Global Policy Forum

By Brian Ligomeka

With one in every 15 pregnant women dying from pregnancy and delivery complications, giving birth is risky business in Malawi.

Doctors say women are dying as a result of loss of blood, inexperienced birth attendants and limited resources and drugs. When 24-year-old Melise Chisale went into labour she was rushed to the local village birth attendant. Melise lives 40 kilometres away from Malawi's commercial city of Blantyre and could not afford to hire a car to take her to hospital.

Her husband, a small-scale farmer, was not even present at home to arrange for any form of transport. Hers was a complicated labour. Since the birth attendant was not trained professionally she failed to stop the bleeding. Four hours into labour Melise died, along with her baby. Melise is not the only woman in the country to die of pregnancy related complications, health authorities say out of 100,000 pregnant women, 1,110 die as a result of birth complications.

Malawi's director of clinical services Dr. Rex Mpazanje attributes the deaths to women having babies either too early or too late and traditions that demand a husband's permission before the wife can go to a hospital. "These numbers are comparable to about eight buses full of passengers crushing in just thirty days. But, while such accidents will get prominence in press reports, the death of women caused by pregnancy complications is never highlighted. In the media women die a quiet death," says Mpazanje.

He says the maternal mortality rate is one of the highest in the sub-Saharan region. Malawi is also ranked as one of the countries with high maternal deaths in the world. For every woman who dies as a result of maternal complications, between 20 and 30 more suffer short and long-term disabilities. This means in the next ten years a large number of women will become infertile.

Studies have indicated that poor maternal health is dramatically reducing the capacity of Malawian women to work and thereby constraining their ability to generate income and grow out of poverty. The five major causes of maternal mortality in the country, says Mpazanje, include haemorrhage, infections, unsafe abortions, high blood pressure and obstructed labour. Problems such as HIV/AIDS, malaria and anaemia seriously contribute to maternal and infant mortality as well.

Then there is the issue of blood. "About 30 percent of maternal deaths in Malawi are due to haemorrhage. Once blood is missing in the system, as has been the case in the past, many women die," he says. The problem of pregnancy and its outcomes have not been highlighted in the country. "The women and the community who are at risk have not been sensitised enough to appreciate that every pregnancy carries a risk of death and because the system is not well prepared for possible emergencies, the chances of death as a result of pregnancy complications are very high," says Mpazanje. Although people are culturally aware that pregnancy carries a risk, they still think it is God's plan because they have never known that there is a solution. "Communities have never had the capacity to address these problems but now we have the right information, we know better so we should be able to educate people in all sectors to take up their roles so we can save the women," he says.

Martha Bokosi, project manager for Safe Motherhood in Malawi, says illegal abortions are also killing a lot of young girls in the country. She says that there have been times that almost half the women admitted to gynaecology ward at the country largest health facility, Queen Elizabeth Central Hospital, were treated for botched up back street abortions. Bokosi says recently of 4,700 women admitted to the hospital in Blantyre, 2,500 had had abortions on the streets. Abortion is the most common reason for admission to gynaecological wards at Malawi's major hospitals, she says. Bokosi states that 25 percent of back street abortion patients are teenagers under 19; while up to 30 percent of the women die from severe bleeding and infection.

Abortion is illegal in Malawi and Bokosi says teenagers, desperate to get rid of unwanted pregnancies, often try to induce a miscarriage by taking the anti-malaria drugs but instead die of an overdose. Others go to abortionists who are known to use objects like wire coat hangers to remove the foetus. Malawi Secretary for Health Richard Pendame admits illegal abortions are a 'big problem'. What we see in the hospital is simply the tip of the iceberg. The situation is really bad. We are losing a lot of girls, says Pendame. "Abortion in the country is allowed within certain limits, like when a mother's life is at risk," he says.

Police spokesperson George Chikowi says women permanently damaged during illegal abortions are too afraid to report the case for fear of prosecution. Families of women, who die after an abortion, are also afraid to go the police. Chikowi says that as abortion is illegal everyone fears to report it. "People know that abortion is a serious offence which is punishable by law," he explains. But Bokosi says if abortion was legalised, desperate women, who would put a strain on hospital staff and medical equipment, would flood hospitals.

Executive director of the Malawi Human Rights Commission Emiliana Tembo says abortion is wrong and violates human rights. Tembo says abortion should only be considered when the life of a pregnant woman is threatened. She says that terminating pregnancy just for the sake of it is wrong because it denies the unborn baby is right to life. "A child is supposed to be protected and nourished from conception. The constitution has a provision where every human being has a right to life. Abortion denies the baby this right," says Tembo.

Malawi's Deputy Minister of Health and Population, Elizabeth Lamba believes education should begin in the homes since every one has a role to play in preventing maternal mortality. "The nutrition of the girl-child and education are important since these will later on empower her economically and socially to make her health better.

Men must be informed about the importance of family planning," says Lamba. Women's lives are also put more at risk when they have big numbers of children. Statistics show that the total fertility rate for every woman is about seven children. Bokosi, however, told IPS that with financial and technical support from Britain, Malawi government has embarked on a six-year programme, which is training clinical, and midwifery personnel safe motherhood skills. She said that the project has also facilitated the building and renovation of hospitals and health centres, provision of ambulances, telephones and radios. "The project also helped increase awareness in the districts about safe motherhood through messages. We have also managed to sensitize the communities on some tradition that contribute to maternal deaths," she said.

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