Maternal Mortality (DEATH)

By Dr. Clarence Addo Yobo

August 22, 2009

The general trend of maternal death is almost always related to the social and economically deprived; lack of adequately suitable healthcare facilities and very few or inadequate distribution of well trained Health care providers-(Doctors and midwives).

The overpopulated slum dwellers who are not educated on the importance of antenatal care rates in our region of the global world are making us look ridiculous during conferences on this topic "Maternal Mortality."

I. The problems are even compounded by superstition and cultural outmoded practices.

II. Some of the many false preachers or prophets are not helping either.

Miseducation of the populace about the healing powers through prayers is rather unfortunate. God had blessed mankind with scientific wisdom and methods to make it possible to reduce the incidence of maternal mortality.

What is Maternal Mortality?

This is defined as death of a mother resulting from obstetric complication of pregnancy state, labour or puerperium (4-6 weeks after birth).

There is the direct death also resulting from exacerbation of pre existing heart, blood and other diseases. The death here refers to the number of deaths that occur during the reproductive process per 100.000 live births.

The Common Causes are :

I. Haemorrhage36%

II. Hypertensive disorder-preeclampsia-Ecclamysia 24%

III. Infections preceded by bleeding associated with abortions (induced/spontaneous) 21%

IV. Undiagnosed extrauterine pregnancy (tubal-ectopic). 5-8%

V. Thrombo embolism, and amniotic fluid embolism

VI. Superstitious believes and habits during pregnancy. Poor diet, indigestion of white clay (Ayilo/shirew)

It is interesting to note that women don’t only go through the ordeal of physiological changes and body disfigurement, but also experience unexpected incidents and death. They are not to be cited as paying the wages of sins, which is death.

The Lord God had endowed mankind with more intelligence to be able to counter most of such catastrophes. It is not the end of the world as stated in Thessalonians 5-2 that;

“The day of the lord will come like a thief in the night or as labour pains upon a pregnant woman.”

Human Scientific wisdom from God had been able to ameliorate labour pains with epidural anesthetics.

Maternal Death- A Historical Perspective in Ghana

Two of such true historical events as told to the author of this article.

My sincerest thanks goes to the late Auntie Gladys Addo of the “Gyae Aware Pup” at Osu. She insisted that some of her listeners put her information down in writing as it related to some of the past historical events in Ghana (Gold Coast)

Maternal mortality was abhorred in many tribal areas of Ghana (Gold Coast). It was a Taboo. It was awful that those who succumbed to death during maternal labour were not given any befitting burial. The remains of the unfortunate mothers and their babies, dead or alive, were dumped in pools and swamps outside the villages at the mercy of Hyenas and other scavengers.

Two of such events are to be narrated here.

I. The Larteh Akonodi Shrine

II. The story of the Makola or Makpo-la market



The Larteh Akonodi Shrine

Lartey, a village in the northern section of Akwapim region had practiced the inhuman abandonment of their dead mothers during labour. Both the dead and few surviving babies were thrown into the swamps, at the mercy of hyenas, crocodiles and other scavengers.

A young woman was once possed by the spirit of the Akonodi god. She ordered for complete abolition of such wicked practices. The people of Larteh complied, but many of them still were scared to keep the babies at home.

They gave the poor orphans up for adoption to infertile couples. Larteh had been well known as the place of adoption of orphans in Ghana.

Akonodi Shrine had been a Mecca for many Black Americans-the followers of Denizula in the early 70’s. It had been a place of counseling for herbal treatment for infertile couples, with fertility dolls for keeps for psychological therapy.


Makola Market (Makpola)

Some Ga traditional groups practiced the same inhuman customs, using the Korle Lagoon extension as ceremonial swamp for dumping the unfortunate mothers and moribund babies. The vicinity can be plotted currently around the Zongo Lane, UAC and the Makola I market -now Rawlings Park.

Markola (B)

Dr. Sir Selwyn Clarke a Physician representative of the then King of England found such practices very repulsive, inhuman and unacceptable.

