Last month, in a public hospital in the Kaffrine Region of Senegal, a woman who had experienced a postpartum hemorrhage was admitted after traveling 95 km from the health center where she had delivered her baby. The woman was transferred to the Kaffrine Hospital for a blood transfusion, but once there, they discovered that the hospital didn’t have her blood type available. She was then moved to another hospital 62 km away in Kaolak, which didn’t have her blood type either, so she was transferred to another facility 116 km further in Touba, where she was finally stabilized, although her baby died.
This disturbing case illustrates the challenges that women, families and health care providers face in countries with a high burden of maternal mortality and morbidity. Unfortunately, it is a story that I have heard many times.
We learned about this woman from Dr. Bineta Diop, the director of the Kaffrine Hospital, during a fact-finding visit to Senegal for the CSIS Task Force on Women’s and Family Health. Dr. Diop told us that maternal mortality was a major challenge for the facility, with 24 deaths in the previous year alone. While the absolute number of deaths from complications in childbirth may not rival those caused by infectious diseases, the death of a woman in the prime of her productive life has far-reaching implications for families, communities and societies.
Four women dying in childbirth every day in Senegal is simply unacceptable – more can be done, more must be done. This was a theme we heard throughout the trip.
Fixing the maternal health system, however, is far more complex than many other health interventions, and there is no simple technological solution. Simply put, preventing maternal mortality is hard. It requires functioning health systems, including skilled personnel available 24/7 with access to medicines, supplies and equipment. Because there is little that can be done to save a woman’s life if she gives birth at home, women must be encouraged to deliver at health facilities with skilled care, which often means shifting social and cultural norms. Health facilities are often far from their homes, and transportation may not be available or affordable. Certainly, Senegal’s progress in increasing access to family planning is an important component in reducing maternal mortality, and those efforts need to be continued.
While Senegal has already put in place many of the measures necessary to reduce maternal mortality, the government and other stakeholders acknowledge that important gaps remain. The overall message is that it is time for Senegal to double down on the commitment. With maternal mortality at 392 per 100,000, the rates are unacceptably high.
But Senegal is committed to taking on the challenge. That’s why the Ministry of Health, during the week of our visit, revealed a new emergency plan on maternal health. The 10-point plan, as described to us by Dr. Bocar Amadou Daff, Director of Reproductive Health and Child Survival, includes a wide array of actions necessary to address comprehensively all three delays contributing to maternal mortality.
- For the first delay, the decision to seek care, the plan includes mobile outreach and community engagement not only for adults but for adolescents as well to help influence health-seeking behaviors.
- For the second delay, getting to care, they are purchasing ambulances for select areas, and are looking at alternative means in other areas such as motorcycles to transport women to care. They are also planning to build maternity waiting homes where women who live far away or have known risk factors can stay nearer to a health facility during the late stages of pregnancy.
- To address the third delay, receiving quality care once at a facility, they are focusing on the quantity and capacity of their human resources, increasing the number of specialists in pediatrics, obstetrics and gynecology and anesthesia, task shifting certain elements of care to lower level providers (e.g. training community health workers to administer misoprostol) and incorporating mobile midwives to bring care closer to the women who need it. They are also developing infrastructure to perform C-sections, and will be conducting maternal death audits that incorporate the community in identifying solutions.
I am hopeful that with this plan, Senegal will succeed in moving the dial on maternal mortality as they have for family planning. Reports indicate that the Minister of Health has requested a dashboard of progress on maternal health that she will personally monitor. This high level of commitment and comprehensive planning by the Ministry of Health, if combined with continued support from international partners, will be critical to their success.