Maternal mortality in Ghana: The sad reality of how women lose their lives in childbirth

He went further to disclose that there has been a notable decline in the death rate over the last five years, from 1.42 per 100,000 to 0.45 per 100,000, suggesting a significant decrease in the rate.

"Our institutional maternal mortality has dropped from 875 deaths in 2018 to about 809 in 2022. And this for mortality looks like a very significant relation but for the maternal mortality, that’s quite significant, especially when your deliveries have moved from about 9000 to increase over the years by about 13%, and we still are able to maintain a significant reduction in deaths," the Chronicle Newspaper quoted Kuma-Aboagye as saying.

However, despite the positive downward trend of maternal mortality, more deliberate efforts, investment, and political will are needed to alleviate the problem to the barest minimum.

What is maternal mortality?

The World Health Organisation (WHO) defines maternal mortality as deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

There is also late maternal death, which is “the death of a woman from direct or indirect obstetric causes, more than 42 days but less than one year after termination of pregnancy.” Like maternal deaths, late maternal deaths also include both direct and indirect maternal/obstetric deaths.

Causes of maternal mortality in Ghana

It has been established that inadequacy of trained birth attendants, limited access to healthcare, bleeding, infection, unsafe abortions, socioeconomic situations, and hypertensive problems are among the major causes of maternal mortality in Ghana.

A five-year Retrospective Study conducted by a team of renowned doctors—E. M. Der, C. Moyer, R. K. Gyasi, A. B. Akosa, Y. Tettey, P. K. Akakpo, A. Blankson, and J. T. Anim—and published in the Ghana Medical Journal (GMJ) in December 2013 discovered various factors responsible for high maternal mortality in Ghana.

The doctors used autopsy results to assess maternal mortality causes in Southern Ghana. Pregnancy-related deaths were examined in the autopsy logbooks of the Korle-Bu Teaching Hospital Mortuary's Department of Pathology from 2004 to 2008. SPSS statistical software was used to examine the data once they were added to a database.

“Of 5,247 deaths among women aged 15–49, 12.1% (634) were pregnancy-related. Eighty-one percent of pregnancy-related deaths (517) occurred in the community or within 24 hours of admission to a health facility, and 18.5% (117) occurred in a health facility. Out of 634 pregnancy-related deaths, 79.5% (504) resulted from direct obstetric causes, including: hemorrhage (21.8%), abortion (20.8%), hypertensive disorders (19.4%), ectopic gestation (8.7%), uterine rupture (4.3%), and genital tract sepsis (2.5%).

"The remaining 20.5% (130) resulted from indirect obstetric causes, including: infections outside the genital tract (9.2%), anemia (2.8%), sickle cell disease (2.7%), pulmonary embolism (1.9%), and disseminated intravascular coagulation (1.3%). The top five causes of maternal death were: hemorrhage (21.8%), abortion (20.7%), hypertensive disorders (19.4%), infections (9.1%), and ectopic gestation (8.7%),” the study found.

The team of doctors recommended that “community-based studies, on maternal mortality,” were “urgently needed in Ghana since our autopsy studies indicate that 81% of deaths recorded in this study occurred in the community or within 24 hours of admission to a health facility.”

Geographical dynamics

Mostly, the majority of maternal mortality cases occur in rural and hard-to-reach communities where access to healthcare facilities and education on antenatal dos and don’ts during pregnancy are low or completely non-existent in some cases.

Mrs Eunice Tanowah Appiah Boame, Senior Midwifery Officer who doubles as the Incharge of the Antenatal Unit of the Manna Mission Hospital in Accra Pulse Ghana

Mrs Eunice Tanowah Appiah Boame, Senior Midwifery Officer who doubles as the Incharge of the Antenatal Unit of the Manna Mission Hospital in Accra, told Andreas Kamasah in an interview that where a pregnant woman is located in Ghana may partly determine whether she will have a safe delivery or not.

“Some of the health centres in the hinterlands, their roads are bad. Sometimes, we see it in the media space. A pregnant woman is being carried in a wheelbarrow. Some people sit on a motto just to assess a health facility in a higher hospital.

"Maybe she's in hospital A, which is a health centre or a cheap compound and now has to be moved to hospital B, which is a referral point. Because they are in the hinterland, access to road and ambulance services are not available,” she lamented.

She, however, added that some pregnant women voluntarily or due to financial and other constraints fail to visit the hospital for antenatal care, which poses a danger to their lives and those of their unborn babies.

“They rather go to those people who are not professionals or who are not skilled to deliver. And such people may not be able to determine when complications are coming, and you can lose your life through that.

“So, we encourage that all pregnant women should also do themselves good by attending hospitals so that they will be attended to by a skilled health professional.”

She emphasised that hospital attendance during pregnancy should not be compromised for anything because it is where the state of the pregnancy is established for proactive action to be taken to save the lives of the baby and its mother.

“If it is outside the uterus, how will you know? And it's also an obstetric emergency because the moment it ruptures, most women die out of ectopic pregnancy just because they don't seek any health intervention.”

How some religious leaders contribute to maternal mortality

Mrs Boame cites religious extremism as one of the causes of maternal mortality, as some women refuse to undergo Caesarean Section even when their situation is dire, and it is the only option for safe delivery. According to her, some religious leaders make their church members believe that CS is evil, so they prefer dying to undergoing it for fear of committing a sin against God.

“Sometimes the way they advise members also brings about difficulties when you're even trying to help them. Because last year we had a case, a woman was booked for CS. She didn't come for the CS, went to church and delivered and died all because she didn't want to have CS,” she recounted.

"How can you entrust your whole life into somebody who is not trained?”

She urged women and the general public to desist from seeing and making CS look evil, adding that it has come to augment the natural childbirth method. In her estimation, in the absence of CS, a lot of women would die avoidable deaths in a bid to bring forth lives.

“They think that one is from the devil. So, when they pray, they say I cancel Cesarean Section in Jesus' name. “Can you imagine if a baby is coming with their legs, a baby who is lying in between the mother's womb - that is the transverse or a baby who is very big? How do you deliver such a baby naturally without the help of CS?” Mrs Boame quizzed.

Brain drain

Ghana, just like other countries across the globe, has a sustainable development goal to reduce maternal mortality ratio to less than 70 per 100,000 live births by 2030. However, as if other factors that threaten the attainment of that goal are not enough, a lot of the country’s experienced midwives and nurses, doctors, and other health workers of various specialties within the health sector have been leaving in their numbers for greener pastures abroad due to poor conditions of service here.

While some analysts and the Ghana Medical Association see it as a threat to the country’s healthcare delivery system, the government says it would have no impact.

“Sometimes you can go to a health facility, all experienced ones are going and the work comes with experience. What an experienced nurse or midwife will see, a junior colleague may not see it. “So, it will get to a time, people who help us serve our women may all be gone for greener pastures,” Boame predicts.

She urged the government to pay attention to what is causing the brain drain and initiate measures to halt it before the situation gets out of hand, rather than downplaying its consequences on the health sector.