The worth of malawian women: a review of the current status of safe motherhood in Malawi.

Background Like many developing sub-Saharan countries, Malawi continues to struggle with very poor indicators of health and development. It is one of the poorest countries in the world ranked number 163 out of 173 countries in the World Bank Human Development Index (World Bank, 2002). The economy is predominantly agro-based with 70% of its exports in 2004 being tobacco, tea, and sugar.(Malawi Demographic and Health Survey (MDHS), 2004). 85% of the population is rural and 65% is defined as poor. Malawi switched from a dictatorship to a multiparty democracy in 1994 and since then there has been a marked rural to urban migration. The introduction of free primary school education has seen a marked increase in literacy rates especially among women, from 49% among women ages 1549 in 2000 to 62% in 2004 while for men it has not been very significant, from 72% in 2000 to 79% in 2004 (MDHS, 2004). These encouraging results are yet to be reflected in improved maternal health. This paper reviews recent reports and studies of maternal mortality in the country attempting to present them as a starting point for dialogue among providers and policy makers. The statistics are probably known to the majority professionals in the health sector . At 984 deaths per 100,000 live births, Malawi’s maternal mortality ratio is among the highest in the world (MDHS, 2004). In their 2004 report commissioned by the Task Force 4 of the UN Millenium Project entitled “ Going from bad to worseMalawi’s maternal mortalityan analysis of the clinical, health systems and underlying reasons....” McCoy, Ashwood-Smith, Ratsma et. al . They concluded with recommendations that if adapted and implemented by the key stakeholders mainly the Ministry of Health, Malawi will realize a reduction in maternal mortality and be in compliance with the Millenium Development Goal number 5. Infant and maternal mortality rates in a country are indicative of the adequacy of health services for infants and pregnant women respectively. However, there are multiple factors that determine pregnancy outcomes. These have been grouped into the three delays; delay to decide to seek care, delay to reach care and delay in receiving care once the patient has arrived at a health facility. Reports of direct and indirect maternal deaths (table 1,2) as well as principle avoidable factors (table 3) in maternal deaths in the Southern Region of the country help illustrate these three delays. It is disturbing to note, these results which were reported in the 2004 review commissioned by the Taskforce 4 of the UN Millenium project, that many of the deaths occur as a result of deficient hospital and health center care. In a country where the literacy rates are low, particularly among women and cultural beliefs about pregnancy and delivery still influence a woman’s decision to seek care, one would assume that delay to seek care would be the major factor contributing to maternal deaths. Frequency Percentage (%) Post-partum Sepsis 62 31.5 Ruptured uterus/obstructed labour 47 23.9 Post-partum hemorrhage 25 12.7 Abortion complication 20 10.2 Eclampsia/ PET 16 8.1 Retained placenta 10 5.1 Ante-partum hemorrhage 8 4.1 Complication from C-section anesthetic mishap 5 2.5