the secret of the area's success in reducing neonatal and maternal mortality
lies in the determination of its women to tackle these problems. They have
organized themselves into teams for taking charge of their health care....
In the event that severe problems
develop during a pregnancy, the coordinator of each village team must ensure
that the woman concerned is transferred to a clinic that is equipped to
deal with such emergencies.'
·Targeted
approaches which integrate transport - Senegal and Mali (Click on link for case study)
'In Mali, interagency collaboration has enabled the country
to build and equip seven new community health centers in three regions and
a new maternity unit. The government of Mali, with support from various donors,
developed a programme to bolster its referral system with a rapid-response
component. The country has invested in radio communication among referral
centers, and has procured vehicles to use for patient transport. District
hospitals and local health centers are now linked by a two-way system of radio
communication and transportation. A car, equipped with a stretcher, is available
to transport women from health centers to district hospitals. Under this system,
the time required to transmit an urgent message and transport a patient is
reduced from up to a day to just a few hours.'
· Walkie-talkies,
transport strategies and a 40% reduction in maternal mortality: RESCUER, a
Ugandan case study/ eastern Uganda's Iganga district. (Click on link for case
study)
' The project has three components: communications,
transport and provision of quality health services. The communications system
uses VHF radios installed in base stations and health units, in the referral
hospital ambulance and the District Medical Officer's vehicle, while the birth
attendants have walkie-talkies. The midwives and birth attendants got additional
training and now there is better quality care. But transport has been the
biggest problem as the ambulance sometimes breaks down.
The initial cost of the project
was under $124,000, covering the cost of the radio and monitoring equipment
and training for technicians and users. After this phase, running costs decreased.
According to Ms. Musoke, the system uses solar energy for electricity. "After
the initial expenses, there are the usual maintenance costs, but these are
small and easy to bear, which means that even when donors pull out, the project
will still be sustainable.
Because of its positive results,
the RESCUER project is already being replicated in three other districts
and there are plans to extend it in phases to 30 more." See also http://iconnect.osc.nl/stories/articles/Story.import47
Some innovative
new schemes are working. Another BBC producer spoke with Pramila Seneyaki,
from the International Planned Parenthood Federation, who described an initiative
in West Africa which uses a local truck drivers union to provide emergency
transport for women. "If there is a woman in difficulty in a village
what we will do is get her family to plant a yellow flag on the main road,"
she stated."When you see a yellow flag you know there is a woman in trouble."Somebody
will be there to tell you, 'look my mother is in trouble. If we bring her
up to the lorry can you take her the 200 miles?'."They were delighted
to be able to help and we reduced maternal mortality quite significantly because
of this initiative."
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Suggested interventions:
Mobile
maternal health clinics?: learning from AIDS/HIV interventions The international
focus on the AIDS/HIV crisis has led to innovative designs for mobile health
facilities in the African context of highly restricted rural accessibility
to health facilities. The overlap between AIDS/HIV
and maternal health is a strong one and these facilities could be developed
to give greater attention to this overlap.
Roadside
welllness centres: the intersection of health needs?
The link between transport routes and the transmission of HIV/AIDS has been
documented by a range of international agencies including the World Bank.
The recognition of this link has led to the development of wellness centres
or health posts along major transportation routes in Africa to service the
male truckers using these routes. Services are also provided to local female
sex workers. There is a need to investigate whether such facilities could
be used in tackling the maternal mortality rates of rural Africa - at the
very least such health posts could provide a link to emergency obstetric transportation
for mothers in crisis.
Toolkit
for assessing the impact of safe motherhood interventions.
The Dugald Baird Centre for research on women's health under the leadership
of Professor Wendy Graham and funded by the Department for International Development,
UK is developing a toolkit for assessing the impact of safe motherhood interventions.
This toolkit should be expanded to include transport interventions.
Customised
transport technologies for safe deliveries - the eRanger experience.
The development of appropriate vehicles for emergency obstetric transport
for use in rural Africa is a key component of any systematic program for the
reduction of maternal mortality on the continent. This link provides information
on the eRanger experience of such development.
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Policy discussion:
Within the policy discussion there is a need
for:
·
more accurate measurement,
·
more focused solutions,
·
more sensitive social scientific analysis of the relationship
between mobility, gender and health.
