Tackling maternal mortality in Africa after 2015: What should the priorities be?

May 27, 2021, 10:17 AM

At the dawn of the new millennium, 189 member states of the United Nations signed the millennium declaration and committed themselves to eight goals (MDGs) for achieving global development parity in the first 15 years of the millennium.

Maternal mortality was on the agenda as the fifth goal (MDG5) to reduce by three quarters, between 1990 and 2015, the Maternal Mortality Ratio (MMR) and to achieve universal access to reproductive health.

To date, Africa accounts for the highest proportion of global maternal mortality estimates, with up to 56 per cent of recorded global maternal deaths occurring in the continent. While a woman’s chance of dying during pregnancy is currently placed at 1 in 42 in Africa, it is only 1 in 25,500 in a developed country such as Greece. Sub-Saharan Africa also has the lowest proportion of women attended by skilled birth attendants at the time of delivery.

While some African countries have made progress in achieving MDG5, several others are still struggling to make significant impact. Of the 10 countries that were reported to have achieved

MDG5 in 20101, at least five were in sub-Saharan Africa. These include Equatorial Guinea that achieved an impressive 81% reduction, Egypt, Eritrea, Cape Verde, and Rwanda. By contrast, although a country such as Nigeria achieved a 41 per cent reduction in maternal mortality during the period, due to its large population, its over 40,000 estimated maternal deaths still accounted for 14 percent of global mortality estimates. Indeed, Nigeria, India and four other countries (Pakistan,

Afghanistan, Ethiopia and Democratic Republic of Congo) currently account for 50 per cent of the total global estimates of maternal mortality.  

These results call for deeper reflections on the nature of the challenges that lie ahead. It points to the fact that maternal mortality will remain a daunting and unmet problem in development in sub-Saharan Africa after 2015. The countries which have recorded successes in reducing maternal mortality provide a glimmer of hope indicating that this goal can be achieved if greater enthusiasm is devoted to addressing the problem in the continent. Maternal mortality is currently one of the most important indicators for measuring human development. As such, going forward its prevention should be firmly rooted in the development aspirations of African nations. A post-2015 agenda is being proposed that will guide African countries in thinking about ways to improve the health of women and prevent maternal deaths.

The technical information and best practices needed to improve maternal health and reduce maternal mortality are well known.  However, what has been lacking is the knowledge and determinism to implement and entrench these practices and develop a strategic approach and framework to make them work in African settings.  Several systemic factors account for the persisting high rate of maternal mortality in Africa, which need to be addressed through 2015 and beyond if significant impact is to be made. These include: the lack of political commitment to address the  issue, inadequate provisions made to promote human development despite high economic growth rates achieved in the region over the past 10 years, poor quality of governance and accountability in some countries with negative consequences for  health systems development, pervading high rates of poverty, the socio-economic and political disempowerment of women, and continuing prevalence of harmful traditional and cultural norms and practices that are disadvantageous to women.

Indeed, policymakers in many sub-Saharan African countries are yet to demonstrate the necessary political will and commitment to address maternal health and to prevent maternal deaths. This is either due to a lack of proper understanding of the problem or to a low level prioritization of the issue. In a continent where countries often grapple with how to allocate scarce resources to address multiple problems, the prioritization of resources to address specific issues can be challenging. In many low income countries, resource allocation for health, especially for maternal health is often problematic as this is often not seen as a “visible” form of development for which politicians would gain immediate benefit. As an example, many African countries are yet to devote substantial financial resources to health to address recurring problems such as maternal mortality reduction.

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