Lack of resources affecting interventions
Despite some success by Africa in achieving much of the Millennium Development Goals (MDGs), improved maternal heath has proved the hardest to deliver.
The fifth development goal sought to reduce the maternal mortality ratio by three-quarters between 1990 and 2015. Despite modest improvements in some areas, Africa falls short of the set targets. The continent still has the highest number of maternal deaths in the world. In 2013, for example, of the total 289,000 maternal deaths reported worldwide, 62% of these occurred in Africa, according to the World Health Organisation. This is about 800 women dying each day due to complications from pregnancy or childbirth.
Maternal mortality in Africa is largely associated with three kinds of delays during the childbearing process – delay in seeking healthcare, delay in reaching caregivers, and delay in receiving care, according to the MDG Report 2015: Lessons learned in implementing the MDGs. The report, released in September 2015, was co-authored by the UN Economic Commission for Africa (ECA), African Union (AU), the African Development Bank (AfDB), and the UN Development Programme (UNDP). Simple healthcare interventions such as antenatal care and having skilled care during and after childbirth could help prevent these deaths.
Although the use of contraception would reduce the number of unplanned pregnancies, unsafe abortions and maternal deaths, the irony of unmet needs for contraceptives for women aged 15-49 in Africa is disturbing. The ensuing acute shortage of contraception means that women who want to prevent or delay pregnancy are not able to. Adolescent childbirth has also been a cause for alarm, considering its harmful consequences on both the girls and the babies they bear.
In addition to these challenges, the absence of accurate and reliable maternal mortality data further complicated the successful implementation of this MDG, as it was difficult to know which interventions to prioritize or whether the interventions were working or not.
The road to safe motherhood with access to sexual and reproductive healthcare in Africa has been long and bumpy, with missed targets and lack of follow-through on the promises made to fund the implementation of the agreed programmes. A year after the launch of the MDGs in 2000, African heads of state and governments signed the Abuja Declaration in Nigeria and pledged to allocate at least 15% of their annual budgets to the health sector.
An assessment of the progress after 10 years showed disappointing results, with WHO reporting that only three countries were on track in meeting the health MDGs, while 27 countries made insufficient progress or none whatsoever. Twenty-six countries had scaled up government spending on health but by 2010, only Tanzania had allocated the pledged amount — at least 15% of its budget to health. In fact, 11 countries cut government spending on health during that period and in another nine countries, progress had completely stalled.
In the midst of insufficient funding to implement health programmes overall, maternal health was the first casualty. Since 2001, several regional and national initiatives and campaigns have been initiated to specifically support Africa’s efforts towards achieving the maternal health goal. These include the Maputo Plan of Action in 2006 by 48 African countries to ensure universal access to comprehensive sexual and reproductive health services on the continent. The African Union launched a major campaign to accelerate the reduction of maternal and child mortality, which has been enacted in 40 of the 53 AU member states. There are also other regional and national initiatives and campaigns on saving mothers in Africa.
These efforts seem to have borne some fruit. Africa reduced its maternal mortality ratio from 870 deaths per 100,000 live births in 1990 to 460 in 2013, a 47% reduction, although still short of the target.
Some steps forward
Between 1990 and 2013, four African countries – Cape Verde, Equatorial Guinea, Eritrea and Rwanda – reduced maternal mortality ratios by over 75%, according to the UN ECA report.
Countries like Angola, Egypt, Ethiopia, Morocco and Mozambique also did well and reduced their ratios by 60%. Those with a slight improvement of less than 10% were Côte d’Ivoire, South Africa and Zimbabwe. Countries affected by conflict such as Burundi, Chad, Democratic Republic of the Congo, Sierra Leone and Somalia reported exceedingly high maternal mortality ratios.
Shockingly, Mauritius, which usually leads in economic indicators, actually increased its maternal mortality ratio by 4.3% (70% in 1990 to 73 % in 2013), according to the report.