Northern Cape and Limpopo most dangerous provinces for moms with newborns

These provinces have the highest rates of death of women in childbirth

Charlotte Mmowa never met her mother. In March 2009, she was born at the St Rita's Hospital in Limpopo. Moments later her mother bled to death.

Now eight years old, Charlotte is being cared for by her grandparents. The family sued and in 2013 won close to R550,000 in damages from the province's health department.

Olof Joubert, the family's lawyer, said: "You have a young girl who never knew her mother, and her grandparents, who are old people, having to look after her.

"It's not right and the families are the ones who suffer."

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But Charlotte's case is not unusual. She is one of more than 1,000 children left in similar situations every year in South Africa.

Maternal mortality statistics contained in the latest District Health Barometer, a publication funded by the Department of Health, show that 1,074 women died in the 2015-16 year during or shortly after childbirth.

While the situation has improved over the past five years, the numbers are still higher than targets set by the World Health Organisation, which wants countries to try to achieve a ratio of 70 deaths per 100,000 births. South Africa's current ratio is 119.1 deaths per 100,000 births.

In Charlotte's home province of Limpopo that ratio is 140.2 deaths per 100,000. Only the North West (148.1 deaths per 100,000) is worse.

In Limpopo's Capricorn district the problem is at its most acute.

The two main hospitals in the district are badly understaffed, the Limpopo health department said. There is also a lack specialists.

The maternal mortality ratio there is 316.9 deaths per 100,000 - nearly triple the national average.

"[There is] a severe shortage of staff, especially in obstetrics and gynaecology, a lack of skills, of staff - especially in the district - and transport, made worse by distances between facilities," said spokesman Derick Kganyago.

He said that the two hospitals - Mankweng and Pietersburg - have a combined staff of 35 working in the specialist obstetrics and gynaecology departments, but that they needed an additional 94 staff members to fill necessary posts, including 20 specialists and eight unit heads.

This critical understaffing has resulted in three court challenges like Charlotte's, all of them involving cases at Mankweng.

The Limpopo health department was unwilling to provide the court papers, or even the case numbers.

But if these cases are anything like that of Charlotte's, the department could again be ordered to pay up.

According to court documents, Charlotte's 24-year-old mother was admitted to the St Rita's Hospital on March 6 2009 to give birth. But there were complications that led to "excessive bleeding".

She was taken for emergency surgery, but it was unsuccessful.

She went into shock, bled out and died at about 9pm that night.

Her lawyers said the hospital and doctors were negligent and failed in at least half-a-dozen ways, including not attending to the bleeding and not calling in senior staff to assist. The family was awarded R547,000 in damages.

Jack Moodley, chairman of the Department of Health's national committee on the confidential inquiries into maternal deaths, said there had been a "considerable decline, and quite significant lowering" of the ratio of deaths since 2010.

block_quotes_start As women are being tested and getting treatment that results in a decline in deaths. Also bleeding in pregnancy block_quotes_end

"It peaked in 2010 and has been coming down quite well. Infections are the common cause of death, basically HIV/Aids infection.

"As women are being tested and getting treatment that results in a decline in deaths. Also bleeding in pregnancy," he said.

"The department has been very good in rolling out anti-retroviral treatment and in the promotion of clinical guidelines for treatment and prevention of haemorrhages."

Moodley advised pregnant women to go for regular check-ups with a doctor.

"We are progressing well. We are the best in Africa and we are winning the war."

Moodley said the committee was also looking for any cases of substandard care.

"If we find there was substandard care we deal with it immediately and have review meetings and talk to doctors and nurses and change our protocols. It has helped tremendously.

"We are now also helping the private hospitals who are setting up the same kind of processes that we have in the public sector," he said.

savidesm@sundaytimes.co.za and pillayt@sundaytimes.co.za