by Mary Raddawi, ’14
The highest priority today in Southern Sudan is maternal health. While the fighting between Northern and Southern Sudan mostly came to an end in 2005 with the Comprehensive Peace Agreement, the struggle against maternal and neonatal mortality continues. In 2006, the Sudan Household Health Survey determined the maternal mortality rate (MMR) to be 2,327 deaths per 100,000 live births. To put this in perspective, in 2006, the MMR for the United States was 13 deaths per 100,000 live births (and this is the highest MMR we have had in decades). And by 2011, with almost no progress made in maternal health services, the United Nations Population Fund (UNFPA) reported that Southern Sudan has the highest maternal mortality rate in the world at 2,054 deaths per 100,000 live births.
Overall health care coverage in Southern Sudan is mostly managed by non-governmental organizations and is limited to an estimated 25% of the population of approximately 8 million people. At these limited health care facilities, maternal health services are non-existent or rarely used. The World Health Organization and UNICEF have five basic standards for proper maternal health services: For every 500,000 people, there should be at least one comprehensive and four basic emergency obstetric care facilities (EmOC); 15% of all births should take place in EmOC facilities; 100% of women with major obstetric complications should be treated in EmOC facilities; 5-15% of all births should be by Cesarean sections; and the Case fatality rate (CFR) for expectant women being treated in EmOC facilities should be less than 1%.
In 2004, the UNICEF Regional Office of Eastern and Southern Africa (ESARO) in partnership with the EmOC Working Group on Indicators in Nairobi, Kenya, assessed basic maternal health care services in Kenya, Rwanda, Southern Sudan and Uganda. While the samples in Kenya, Rwanda and Uganda passed the WHO’S basic standards in each category but the CFR, the 15 basic health care facilities sampled in Southern Sudan failed in every category: For every 500,000 people, there were 0.5 comprehensive and 0 basic EmOC facilities; 0.6% of all births took place in EmOC facilities; 2.1% of major obstetric complications were treated in EmOC facilities; 0.1% of all births were by Cesarean sections; and the case fatality rate for expectant women was 7% in EmOC facilities.
A few practical next steps are: use funding to increase facility access to necessary equipment and medications (ex: ultrasounds, antibiotics), increase the number and quality of EmOC facilities across the region and create community training programs for traditional midwives, who perform approximately 80% of deliveries in homes. Midwives should be taught proper delivery techniques (ex: completely removing the placenta to avoid infection and bleeding) and how to recognize when the woman should be referred to an EmOC. There are simple, life saving procedures that can be done by surgeons–for example, hemorrhagic shock can be avoided by performance of a blood transfusion and caesarean section, etc. However, with a poor referral system, mothers with major complications arrive at emergency facilities when it is too late. And additionally, women with complications would have to travel long distances to reach one of the few EmOC facilities, and major complications can kill expectant mothers within hours or a few days: hemorrhagic shock*(2 hours), ruptured uterus* (1 day), and eclampsia*(2 days). Therefore, improving the education of midwives, increasing access to transportation and the numbers of EmOC facilities across the region are needed all together. These steps would be an effort against maternal mortality, neonatal mortality and infant mortality, as infants suffer from extreme malnutrition without breastfeeding from a surviving, healthy mother. Both Sudanese women and children deserve peace and health, and there are clear, practical steps we can take in maternal health care to relieve them of their current struggle for life.
Mary Raddawi is a sophomore living in Columbae. She is currently a class president at Stanford ASSU. She has not declared a major and has no idea what to do.