Maternal Health in Sub-Saharan Africa: The Issues and How We Can Make a Change.

Written By NYU African Graduate Students Association

By Deborah Denis

According to the latest data from the United Nations Population Fund (UNFPA), 800 women die daily from preventable maternal and childbirth issues worldwide. 70% of these deaths are from sub-Saharan Africa, amounting to about 202,000 preventable deaths annually; this right here keeps me awake most nights.

The question is, why is 70% of the world’s maternal death in the cradle of life? If indeed the future is African, what are we doing to protect the ‘future,' our women and newborns?

To answer the first part of my question, high maternal death rates in sub-Saharan Africa are uniquely attributed to many factors that are social, political, economic, and environmental in nature. Even though the direct causes of death are preventable, yes, very avoidable, these many variables create a complex problem leading to high death rates.

In this article, I explored the root causes of these high death rates based on my research and experience working in the field. I also shared action steps that will help combat these issues. I recognize that we need a multi-sector approach in tackling this problem; I believe in actionable steps at various levels, individual, organizational, and institutional. We must put hands on deck to improve health outcomes for women and girls, especially those in sub-Saharan Africa.

The direct causes of maternal death in this region, according to the World Health Organization, are:

  • Severe bleeding, mostly bleeding after childbirth.

  • Infections, usually after childbirth

  • high blood pressure during pregnancy

  • complications from delivery

  • unsafe abortion

The above-listed causes sound very easy to manage and should not be the leading cause of death, right? But they are. This can be resolved with skilled workers, nurses, and midwives. However, there is more to the story when it comes to low and middle-income countries.

Among many other issues, sub-Saharan Africa is saddled with a deficient number of skilled workers (only 3% of global totals) to provide healthcare and health education, high numbers of unsafe abortions, and early pregnancies. The Center for Reproductive Rights Africa program shared that an estimated 6.2 million unsafe abortions happen every year, leading to about 15,000 deaths, and 1 in 5 adolescents get pregnant before the age of 19.  There are external variables that contribute to these high numbers, such as lack of access to care, low literacy levels, lack of access to contraception to prevent unwanted pregnancies that lead to unsafe abortion, and, of course, instability due to decades of humanitarian crises in several parts of Africa. These all combine to create a labyrinth of issues that contribute to poor health outcomes for women and adolescents.

In terms of Women’s health in general, research has shown that women are less likely to receive proper medical care than men with similar conditions in many instances; this is a result of so many impediments; for sub-Saharan Africa, the World Health Organization identified gender inequity, poverty, weak economic capacity, sexual gender-based violence, as some of contributing factors to this.

Women of reproductive age are between the ages of 15-49 years; for most of their lives, women will need access to healthcare services that will either prepare them for healthy pregnancies, help them through pregnancy, or support them to be healthy after giving birth. This is in addition to other reproductive health issues that are not related to pregnancy or childbirth.

The reason why the situation in sub-Saharan Africa is dire is because of the myriad levels of issues that create a poly-crisis. The combination of multifaceted problems such as humanitarian crises in many regions of the continent, malnutrition, poverty, inadequate provision of healthcare services, climate crisis, and, of course, economic recession are but a few of the problems that create a web of social, economic, environmental, and political poly-crisis.

In each of the mentioned categories above, women and adolescent girls are affected the most, as proven by data. Thinking about it from the lens of determinants of health, you will find that all these directly or indirectly contribute to high maternal death rates, and solutions must be designed using a systems thinking model to put into perspective the interconnectedness of the issues and identify holistic approaches to solving the problem on the very many different levels that it manifests itself.

Taking into consideration all the above-listed variables that are correlated to low-quality health outcomes for women in sub-Saharan Africa, there is so much that needs to be done on various levels. Taking action may sound daunting due to the complexity of this problem, and to be honest, sometimes I feel overwhelmed just thinking about it.

Below, I shared recommendations based on strategies that I found helpful during my time in Northeast Nigeria, as well as new perspectives gained from research and evidence-based practice. I broke down the action at various levels for families, communities, organizations, and governments; we all need to unite as allies to support women and girls.

  • Raising awareness through educational and sensitization activities: this action point is for individuals, families, and small community groups. Educating women and girls about risk factors and potential early signals of diseases is vital to make them seek health care in good time. This research on preconception care in sub-Saharan Africa, published by the National Library of Medicine, shows a correlation between women's knowledge level and the utilization of preconception care. This is also true in my experience in northeast Nigeria; when the International Rescue Committee started implementing the Sexual Reproductive Health program in Maiduguri, they built temporary clinics in displaced people's camps to provide immediate basic maternal and newborn care, including antenatal care, treatment for sexually transmitted infection and more reproductive healthcare services that those camps need but do not have access to.  Initially, the service utilization rate was low because most of these communities, coming from very rural areas, have little knowledge about care and its importance; some women have never been to the four walls of a clinic. Therefore, we got to work to create Information Education and Communication materials, curated educational and promotional activities that were context-specific and implemented those activities. At the end of 2017, we reached thousands of beneficiaries with reproductive healthcare services they otherwise would not have utilized. This shows that access to the correct information to tackle low knowledge levels, and misconceptions are efficacious in improving the utilization of available healthcare services.

  • Behavior Change Models: organizations implementing sexual reproductive healthcare programs should use behavior change communication models in communities. For sustainable impact, they should work with relevant stakeholders, churches, masjids, synagogues, women's groups, men's groups, and adolescent groups to engage the whole community in deep conversations about health issues that impact women and gear towards creating positive behaviors towards, identifying problems, seeking early care and advocating for better healthcare facilities within their communities and emergency referral services. Community action is very vital to the overall outcomes of health programs. I learned from my work that health facilities alone are not enough to bring about relevant change; community participation and action invariably lead to elevated outcomes regarding social justice and who made change for communities. Organizations can also support health systems within their areas of implementation by partnering with ministries of health to identify loopholes that such organizations can help. Multisector partnerships go a long way in supplementing the gaps that state or federal governments cannot reach due to resource constraints.

  • Health System Strengthening: institutions can target policy advocacy towards funding reproductive health programs and creating pathways for improving health facilities with adequate equipment and staff training. Additionally, provisioning scholarships for training in midwifery and nursing will go a long way in improving the low numbers of service providers needed to provide health care in sub-Saharan Africa.

  • Investing in Health Information Systems: all listed levels should work towards quality data tracking and sharing. A reliable and consistent system that collates and provides access to quality data on maternal health will support intervention design and decision-making by policymakers, donors, and relevant stakeholders. I published an article last year on my Python coding research project that focused on using Python coding technology to analyze the SDG target 3.7, sexual and reproductive health target indicators. My major challenge in that research was the inconsistencies in the data collected and the varied format used in data entry. This experience made me realize the importance of quality, consistent data collected. It enhances efficiency not just for data users but also for evaluation purposes in terms of measuring success and identifying areas of improvement.

Investing in improving maternal health outcomes in sub-Saharan Africa is not only a justified cause; it is a demand for equity and equitable access to healthcare regardless of where one is born. These women have the right to health, the right to life, and the right to determine their fate. We can protect the future by acting on these issues; you can help to make that happen.

Additional Resources

NYU African Graduate Students Association
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