confidential enquiries into maternal deaths in South Africa, Saving Mothers
Report
19 September 2006
It gives me great pleasure to address you this morning as we discuss the
critical issue of the health of mothers in our country.
This is one of the groundbreaking works that we have been involved in as a
country. I do not know of any other developing country that not only records
maternal deaths, but goes on to investigates the causes with the aim of
preventing these unfortunate incidents.
We should be confident as South Africans of the work we are doing in the
health area, which unfortunately sometimes puts us in a negative light. We
note, for instance, that the World Health Organisation (WHO) has finally
endorsed indoor residual spraying using DDT as an important intervention in
addressing the challenge of malaria. We have been the sole voice defending this
intervention at an international level, despite the strong opposition and
pressure to move away from this position.
We welcome the new position taken by WHO and will continue to use this
intervention in a controlled manner to support our efforts to eliminate malaria
in our region. I am sure we all appreciate the impact that malaria has on
health particularly of pregnant women and children.
While we remain part of the global community, we should be confident and
defend the positions we take as a nation in responding to our health challenges
in a manner that is relevant to our local realities. Sometimes our approaches
may not be popular amongst certain role players. But we need to remain focused
on our conviction to improve the health of the people of our country and the
continent.
When we attained our freedom, many laws and policies were put in place to
improve the lives of the people of South Africa, including free health care for
pregnant and lactating women and children under the age of six years. Regarding
maternal health, the Choice on Termination of Pregnancy Act of 1996,
notification of maternal deaths, as well as the confidential enquiries into the
maternal deaths process are some examples of the policies that we introduced to
improve the quality of life of the women of South Africa.
The implementation of the Choice on Termination of Pregnancy (CTOP) Act has
had a positive impact on the lives of women. Access to termination of pregnancy
services has improved remarkably. A study commissioned to evaluate the health
impact of the CTOP Act of 1996 in 2000 showed that there was a significant
reduction in morbidity from complications of incomplete abortion compared to a
similar study conducted in 1994.
In addition, the confidential enquiries into maternal deaths indicate that
there has been a reduction in deaths resulting from unsafe terminations of
pregnancy. Before the implementation of this Act, it was estimated that 425
deaths occurred each year in public facilities from unsafe abortion. Deaths
from unsafe abortion reported by the Saving Mothers' reports one and two (which
covers Confidential Enquiry of 1998 and 2002) were 32 and 40 per respective
years.
The policy on free health care services has had a positive impact on access
to reproductive health services. About 94% of women attend antenatal care at
least once during pregnancy and over 84% of women deliver in health care
facilities. We have also made significant strides since we set up the
confidential enquiries into the maternal deaths process. It is however of great
concern that maternal mortality remains high in South Africa. This is
particularly concerning as access to health care services does not seem to be a
problem.
The questions we have to resolve are:
* Why then are numbers of maternal deaths still high when the majority of
women access care?
* Where are we getting it wrong?
* Is this a reflection of lack of necessary skills on the part of our health
care professionals?
* Or is it a reflection of lack of the essential tools to facilitate care by
our health care professionals?
* Is it simply an attitudinal problem and lack of support for the health care
professionals?
I am asking these questions because I could not get a clear answer, even
from the avoidable factors, where we are missing the boat. I hope your
deliberations will come up with strategies that will respond to some of these
questions and facilitate the improved care of women. We should ensure that all
women who present themselves for care in our facilities get the best care
available. I am sure with your help and commitment we can achieve this.
We have to particularly address the point raised in the report that a
significant number of deaths could have been avoided.
The report makes recommendations on how some of these challenges can be
addressed. We need to consider these recommendations within our policy
development processes and intensify efforts in rectifying any shortcoming that
may be existing within the health care delivery system to prevent these
incidents. We have to ensure that preventable deaths are eliminated within the
health system.
We know that it is possible to reduce the magnitude of both maternal and
perinatal morbidity and mortality in countries with limited resources. The
report before us has assisted us to understand what is causing both perinatal
and maternal deaths, as well as what needs to be done to improve the situation.
The recommendations of the Saving Mothers report clearly indicate to us how the
situation can be improved. For the first time, the Committee on Confidential
Enquiries into Maternal Deaths (NCCEMD) also provided us with strategies to
facilitate implementation of these recommendations. We really appreciate your
efforts in this regard.
Amongst us here are people responsible for the education and training of
health professionals. As custodians of health education and training in our
country, you need to discuss what changes in the health educational programmes
are needed to bring about both the prevention of maternal deaths and the
appropriate treatment of pregnant women with obstetric complications. How can
we all join hands (the Department of Health and training institutions) to
ensure continuing professional development of health care professionals in this
field?
The Department of Health has already started conducting workshops with
relevant managers in provinces. These workshops discuss the issues raised in
the reports and identify interventions that have to be made at an operational
level to prevent maternal deaths.
Colleagues, I have outlined some of our achievements and the challenges we
face with maternal health care in South Africa. Most of these challenges can be
overcome if we all intensify efforts at improving the quality of lives of
women. I would like to thank all the members of the Committee on Confidential
Enquiries into Maternal Deaths for all their hard work and for producing the
latest Saving Mothers Report.
I would also like to express my gratitude to you all for making time to
avail yourselves for this important activity. I wish you successful
deliberations and hope the outcome of this workshop will help shape the
education and training of our doctors, midwives and all other health workers
involved in the delivery of maternal care. I hope you can come with means to
enhance continuing professional development, which I believe is essential to
improving the quality of care in our facilities.
With your support, we can indeed achieve our goal of improving the health of
women and children.
Thank you
Issued by: Department of Health
19 September 2006
