OB/GYN: Better access to care needed to save African moms in childbirth

From the 57th annual clinical meeting of the American College of Obstetricians and Gynecologists held in ChicagoChicago | Canada’s Dr. Jean Chamberlain Froese came to the ACOG meeting here to tell attendees about a funeral.It was the funeral of Fatima, a colleague and a mother in Uganda who had worked and studied with her.The professor at McMaster University spends eight months a year in Uganda running medical education programs, most notably a master’s of public health at the Ugandan Christian University in Kampala. More important is that she is the executive director of Save the Mothers, a Canadian-based organization: “Our vision is that no mother or her child should die of preventable pregnancy complications.”At the service for her colleague, a mother of nine who died of a postpartum hemorrhage, close to 400 people attended and the special position women and mothers hold in the fabric of African communities was obvious.During one of the largest plenary sessions at the meeting, Dr. Froese told the hundreds of ob/gyns in attendance that in Africa women are the linchpins of the family, responsible not only for children and the home but also for earning income and caring for an extended family. “I was reminded of the huge impact of the death of one mother on this community and this family,” Dr. Chamberlain Froese said. It all has to do with geography, she said.Globally, 529,000 mothers die every year from pregnancy complications. In sub-Saharan Africa, one in 22 women will die from pregnancy complications, compared with one in eight women in Afghanistan, one in 4,800 in the U.S. and one in 11,000 in Canada.“Why do mothers die? Most of them die from hemorrhage,” she continued.“We’re not looking for the cure to these complications. . . . We have the cure for most of these complications. It is access to care we need; care in a timely way.”There are three problems with providing care to women in developing nations: delay at home, delay in transportation and problems at the care centres.“If you don’t have a dollar to your possession, you know you can’t show up at the hospital,” she said, so women often delay seeking attention.Then there are social problems for women seeking care. “Even educated women, doctors themselves, still have their husbands sign for surgery,” Dr. Chamberlain Froese said. “Fatima had to wait for her husband to come home.”Even then, Fatima was an hour away from the care she needed. “Seeing women on the back of a motorbike being transferred to the next level of care because there are no ambulances,” she told the audience. “For any of you women who have been in labour before, I’m sure you can’t imagine hopping on the back of a motorbike while you are in labour to get to the next level of care.“At least 50% of all maternal deaths are attributable to these first two delays—the delay in the home and the delay in reaching the facility.”And when they reach a medical facility there are still questions about availability of personnel, supplies and basic things such as blood.Saving children, tooShe emphasized that saving mothers will save children’s lives. “We focus on mothers dying, but every year there are four million stillborns around the world,” and the same number of neonatal deaths.“We estimate that half of those stillborns and half of those neonatal deaths are attributable to poor maternal care. . . . Fatima’s little son who was born, he is five times more likely to die before his fifth birthday than a child who has a mother.”There are myriad obstacles, political and social, to changing attitudes about mothers’ health. Around 1985 there was a push to start organizing around providing safe motherhood, resulting in a United Nations Millennium Development Goal to reduce maternal deaths by 75%. We are not even close, said Dr. Chamberlain Froese. New strategies and voices are needed to move ahead, and she urged her fellow ob/gyns to “be a voice for these mothers.”In an interview after her talk, Dr. Chamberlain Froese credited Canadian health-care workers and doctors, and the Society of Obstetricians and Gynaecologists of Canada, with helping move issues of mothers’ health forward.“Sometimes the smaller centres can do more,” she said.Still, she was glad to be invited to give a prestigious talk at the ACOG conference, and to return from Africa a little earlier than usual with her husband and two children, one of whom is a Ugandan child she and husband, Thomas Froese, are adopting. She will return to Africa in September.

OB/GYN: Better access to care needed to save African moms in childbirth

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