Wednesday, June 5, 2013

Will Tanzania meet 2015 deadline on child, maternal mortality?

Investing in girls and women's health is not just the best thing to do, it is the smartest thing to do. (File photo)
Between January and March, nine mothers lost their lives giving birth at Makole Health Centre in Dodoma district. The number is three times the deaths recorded at the centre between October and December last year where three women died.

Harriet Kidayi, the Reproductive and Child Health Coordinator in Dodoma district based at the health centre blames this on late referrals to hospital.

To some, the number of women who died giving birth at the health centre, may not seem to be a big deal. But the reality is no woman should die giving birth. No woman should die giving life.

Globally, almost every minute a woman dies of complications related to pregnancy and child birth. And 99 per cent of these deaths occur in developing countries. Experts say the likelihood of a motherless child dying prematurely is ten times more than that with a mother. Every year, more than one million children are left motherless.

The late referrals that Kidayi, the reproductive and child health coordinator in Dodoma district says caused the deaths of mothers at Makole health centre this year are just one among many causes of maternal deaths in Tanzania. And there are various reasons why expectant mothers get to the hospital late and many are beyond their control.

Things like lack of transport to the nearest health facility. This is a big problem in rural areas. There are areas where expectant mothers walk for two days to get to hospital for delivery. Because of poverty, they can’t afford to hire a vehicle to the hospital. And the list of reasons for late referrals is long.

With only 18 months left before the 2015 Millennium Development Goals deadline, the Tanzanian government and other stakeholders in the health sector are fighting to see to it that the country attains goals number four on reducing child mortality by two thirds and number five on maternal mortality reduction by three quarters by 2015.

The government has been promoting family planning as part of the national reproductive health strategy. This is because 20- 25 per cent of maternal deaths could be avoided through prevention of unplanned and unwanted pregnancies.

Also mothers and children can become healthier and families can better provide for the care and upbringing of their children. Girls will not be forced to drop out of school because of unexpected pregnancies. Moreover, family planning is good for the overall development of the country.

Tanzania’s target is to have 60 per cent of women and girls using contraceptives by 2015 in a bid to reduce child and maternal mortality rates and improve women’s health. However, this is a challenge given that only 34 per cent of all women use family planning today. But we can get there if we want and this year’s health budget allocation of 1bn/- for reproduction health is a good move.

This is the first time that the government is allocating its own money for the purpose. The minister for Health and Social Welfare, Dr. Hussein Mwinyi said when tabling the health budget in parliament last month that this is a big step that signals to development partners that Tanzania is serious about the matter. However, some Members of Parliament were not convinced 1bn/- was enough. This year’s budget allocation for health is 753.9bn/-.

Family planning is one of the most powerful ways of improving the health of women and children and of controlling population growth of a country. This is a fact that is yet to be known by many people especially those living in the rural areas of developing countries like Tanzania.

It is because of this high level of illiteracy that the US-based Population Reference Bureau (PRB) recently organised a one-week workshop in Dar Es Salaam for health journalists who can be good ambassadors in spreading the message.

The journalists were equipped with information on maternal and reproductive health. They also discussed how the press can play a vital role in addressing reproductive health and fertility issues and how these can cause socioeconomic development.

PRB is a non-partisan and evidence based organization with a mandate of informing people around the world about population, health and the environment and at the same time empowering them to use that information to advance their well being and that of generations to come.

Presenting the Tanzania MDGs progress report at the journalists’ workshop, the Director of Advanced Family Planning, Halima Shariff said infant mortality rates have declined by more than a half in the last decade. According to 2010 statistics, the rate stands at 51 per every 1,000 live births. This therefore is a green light that the set target of reducing infant mortality rate to 31 out of every 1000 births by 2015 is achievable.

On the other hand, reducing maternal mortality ratio remains a challenge. In 1990, the maternal mortality ratio stood at 529 per every 100,000 live births and after 10 years, in 2010 that is, the ratio was 454 women per every 100,000 live births. At this slow pace, the efforts of decreasing this to 133 by 2015 may clearly not be achieved.

Access to family planning services is one key component in achieving the above. Both men and women need to know the importance of child spacing and how this greatly contributes to improving the health of both the mother and the child. They also need to know the importance of giving birth in a health facility.

2010 statistics show that only 51 per cent of births in Tanzania are attended to by a skilled personnel. It therefore becomes difficult for the 90 per cent target to be attained in less than two years. This is given the country’s serious shortage of skilled workforce among other reasons.

To curb the shortage, the government has promised to increase the number of medical personnel and also to create a user-friendly environment for family planning services especially for youths since most are denied access to the services.

Harriet Kidayi, the Dodoma Reproductive and Child Health Coordinator says there has been an improvement in accessibility and use of family planning in Dodoma. She says most women prefer modern methods like the injectable method.

In 2011 62 per cent (84,804) of the targeted women were using contraceptives out of the targeted 136,004. In 2012, the percentage rose to 77 per cent (110,234) out of the targeted 142,596.

She however says that there is still more to be done in the peri-urban areas to have more women enlightened on the matter.

“Men’s involvement in family planning issues should be enhanced to help the current situation. Though as a district we have never received serious complaints of men battering their wives due to decisions they take on family planning as is the case in some regions,” Harriet says.

On maternal deaths, Harriet says; “to address this, the government has increased the number of health centres in the region by introducing Hombolo and Kikombo facilities. It has also introduced clean delivery packs containing all the necessities needed by women during labour and this is given to every woman at 39 weeks of pregnancy to help in case of emergencies.”

She also added that the number of mothers dying during delivery had greatly gone down in Dodoma district. A total 66 deaths were recorded in 2012 compared to 129 in 2011.

To attain the target goals by 2015, more efforts are needed and these include channeling more funds in the sector. The government needs to stop depending entirely on donors since delay of funds usually causes shortages. For years, family planning budget has been dependent on donor funds.

Another area of concern is addressing high fertility rates especially in the lake zone regions. Women in rural areas still have a high rate of seven children while those in urban areas have four children per woman. Lack of access to family planning services in rural areas, lack of willingness to use them and teenage pregnancies are cited as major factors contributing to the high fertility rates.

Dr. Muzdalifat Abeid, Head of Maternal Unit at Temeke Hospital says women are not willing to use family planning due to myths and misconceptions, low understanding of family planning by men thus discouraging their wives, religious beliefs and inadequate resources to sensitize people and facilitate delivery of the services.

All these are vices to fight if we want to see changes in infant and maternal mortality rates.

Speaking at the opening of the recently concluded high level global meeting on girls’ and women’s rights in Kuala Lumpur, Malaysia, Women Deliver President, Jill Sheffield said investing in the health and reproductive rights of women and girls has benefits for both the families and the country at large.

“When we invest in girls and women’s health, it’s not just the best thing to do, it is the smartest thing to do,” said Ms Sheffield. She explained that sexual and reproductive health should be looked at as a human rights issue.

“We should look at it as a human right to have access to contraceptives and give it a central place in our work. All these commitments are in place and governments only need to implement them,” she said.

World leaders attending the meeting called on governments to invest more in the wellbeing of mothers and girls. Having been represented at the conference, we hope Tanzania will heed the call and thus meet the MDGs on maternal and child mortality come year 2015.

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