The Agony of Childbirth: One foot on the grave


There is an African proverb that says: “every woman who gives birth has one foot on her grave”.

This gloomily illustrates the danger every woman faces to bring another human being into this world.

Although this proverb is supposed to be a historical fact, sadly this is still true today, especially within the context of the AIDS pandemic where the majority of HIV positive women lose their lives while giving birth, says Miriam Gathingah.

Writing for the IPS News Agency, Gathingah noted that while huge advances in the prevention of mother-to-child transmission (PMTCT) of  HIV have been reported in Africa, there still remains concerns that such efforts have not matched other pillars needed to eliminate maternal mortality caused by HIV and AIDS.

Many of our sisters, wives and mothers lose their lives and that of their babies, and suffer because there is a communication gap, and a problem of rapid intervention and assistance.

A recent report released by Namibia’s Ministry of Health and Social Services on maternal and neonatal deaths indicates that preventing unintended pregnancies among women living with HIV, as well as providing contraceptives for women who need them, are some of the missing pillars. Another pillar is making motherhood safer for all women.

Pregnant women living with HIV die at much higher rates than their HIV negative counterparts, according to the government report.

The study further reveals that HIV increases maternal mortality directly from the progression of the HIV disease itself, and indirectly through higher rates of sepsis, anaemia and other pregnancy-related conditions.

This is bad news at a big scale.

In Namibia, approximately 60 percent of mothers who die are known to be HIV-positive.

The ministry said in its report that all HIV positive women, whether on antiretroviral therapy (ART) or not, are more vulnerable to sepsis and anaemia because of their compromised immune system.

Another problem is that women become infected with HIV during pregnancy at higher rates compared to those who are not pregnant.

Researchers attribute this to biological changes in the woman’s reproductive tract, including the increased blood volume and hormonal changes.

Therefore, there is need to rethink and come up with alternative ways to reach more women and children sooner, thereby saving more lives.

While ART for prevention of mother-to-child transmission of HIV is key to reducing maternal mortality, one should also consider that fighting HIV is not only about pushing medications into health systems, but more about ensuring that women access antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth.

Therefore, an improvement in health care delivery and staff attitudes is highly needed as there are still some health workers who believe that HIV positive women have no right to get medical care, which contributes to the increase in maternal deaths, as many women show up late for antenatal care or deliver at home.

As the Namibia report on maternal and neonatal deaths suggests, there is really a need to put emphasis on strengthening maternal and neonatal health care at community and facility level. In particular, the care needs of HIV-positive pregnant women should be addressed to ensure compliance with HAART and safe and respectful childbirth practice for women with HIV/AIDS.

In conclusion, I believe that by strengthening all the pillars needed to improve maternal health, the African proverb about mothers having a foot on their graves will become history instead of grim reality.

November 2014
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