Article: Maternal Mortality and Africa’s Internally Displaced Persons

Crosslinked at Future Challenges Organization’s blog and at my other blog:

Internally displaced people (IDP) face a very specific set of dangers. In addition to susceptibility to famine in conflict zones, IDPs also deal with lessened (or near-non-existent) access to basic amenities like clean water sources, food sources and medical care. Lessened access to medical care is a major factor in maternal mortality rates among internally displaced populations.

There are an estimated 11.8 million internally displaced people on the continent of Africa according to the United Nations (“Internal Displacement: Global Overview of Trends and Developments in 2006”). Internal Displacement Monitoring Centre (IDMC). April 2007)  The creation of internally displaced populations in areas like Chad, Democratic Republic of the Congo, Côte D‘Ivoire‘s western regions, Kenya (250,000 – 400,000, post 2007-elections), Sudan (5-6 million) and Somalia (about a 1 million due to civil war) is usually attributed to weak governments and armed conflicts.

Among internally displaced persons, there is generally a lack of civil registration. In Sudan and Somalia, these problems might be pronounced due to governmental disputes or the absence of a government.  Additionally, geographic location plays a role here; rural areas further removed from major administrative centers. Lack of viable government-issued identification papers also hinders access to legal recourse in the event of a crime. It may also hinder sustained access to medical care. Without identification documents, it is difficult to monitor patients or keep records. Considering that most births take place in a place of residence, it is even more difficult to track live births and maternal mortality. The health practitioner-to-population ratio in Sub-Saharan Africa is reported as 1:23,540 on average. The range is from 1:750 in South Africa to 1:72,000 in Rwanda. The nurse-to-population ratio is 1:3,460; with a range from 1:600 in Zambia to 1:5,470 in Tanzania (Howson, Harrison, and Law 1996).

About 60% of maternal deaths occur during childbirth and in the postpartum period.  Approximately 50% of these deaths occur within 24 hours of delivery.

„In a recent study in Eritrea, 16 percent of maternal deaths occurred during pregnancy, 48 percent during childbirth, and 36 percent postpartum (Ghebrehiwot 2004). These findings imply that the causes of the deaths in this critical period are either the result of labor or worsened by labor and delivery.“ (Source: Disease and Mortality in Sub-Saharan Africa. 2nd edition. Jamison DT, Feachem RG, Makgoba MW, et al., editors. Washington (DC): World Bank; 2006.).

The maternal mortality rate is the ratio of maternal deaths over live births times 100,000.  Another measurement of maternal mortality is the number of maternal deaths over the number of women aged 15-49 times 100,000. Factors in maternal mortality include:

Malnutrition-Infection Syndrome

  • Vitamin deficits: Lack of micro/macro nutrients in a woman‘s diet leave her physiologically unprepared for pregnancy. For many women, these deficiencies present as some form of anemia.

HIV/AIDS

  • In Eastern and Southern Africa, between 20-30% of pregnant women are infected with HIV.
  • Available evidence indicates that HIV/AIDS currently accounts for at least 18% of maternal deaths. Causes of death include opportunistic infections, puerperal sepsis, meningitis, tuberculosis, pneumonia, post abortion sepsis, encephalitis, and probably malaria (Mbaruku 2005Pattinson et al. 2005).
  • HIV is noted to cause anemia during pregnancy.
  • Note: HIV is not a primary cause of death unless a mother is diagnosed with AIDS.

Unsafe abortions

Post-abortal septsis:

Post-Partum Hemhorrage:

  • Post-partum hemhorrage accounts for nearly 25% of maternal mortality on the African continent.

In response to these figures, it makes sense to promote sexual education and awareness of contraceptive methods while working to mitigate the situations that make women and girls part of vulnerable populations.  Solutions designed to lower maternal mortality rates should work in lock-step with efforts to resolve conflict peacefully and rebuild and fortify existing infrastructure within nations with large internally displaced populations. Non-governmental Organizations like Doctors Without Borders are necessary, but not a sufficient response to the lack of access to medical care in parts of Africa.  It will be necessary to have more indigenous doctors with lower turnover rates and more investment into the improvement of the plights of women and children in the area.

It is difficult to talk about the role of governments in the case of Somalia, where there has been no viable government since 1991.  Sudan also presents difficulties as it is now in the middle of a referendum on whether the country should split between the northern nd southern regions.  In the Democratic Republic of the Congo,nearly 20 years of civil war has undermined the Congolese government severely. However, in the cases of Chad and Côte D‘Ivoire, there is potential for effective action to prevent and decrease maternal mortality among internally displaced populations.  These actions may include allocation of funds to building hospitals and clinics in high-need areas.  Additionally, the issuance of civil registration of vital records and the bolstering of pre-existing healthcare systems are necessary steps to be taken.  The passage of laws ensuring the legal protections of internally displaced populations and their rights should be accompanied with proactive and adaptive policies regarding the specific needs of this demographic.

2 Comments

  1. This is a great piece which opens the eye to the truths. It may sound like statistics but when you live in Africa, you will truly appreciate the realities. Our mothers matter and I hope with time, education and political commitment will make everything better for them. Worth the read.

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