As the deadline for the Millennium Development Goals (MDGs) is drawing closer, countries are working to prepare national reports that highlight their achievements and substantiate their failures. Malawi is on track to achieve MDG 5, which aims to reduce maternal mortality rate. Malawi, like many other low income countries in Africa, has a high rate of maternal mortality. Some of the underlying causes of high maternal death include early childbearing and the high fertility rate. Childbearing starts quite early in Malawi with a mean age of first child birth reported at 19 years. Adolescent fertility rate in Malawi is one of the highest in sub Saharan Africa with 152 births for every 1,000 women in women aged 15-19. This is high in comparison to the 118 births for every 1,000 women in the greater Sub Saharan region.
Adolescent pregnancies comprise about 25% of all births and 20% of maternal deaths. The total fertility rate is 5.7 and the neonatal mortality rate is equally high, at 31/1000 live births. Regular national surveys to estimate the Maternal Mortality Rate (MMR) such as the Demographic and Health Surveys of 2000 and 2004 have estimated the MMR at 1120 and 984 per 100,000 live births, respectively. Furthermore, the Multiple Indicator Cluster Survey (MICS) conducted by Unicef in 2006, estimated the MMR for Malawi to have declined to 807 per 100,000 live births. These MMRs are critical to monitoring progress towards MDG 5 which aims to reduce the maternal mortality ration by three quarters between 1990 and 2015.
Malawi has since taken enormous efforts to prepare health facilities for delivery of emergency obstetric and neonatal care (EmONC) with the objective of promoting the UN standard that for every 500,000people in a population, there should be, at a minimum, 1 comprehensive EmONC facility and 4 basic EmONC facilities. The EmONC facilities must also be geographically distributed and accessible to all women in Malawi and they must function well enough to provide quality EmONC services. To track the progress of this commitment an assessment is done every 5 years to determine what progress has been made in improving access to EmONC services to pregnant women requiring the services.
In mid-September of this year, Malawi commenced on its the third National Emergency Obstetrics and Neonatal Care (EmONC) Assessment. The results of this assessment will directly feed into the national report for the achievement of MDGs, specifically for goal five, but also give a true reflection of the improvement, if any, of the EmONC services that are being provided in the established facilities. However, there are so many challenges facing the quality of care that is provided at these facilities such as lack of basic infrastructures and equipment like maternity waiting homes, guardian shelters, well equipped labour and delivery rooms as well as lack of water and electricity, inadequate skilled birth attendants, lack of drugs, and referral systems among many others. All these factors are compounded by the inadequate government funding to the Health Ministry. Most recently, the Ministry was allocated a meager 8.8% of the total national government budget. With such lack of commitment, one has to wonder whether the government really prioritizes health.
Women are not dying because of diseases that we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving. – Professor Mahmoud Fathalla, 1997