The low status of women is the basic cause of high maternal mortality in Chad, as in most of Africa. Deaths could be prevented if women were able to access maternal health services staffed by skilled health workers.
Dr Grace Kodindo, our patron and a long-time obstetrician in Chad, here gives her analysis of the problems, and points to solutions – a responsibility for all.
In 2010, the W.H.O. published a document titled Developments inMaternal Mortality : 1090 – 2008 giving estimated figures for maternal mortality in Chad as well as other countries such as Afghanistan, Guinea Bissua and Somalia, the 4 countries having the highest maternal mortality [defined as those with a ratio close to 1000 deaths per 100,000 live births. (1)] Many factors contribute to this situation. These include frequent pregnancies ( 5 births or more), births too close together ( less than 2 years apart), and women giving birth too young ( before they are 18) or too old ( after 35).
The social status of women in Chad.
Sociocultural factors (2) especially the status of women in society, are important. A woman’s access to resources, to control her fertility and health, her access to health care, all have an impact on maternal mortality. When a woman has low social status, her health and her life are ignored, as well as her access to life-saving services.
Being educated and informed about health issues makes it possible to avoid delays in reaching care when it may be needed. But the level of education in Chad is low. According to UN statistics, the literacy rate in Chad is 31.8% ( UNDP 2009) and for girls, 37.2% ( World Bank, 2008).
What must be done?
To prevent maternal mortality, there must be access to health structures where the employees are well enough trained to be able to recognise, quickly, the signs of a complication and be able to give appropriate treatment. However, in Chad, as in many other developing countries, the health structures are often inadequate, with too few, too poorly trained people, and with insufficient materials, equipment and services . Very often cost is a barrier to the poor, preventing access to what services there are.
According to UNICEF figures (March 2010), only 18% of pregnancies in Chad are monitored at all, and just 14% of deliveries are attended by a trained, qualified person. (3) The majority of women deliver with a traditional birth attendant who will be untrained and unsupervised. Even in hospitals, the mortality rate is high because of poor training and lack of training updates for health workers in how to manage delivery appropriately, and how to manage obstetric and neo-natal emergencies.
The use of modern contraceptives allows births to be spaced out, and reduces unwanted pregnancies. However, only 3% of women in Tchad use modern contraceptives ( Unicef, 2009).
Everyone has a part to play in reducing maternal mortality in Chad – the government, the community, individuals, and health personnel. The focus must be on education for the community about investing in health and in women’s lives, and on community motivation. The government, NGOs and other partners must act together to improve both the quality and the accessibility of maternity services. This improvement should start with training and/or with the retraining of those in charge of childbirth; the focus should not be solely on technical competence, but also on attitudes of staff and their behaviour towards women giving birth. The staff should be supported in their work by adequate provision of appropriate equipment, tools and drugs; they should have regular supportive supervision so that they can maintain and progressively improve on good standards of practice within a positive framework. Grace Kodindo, MD/Ob-gyn 2011.
1. Trends in Maternal Mortality : 1990 to 2008 , Estimates developed by WHO,UNICEF,UNFPA and the World Bank, 2010
2. Maternity Worldwide, “Causes of maternal mortality”
3. UNICEF-Chad statistics, 2009
In 2010 the Chad Health Ministry published the “Road-Map for the Accelerated Reduction of Maternal and Infant Mortality”. This three-year programme , 2011 – 2013, is 98% funded by the European Union.
In May 2011, the maternity department of the National Reference Hospital in N’Djamena was moved to the new, purpose-built “Mother and Baby” hospital in the centre of the city. The decision to fund the building of a new reference hospital for mothers and infants was taken by President Deby after the screening in Chad of the Panorama film “Dead Mothers Don’t Cry”.