By Eunice Naffie Mustapha, LL.M and Claudine Anita Hingston, Ph.D
Introduction
Globally, almost 800 women died every day in 2020 from preventable causes connected to pregnancy and childbirth. According to the World Health Organization (WHO), about 95% of maternal deaths occurred in low and lower-middle income countries, with sub-Saharan Africa accounting for around 70%. Sub-Saharan Africa carrying the highest burden of maternal mortality in the world is alarming, especially when goal 3 of the Sustainable Development Goals provides for the reduction of the global maternal mortality ratio by 2030.
Article 16 of the African Charter on Human and Peoples’ Rights provides for access to the highest attainable standard of health for everyone. Article XIV of the Maputo Protocol reiterates the promotion, realization and protection of the rights of African women, including their health and reproductive rights. Therefore, addressing maternal mortality is fundamental to upholding the right to health of women in Africa. Impactful community engagement through maternal death surveillance and response (MDSR) is instrumental in achieving positive health outcomes by ensuring community members are actively involved in upholding the human rights of African women and in addressing barriers to the enjoyment of their right to health.
This article briefly discusses the state of maternal mortality in sub-Saharan Africa, the importance of a gender lens, the role of MDSR and how impactful community engagement can be leveraged in addressing maternal mortality in sub-Saharan Africa.
Background
According to WHO, maternal death is “the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.”
Maternal mortality is high in sub-Saharan Africa because of varied reasons, inclusive of the role of gender dynamics. Gender inequality drives unequal power relations and disadvantages that impact maternal health outcomes. It contributes to maternal morbidity and mortality. A study that used data from low-income countries, the majority of which are in Africa—found that women’s educational, economic and empowerment status are significantly associated with the utilization of maternal health services. Its findings indicate that women who have completed primary education are nearly five times more likely to have had a skilled birth attendant at delivery than less educated women and almost three times more likely to have attended at least four antenatal care visits. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile.
Also, gender-based violence, including intimate partner violence, can have serious health consequences for pregnant women, such as increased risk of miscarriages, abortions, premature labour, fetal distress, bleeding, pregnancy complications and even death. Intimate partner violence, for instance, accounts for a large proportion of adverse maternal and neonatal health outcomes as well as maternal death.
Additionally, adolescent pregnancy, which is common in sub-Saharan Africa due to several factors, including the frequent occurrence of child marriage, puts girls at increased risk of maternal morbidity and mortality. This group is at particularly high risk because they are prone to obstructed labour, which can cause maternal mortality or disability.
Moreover, certain groups of women, including indigenous women, women living in rural areas, and displaced or refugee women, are also at risk, as they are subjected to multiple forms of discrimination, which affect not only their access to facilities but also the way in which they are treated at facilities.
Active Community Engagement
Maternal health, which is the health of women during pregnancy, childbirth and the postpartum period, can be advanced through access to comprehensive affordable care and the collection of high-quality data to aid effective response.
The Maternal Death Surveillance and Response: Technical Guidance (MDSRTG) provides for ending preventable maternal death through “routine identification and timely notification of maternal deaths, review of maternal deaths, implementation and monitoring of steps to prevent similar deaths in the future.” Reducing maternal mortality remains a public health challenge for low-resource countries, leading to the adoption of MDSR. In implementing the MDSRTG, community members in sub-Saharan Africa should be adequately engaged to get quality data. In adopting the active engagement of community members approach, the focus should not only be determining the medical causes of maternal death but also ascertaining the personal, family, or community factors
Active and impactful community engagement requires community leadership that can be achieved through community motivation. Ownership keeps the community interested and invested, turning community members into champions through powerful and genuine local partnerships. Gender equality, which plays a crucial role in maternal health outcomes, should be mainstreamed into these engagements and centered on MDSR systems. Gender lenses should be integrated into maternal death audit training to raise awareness of the role of gender inequality in access to health services, with the expected outcome of members of review committees viewing events through such lenses.
Gender equality is undoubtedly important for women’s reproductive health enhancement and subsequent curbing of maternal mortality. Team-building agendas should include interactive sessions on the intersection between gender and health. Women’s sexual and reproductive health rights require available, accessible, affordable, acceptable, and good quality sexual and reproductive health services, including family planning services, detection and treatment of sexually transmitted infections, detection of domestic violence, management of unintended pregnancies, skilled birth attendance, emergency obstetric care, and appropriate postpartum care. Therefore, gender inequality and gender-based violence-related prompts should be highlighted.
Even though the act of investigating maternal death is crucial, the objective must be prioritizing the prevention of future deaths. Community members should be encouraged to proffer community solutions and deliberately play leading roles in their implementation. These solutions should give credence to the unique barriers women face. Nonetheless, acknowledging the voices of communities requires moving beyond accumulating recommendations to showing consistent evidence of their implementation in gradually developing and assessing best practices. Communities in sub-Saharan Africa should be actively involved in monitoring and evaluation activities. They should play substantial roles in holding governments accountable for the implementation of recommendations aimed at addressing maternal deaths.
Conclusion
Addressing maternal mortality is essential to upholding the right to health of women in Africa. Goal 3 of the Sustainable Development Goals provides for the reduction of the global maternal mortality ratio by 2030. Maternal deaths in sub-Saharan Africa do not occur in space, as they affect members of communities. In reducing the maternal mortality ratio in sub-Saharan Africa, we should use an inclusive approach. This requires the impactful involvement of community members in the collection of quality data on maternal deaths, the supervision and training of community health workers, the prioritization of gender equality and the implementation of community driven solutions. Furthering human rights by ensuring community members in sub-Saharan Africa become actively involved in tackling maternal deaths should be a priority and never an option!
About Authors
Eunice Naffie Mustapha is a Sierra Leonean Health Lawyer with an LL.M in National and Global Health Law and a Certificate in International Human Rights Law from Georgetown University Law Center. She is an alumna of Fourah Bay College, University of Sierra Leone, and the Sierra Leone Law School. Currently, Eunice serves as a Senior Public Health Law Fellow at the Centers for Disease Control and Prevention, participating in the Oak Ridge Institute for Science and Education (ORISE) Research Program. The views expressed in her profile are her own and may not necessarily represent those of the Centers for Disease Control and Prevention or the United States Government. You can reach her via LinkedIn or Twitter.
Claudine Anita Hingston is an academic, gender expert, researcher, mentor, humanitarian, African feminist, and advocate for women’s empowerment and rights. With over two decades of experience, she has worked in diverse institutions spanning Sierra Leone, the United Kingdom, and South Africa. Claudine holds a Bachelor of Arts degree, a Diploma in Mass Communication, a Diploma in Cultural Studies, a Masters in Gender Studies, and a PhD in Gender Studies. Her extensive academic background is complemented by a rich array of practical experience. Her primary areas of interest and expertise encompass gender studies, women’s empowerment, leadership, feminism, media, and Africanism. Claudine has significantly contributed to these fields through the publication of numerous articles. Driven by a passion to positively impact lives, Claudine is dedicated to making meaningful contributions in both South Africa and her home country, Sierra Leone. Her commitment to advancing women’s rights and empowerment underscores her broader mission to effect positive change in society.
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