Sir Selwyn instituted an executive order for the immediate cessation of such ghoulish and primitive practices. He ordered for complete obliteration of the area by filling the swamp with gravel brought down from the Nsawam hills.

This created jobs for the unemployed from different parts of the country. A pail of the gravel was worth one penny. A market was finally installed at the spot in honour of the dead mothers.

The  swamp graves were invaded by tourists from  neighbouring Togo and Dahomey, particularly to collect free human bony parts for their shrines. The spread of the news was all over the West Coast.

It is believed that the market built by Sir Selwin Clarke got its name from the Ewe expression, Makpola; i.e, for “your eyes only” or “come and see” or “seeing is believing”.

For superstitious reasons, the “Makola “ market was unappreciated by the Ga inhabitants and therefore they  boycotted the market stalls in its entirety. The market stalls were taken over by other tribes from other parts of the country.

Sir Selwyn even went further to build another market to appease the Ga tribal groups at the former Slave Market spot, Salaga -Salaha market, now Selwyn Market. The Makola (Makpola) market stalls were often times visited by snakes, crabs and snails which many at the time considered as witches and wizards.

But it was only natural that the former swamps and pools had been the habitat of such creatures. Most Accra dwellers in their 40’s by age quite remember the monumental statute of Dr. Sir Selwyn Clarke at the 1st Gate of Makola I market. It was unfortunately demolished by actors of the 1981 coup; now Rawlings Park.

The way forward to reduce the spiraling rate of maternal mortality in Ghana should be tackled very seriously. The mortality rates in some countries, as of 2007, could be mentioned here.

Sweden  =  4-5 per 100,000 births

UK  =  5-6 per 100,000 births

USA  =  6-8 per 100,000 births (influx of immigrants from 3rd world countries being responsible for the increase)

Ghana  =  about 680 per 100,000 births

Bokina Faso  =  1,500 per 100,000 births

Afghanistan  =  1,500-2000 per 100,000 births

Some Pearls of Practical Solutions to reduce the alarming Rate of Maternal Mortality in Ghana

We should give accolades to our rural lay midwives for doing their very best for our pregnant mothers during their difficult times. Kudo’s to my late maternal grandmother “OHENEWA” who delivered my twin sister and me with no damage to us including my late mother.

The following are some of the suggestions I have been pondering over.

i. Rural and city communities should be educated on what pregnancy and delivery is all about. Television are now available in almost every area of Ghana. Current audiovisual tapes are available.

ii. Rural Hospitals and Health care facilities should be equipped for safe obstetrical procedures. Such facilities should be well inspected and approved by the Health department before licensing.

iii. The Health care Centre should have highly skilled health care providers viz Midwives and Doctors.

iv. Education programmes on good nutritional habits particularly during pregnancy.. ...Abstinence from eating clay; chalk, ayilo, etc.

v. Blood donation and adequate blood storage facilities for bleeding incidents.


CAUTION:

Transferring the newly trained doctor after one year internship to rural areas could be very risky. Our rural dwellers need equally good healthcare, intensive training skills for about 2 years is advisable.

Orientation through Pediatrics, Obstetrics and Gynecology basic general surgical skills to enable the young doctors to handle emergency cases should be mandatory. Treatment of simple bone fractures, fire and chemical burns should be part of the training.

Rural and slum dwellers should be requested to pay token fees towards the maintenance of the environmental facilities. This is not a revival of “cash and carry” system. It is a humble appeal to dwellers to save a fraction of the amount spent on cellular phone cards for their own benefit.

Citizens with good resources should be encouraged to contribute significantly towards the health system, with tax benefits for them from the Central Government.

Churches and Mosques and shrines should be part of the venues for education on maternal death.

Training of paramedics and physician assistants, with adequate orientation, could compliment the health care procedures. Strict limits to their comradeship, practice or partnership must be spelled out to them. Abortions either surgical or medical procedures will be prohibited.

Hopefully with some of the above suggestions, the spiraling appalling rate of Maternal Death in Ghana will be reduced considerably. God bless Ghana and Ghanaians.

Dr. Clarence Addo Yobo