No significant decline in maternal mortality rates – UNICEF report

The estimated maternal mortality rate, which presently stands at 229/100,000 live births, has not shown any significant decline since the year 2000, the United Nations Children’s Fund (UNICEF) Situation Analysis of Children and Women in Guyana 2016 reported.
According to the recently released report, neonatal mortality continues to be the major component of under-five mortality in the country.
The report also pointed to the health of mothers – present and potential – as the most crucial area to be addressed with the Millennium Development Goals Acceleration Framework.
The most recent estimates show that maternal mortality in Guyana for 2015 was 229/100,000 live births, a number that has been showing signs of decrease in the past five years, but was still higher than the 2000 value.

Reasons
UNICEF said maternal deaths could be divided into two types based on causative groups: deaths directly related to obstetric complications during pregnancy and indirect obstetric deaths. According to the report, around 73 per cent of the maternal deaths in 2012 were direct maternal deaths, ie, those resulting from obstetric difficulties of the pregnant state (pregnancy, delivery and postpartum), interventions, omissions, incorrect treatment, or a chain of events resulting from any of these.
On the other hand, indirect obstetric deaths occur as a result of either previously existing conditions or from complications arising in pregnancy, which are not related to direct obstetric causes but may be aggravated by the physiological effects of pregnancy. These include such conditions as HIV and AIDS, malaria, anaemia and cardiovascular diseases. Indirect causes were responsible for 27 per cent of the deaths in 2012.

Better health services
The report stressed that both causes could be seen under two lenses: first in terms of services, since many deaths could be avoided if quality services for pregnant women were available.
“While obstetric risks are considered to be immediate causes of maternal and child mortalities, these risks are caused by inadequate access to good quality health care, especially prenatal care, delivery and postnatal care,” it said, noting that the antenatal period was essential to prevent complications during pregnancy and at births, to prevent HIV transmission from the mother to the child and to monitor the health and nutritional status of the mother and the baby.
Antenatal care is available in Guyana at different levels of the healthcare system. Although differences still exist between the coastal and hinterland regions in Guyana, the national antenatal coverage rate has been above 90 per cent since the year 2000. According to the 2014 Multiple Indicator Cluster Surveys (MICS), a little more than nine in ten mothers (91 per cent) received antenatal care more than once and a vast majority of them had at least four visits (87 per cent).
“In reality, taking congenital factors outside the equation, most of the deaths could have been avoided if appropriate care of pregnant women, attention at birth and/or post-partum and in the initial stages of life of the newborn were available for all pregnant women in the country,” it said.
Moreover, the fact that 59 per cent of the under-five deaths happens in the first month after delivery indicates that the poor quality of prenatal, delivery and postnatal care is also connected to high levels of neonatal mortality in the country.
Therefore, it stated that neonatal sepsis, congenital anomalies, birth asphyxia and prematurity could all be reduced with appropriate access to quality maternal health services.
Additionally, some of the causes are directly and/or indirectly associated with personal characteristics of the mother – nutritional status; health situation; quality of the environment where she lives (including access to proper water and sanitation); and access to government supplies, among others.

Child mortality
As it relates to child mortality, the report stated that the same service and personal characteristic lenses that were seen related to maternal mortality also apply to child mortality. Similar socio and economic structural conditions that will negatively impact on the chances of mothers dying during delivery and postnatal periods will influence the child’s propensity of dying before the age of five. The next sub-sections explore the different causes in more detail, the report noted. “For child mortality, when looking at the direct causes of death between birth and 12 months – respiratory infections, nutrition and other factors that are independent – but maybe consequences – of the ANC [antenatal care], delivery and PNC [postnatal care ]periods start showing up as important immediate and underlying causes of child mortality,” it said.