Wednesday, October 20, 2010

[pima.nius] Pacific child and maternal mortality rates not all doom and gloom, say analysts

12:21 PM |

Pacific child and maternal mortality rates not all doom and gloom, say analysts


While child and maternal mortality rates worldwide are a concern – and much needs to be done – commentators say the Pacific region is on track, considering the geographical, financial and cultural challenges it faces.

Pacific Scoop:
Report – By Dominique Fourie.

In Fiji alone, 15 infants in every 1000 are dying every year. In Papua New Guinea, the figure is 52, in Samoa, 21.

Grim figures? Some analysts argue that the statistics are not always as bad as they seem. Important child mortality initiatives are under way in the Pacific and having a positive impact.

The White Ribbon Safe Motherhood Initiative, established in Fiji to promote public awareness of the need to make pregnancy and childbirth safe for all women in Fiji, has just celebrated its first anniversary.

The initiative targets women of reproductive age, but also family decision makers, community health providers, birth attendants and policy makers.

In 1987, the World Health Organisation estimated the number of women suffering maternal deaths worldwide was at least 600,000 each year, almost all of these deaths occurring in the developing world.

By 2005, and despite numerous medical advances, that figure had barely moved, meaning more than one maternal death is happening worldwide every minute.

Governments in the United Nations General Assembly voted for the reduction in maternal mortality as one of the eight Millennium Development Goals, a series of objectives aimed at providing aid to key issues such as education and poverty, to be met by 2015.

'Insufficient progress'

In 2009, the United Nations released a report outlining levels and trends in child mortality. The report showed the Pacific region still experiences 59 deaths per thousand births annually.

This figure has reduced from 76 deaths in 1990. Despite the reduction, the UN deemed this "insufficient progress".

The Safe Motherhood Initiative was launched by the World Health Organisation in 1987 to promote awareness of maternal death and to help achieve the MDG by 2015. The initiative was immediately supported by the International Confederation of Midwives (ICM).

The ICM's clear message in the campaign for Safe Motherhood is that care during childbirth from an attendant with midwifery skills is the single most effective way to reduce maternal death.

Professor Lesley Barclay, director of the Northern Rivers University Department of Rural Health for Sydney University, says one of the biggest problems the Pacific region faces is a lack of specialist care.

"There are not enough midwives in the Pacific Islands, and that is certainly true in the areas where I have worked," she says.

There has not been enough good quality education programmes offered frequently enough. When midwifery is a relatively small component of the health workforce, it's very difficult to run a good quality training programme.

Collaborative approach

"We've had discussions in the Pacific for about 15 years about getting some sort of collaborative approach for midwifery training and for specialist nursing training. And it's really overdue. There needs to be university-level, specialist and health-worker training for the smaller components of the workforce.

"If you're talking about a general nursing programme where you can train 20 or 30 people a year or more, that's fine, but if you need 20 or 30 midwives trained every 5 or 10 years, it's very difficult to put a sustained programme in."

Dr Tema McCaig, gynaecological specialist the Colonial War Memorial Hospital in Suva, told the Fiji Times that a majority of women in Fiji do not plan their pregnancies, and because of this, they avoid going to hospital.

"They end up missing their clinics and they are unaware of the fact they have a complication," Dr McCaig says.

And Professor Barclay says almost all maternal deaths occur from complications in childbirth, but this fact is not specific to the Pacific.

"Certainly in my recent experience, I know from one of the recent inquiries I've done, some deaths could have happened in a large capital city like New Zealand or Australia. They were inevitable.

Geographical obstacles

But in the Pacific, geographical obstacles can make the situation much worse.

"Particularly in the Pacific Islands and its mountainous regions, there's an absence of ready evacuation, people can get into difficulty and find it hard to get good emergency care. Remote dwellings, or living on a small island where the only access is by boat, and if the seas are high you may not be able to get out. So there are some things that affect you no matter where you are. Sometimes it's just very difficult to get help in an emergency.

"In many of the Pacific Islands, there's only very, very limited obstetric specialist care, and that's what is necessary if you get into an emergency.

"You can have excellent primary health care at the village level which might be provided by a midwife, but when you get into an emergency situation, you need obstetrician, you need an operating theatre, you need a blood transfusion, and those are not necessarily readily accessible.

"You also need a good quality of care, because complications can arise from care itself if it's not administered properly."

Retired Pacific academic Professor Crosbie Walsh, formerly director of development studies at the University of the South Pacific, is wary of the bleak statistics.

"The White Ribbon campaign is a good campaign and there does need to be improvement in the Fiji stats, but like all campaigns it tends to overstate the negative in the hope of attracting more support. In Third World terms, the Fiji stats are not all that bad."

Professor Barclay says there is a lot of effort being made by Pacific Island governments to look at the deaths that occur, and establishing what could have been done to avoid them.

Careful reviews

"Fifteen years ago in the Pacific there was very little review of death. Now there's a very careful review of deaths to make sure the quality of care provided by health professionals is very good, and if there are any lessons to be learned, certainly in the larger Pacific Islands like Fiji or Samoa, that those lessons are learned."

Also, since awareness on child and maternal mortality was raised by the UN, Professor Barclay says nations are getting better at recording the numbers of child and maternal deaths.

"It's called ascertainment. So in the past, from Melanesia through to the Pacific Islands, women have died, particularly in remote islands or in mountainous regions, and that hasn't necessarily been reported, or hasn't necessarily been classified as a maternal death," she says.

"So we've got better recording systems starting to operate, and better investigation and monitoring. So the first thing that happens quite often when you get those systems is it looks like you have an increased death rate which may in fact be a more correct reporting of those deaths when perhaps they were not recognised in the past.

Asked whether the World Health Organisation was doing enough to improve the situation in the Pacific, Professor Barclay said that the responsibility lay equally with the countries involved.

"The World Health Organisation is a very limited organisation with very limited funds. It's not a large aid donor that can give lots of money to countries. What it does is provide specialist technical advice.

"I know in relation to midwifery, it's being approached by Samoa at the moment, and that sort of advice and wisdom is very helpful, and that sort of encouragement to try and look at how a combination of outside technical advice with what is available locally can be advantageous.

"We have to look at collaboration because of the size of the islands. Those partnerships need to be developed to provide the depth that will ultimately make the difference at a professional level to reduce those deaths."

Dominique Fourie is a Postgraduate Diploma in Communication Studies student on the Asia-Pacific Journalism course at AUT University.

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