Maternal mortality remains source of concern

The United Nations Children's Fund (UNICEF), in collaboration with the Kazakh government, aims to reduce the level of maternal mortality in Central Asia's largest nation, where rates over the past decade reveal little sign of significant progress. "The maternal mortality rate (MMR) remains a source of concern," Juan Aguilar, UNICEF area representative for the Central Asian republics and Kazakhstan, told IRIN in the Kazakh commercial capital of Almaty, noting that mothers continued to die in the former Soviet republic during birth. The MMR, the annual rate of deaths of women from pregnancy-related causes per 100,000 live births, reflects a woman's access to and use of healthcare during pregnancy and childbirth, as well as broader underlying socio-economic factors. Although there had been a fluctuating decline in Kazakhstan's MMR over the past few years - 60.9 in 2000, 48.6 in 2001, and 51.8 in 2002 - clearly much more was needed, particularly with regard to care provided in institutions. "Since 1991, there has not been any significant improvement in the situation," Aguilar remarked, referring to the number of women dying as a consequence of childbirth. Of particular interest was the fact that maternal mortality was occurring mainly in maternity wards, while prenatal mortality was not occurring in small and low-weight babies, but rather in normal babies and those weighing above 2.5 kg. According to a UN country report, the primary factors contributing to maternal mortality were the poor health status and nutrition of women. As a result, there was a high rate of complications during pregnancy and births. Sixty percent of deliveries were with complications, with the Kazakh government conceding that 40 percent of all maternal deaths might have been prevented by improving access to quality healthcare. "What these statistics tell us is that there is a tremendous problem with quality healthcare within institutions where women and babies should not die," the UNICEF official said, noting that their new country programme for 2005 would be addressing just that. "Our programme hopes to have an impact on the institutions with the result being that women and babies have the best chances to go through the childbirth process [without complications]." As part of this year's agency effort, UNICEF would provide some means to facilitate the processes that would help the government, particularly the Ministry of Health (MoH) and other institutions, to have better standards for women coming to maternity wards. "What we are proposing is to look at the standards, protocols and working together with the World Health Organisation [WHO] and other major institutions like the Asian Development Bank [ADB] and the World Bank, which are also interested in health reform." There is a real need to retrain most of the country's gynaecologists and nutritionists, he said, noting that the training they had received during the time of the Soviet Union was now obsolete. "It's absolutely outdated when you compare it with the advances of modern healthcare. Here care is very much medicalised, heavily dependent on doctors and nurses, with very little on prevention," Aguilar explained. "You would be surprised at the frequency of injecting solutions and drugs for many, many treatments, which in other parts of the world are seldom used. We are trying to provide our protocols to look at the same issue, but in a more simplified way." The capacity of maternal wards across the country varied, he said, adding: "You can find in this country very well equipped, very modern facilities, while just a few blocks away, you might have a facility in shambles." According to the Kazakh MoH, the causes of maternal mortality in 2001 were: obstetric haemorrhages (29.6 percent), abortions (23.2 percent), gestoses (20.4 percent), other complications during pregnancy and delivery (17.6 percent), sepsis (8.3 percent), extra-uterine pregnancies (0.9 percent). Abortions as a cause of maternal mortality did not only mean induced abortion but a termination of the pregnancy before 27 weeks of pregnancy due to any reason related to the pregnancy, the UN report said. Induced abortions adversely affected a woman's health, reduced her chances for further child bearing and contributed to maternal and perinatal mortality, it added.