High maternal mortality despite improved health services

Djibouti has made significant progress in reducing maternal mortality over the past 10 years, but the number of women who die in childbirth is still high, the Djiboutian national coordinator for reproductive health, Safia Elmi, said. "In 1994, Djibouti's maternal mortality rate was 740 for 100,000 live births. That is a lot. By 2002, it had fallen to 690 deaths per 100,000 live births," Elmi told IRIN. Over the same period, she added, the average family size had fallen from 5.8 to 4.2 children per woman. Noting that maternal health had significantly improved through better services in hospitals and increased numbers of trained birth attendants and midwives, Elmi said more women had died giving birth at home rather than in hospitals. Many of those who died in the hospitals, she added, had suffered haemorrhaging. According to the Djibouti government, the key causes of high maternal mortality were high fertility rates, poor emergency obstetric care, and the persistence of harmful practices such as excision, infibulation and the more severe types of female genital mutilation (FGM). Some 9 percent of "extremely poor" women die while giving birth, government statistics show. Speaking to IRIN on Monday, on the occasion of World Population Day, Elmi said efforts were being made to reduce FGM. "People used to believe that female mutilation was part of religion, but we told them it is tradition and you can drop tradition," she noted. Thomas Davin, programme coordinator in Djibouti for the United Nations Children's Fund, told IRIN that mild or severe haemorrhaging occurred in the overwhelming majority of births, and was inextricably linked to the more severe forms of FGM. The World Population Day, which was designated 10 years ago during the 1994 International Conference on Population and Development in Cairo, set 20-year targets for countries to meet in four key areas: universal education, reduction of infant and child mortality, reduction of maternal mortality, and access to reproductive and sexual health services, including family planning.