Many South African women still needlessly die during childbirth: Phaahla

South Africa is lagging behind in reducing maternal mortality and is unlikely to meet the 2030 global targets to reduce death of mothers to less than 70 per 100,000 live births.  

Health minister Joe Phaahla said though the country had made progress in the past decade and reduced institutional maternal mortality rate from 147.3 deaths per 100,000 in 2011 to 93.1 per 100,000 in 2019, the pandemic put a spanner in the works and between 2020/2021 direct maternal deaths and indirect deaths increased. Deaths were due to Covid-19 infections or disruption in the health services.

Addressing delegates at the inaugural international maternal newborn conference in Cape Town this week, Phaahla said trends showed that maternal mortality ratio had declined from 276 per 100,000 births in 2007 to 87 per 100,000 in 2018. He raised concerns about the country's rate of stillbirth, saying the 20 deaths per 1,000 births remained high.

“This is a matter that needs our focused, collective and urgent intervention. The interventions required will include, but not limited to broad multisectoral, socioeconomic interventions aimed at empowering women.”

Child mortality also remained high and among assaults on neonatal health was prematurity.

“We continue to battle serious problems of prematurity and intrapartum-related trauma which remain the leading causes of death. Hypertension and obstetric haemorrhage remain challenges contributing to maternal deaths. Infections from TB and HIV, re-emergence of previously eradicated conditions, play a part in maternal and neonatal deaths. We are also realising the increasing congenital abnormalities that have become contributing factors which require more robust interventions. The broader goals of reducing maternal and neonatal mortality are what we still need to focus on,” said Phaahla.

Meanwhile, a UN report released this week showed global progress in tackling maternal deaths had stalled since 2015 due to decreasing investments in maternal and newborn health. The report shows that more than 4.5-million women and babies die every year during pregnancy, childbirth or the first weeks after birth — equivalent to one death every seven seconds — mostly from preventable or treatable causes if proper care was available.

“Pregnant women and newborns continue to die at unacceptably high rates worldwide, and the pandemic has created further setbacks to providing them with the healthcare they need,” said Dr Anshu Banerjee, director of maternal, newborn, child and adolescent health and ageing at the World Health Organization (WHO).

“If we wish to see different results, we must do things differently. More and smarter investments in primary healthcare are needed so that every woman and baby, no matter where they live, has the best chance of health and survival.”

The report, “Improving maternal and newborn health and survival and reducing stillbirth”, assesses the latest data on these deaths and tracks the provision of critical health services. Overall it showed that progress in improving survival had stagnated since 2015, with about 290,000 maternal deaths each year, 1.9-million stillbirths and a staggering 2.3-million newborn deaths.

While global targets to reduce maternal and neonatal deaths in 2030 are 90/90/80/80 — which is 90% of pregnant women attending four or more antenatal care visits, 90% attended by skilled health personnel, 80% of mothers having access to postnatal care, 80% of newborns having access to care, South Africa is lagging in almost all.

Phaahla said access to antenatal care visits was at 76% against the 90% target. Access to skilled birth attendants was at 78.3% against 90% target.

Other challenges such as responding to gender-based violence including violence against pregnant women and children remained prevalent.

“High teenage pregnancy rate with the age of young girls falling pregnant is becoming younger and younger,” he said.

“Despite the challenges faced, there continues to be a bright light at the end of the dark tunnel. Through integration of HIV care into routine maternal and newborn care, vertical transmission of HIV infection has been reduced from almost 30% in 2002 to less than 3% in 2022.” 

Under-five mortality declined from a high of 81 per 1,000 live births in 2003 to 28 per 1,000 live births in 2020. This decline was attributed to a reduction in deaths due to HIV/Aids.   

“This is one of the success stories of our prevention of mother-to-child programme which will hopefully assist in eliminating vertical transmission of the disease and improve neonatal survival and thriving rates. The other contributors to the success are the introduction of childhood vaccines, and improvements programmes addressing social determinants of health such as social grants to children and vulnerable pregnant women, which have also contributed to the food security, among others,” Phaahla said.