There is now a policy goal
of dramatically reducing maternal mortality in Africa and there is a body
of evidence which speaks to the scale of the problem but the literature on
concrete measures for bringing about this goal and the operational
activities of development agencies in pursuit of this goal are thin on the
ground, most particularly in respect of the transport and maternal mortality
link.
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A bicycle ambulance in Malawi
- bicycles can be the link from remote rural locations to the motorised
highways. Radio connections can be used to make sure a vehicle awaits
the patient. Bicycle ambulances have been used in some maternal mortality
reduction transport interventions - an evaluation of the role bicycle
ambulance can play is now needed.
Source: http://www.transaid.org
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Conclusion:
There is sufficient evidence that transport
organisation and provision is highly gendered in both the
developing and developed context. Gender methodologies have not yet been sufficiently
mainstreamed to tackle this existing pattern of equity. The reduction of maternal
mortality in Africa - a Millenium Development Goal - provides an
operational ground in which such methodologies are in need of urgent
development.
There is evidence that more systematic approaches
are beginning to be adopted but as of yet transport and gender statistics
are of a limited character as evidenced by the World Bank's own gender statistics
site. The development of a web site which provided consolidated information
on the relationship between gender, transport and maternal mortality and carried
detailed information on best practice and how to effect it would be a useful
addition to the toolkit and process necessary to achieving the Millenium Development
Goal of reduced maternal mortality in Africa.
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References and on line
resources on transport and maternal mortality:
Auxiliary
technologies related to transport and communication for obstetric emergencies:
K. Krasovec*/Program for Appropriate Technology
in Health (PATH), Washington, DC, USA link This article is a key resource and provides a rare and useful review of
studies of the relationship between transport and maternal mortality.
Maternal
mortality update 2002: a focus on emergency obstetric care / UNFPA This
document explicitly considers the need for transport interventions and suggests
important innovations such as prepaid transport arrangements to enable women
to travel to emergency facilities.
The road to
safe motherhood -WHO/Africa Regional Office This document identifies transport
as an issue but then fails to develop the analysis of transport strategies
necessary to the reduction of maternal mortality
Maternal mortality:
helping mothers live. OECD Observer. OECD argues that reductions in maternal
mortality can be achieved at very low cost and is not dependent on high levels
of economic growth.
West
Africa Project - hosted on Harvard Web Site
WHO/
World Bank - on maternal mortality and transport
Reducing
maternal deaths - transport dimensions: WHO/ Africa Regional Office
http://www.rpmm.org/
(site presently under reconstruction) Regional prevention of maternal mortality
network.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14516306
-"CONCLUSION: Despite the limitations of this ecological study, there
can be little doubt that the huge rural-urban differences in maternal mortality
are due, at least in part, to differential access to high quality maternity
care. Whether any of the indicators examined here will by themselves be good
enough as a proxy for maternal mortality is doubtful however, as more than
half of the variation in mortality remained unexplained by any one of them.".
http://www.sahims.net/regional/exec-review/2004/02_feb'/reg_review_04_02_20.htm
Africa Recovery
Briefing Paper Number 11, April 1998
Maternal mortality
- South Africa: failures of the transport and referral systems between health
institutions - to give an indication, "In Mpumalanga, lack of emergency transport between health institutions
was identified as a major factor in at least 38% of maternal mortalities last
year"
Maternal mortality and Africa - a Canadian review of problems and
solutions.
Maternal
mortality and transport - a World Bank powerpoint summary. The final argument
on this PowerPoint is that transport intervention is not a silver bullet for
the reduction of maternal mortality: a better summary of the situation would
be that transport is an important intervention and a critical tool in the
reduction of maternal mortality.
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Safe motherhood galleries
of images:
Ghana: A gallery of images by Nancy Durrell McKenna on Safe Motherhood
in Ghana in collaboration with Save
The Children - Canada
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If
you are aware of other maternal
mortality and transport projects, please get in contact and provide the information
for display on this site.
e-mail mg294@cornell.edu
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Appendix:
1. Definition: Maternal Mortality
Maternal mortality is defined
as "the death of a woman while pregnant or within 42 days of termination
of pregnancy, regardless of the duration of the pregnancy, from any cause
related to or aggravated by the pregnancy or its management."
2. Contextualising a specific case: Ethiopia
Ethiopia: maternal mortality, the context in indicators - http://www.globalis.no/country.cfm?country=ET&lang=en