this year four-year old Charlotte Mmowa instituted a negligence claim against
the Limpopo department of health with the help of a curator. Charlotte’s
mother, Matlou Mmowa, died just hours after giving birth to Charlotte in St
Rita’s Hospital, Limpopo. She died after failure to remove the placenta, which
caused excessive bleeding. It is alleged that this was due to the negligence of
the health workers involved.
and Matlou’s story is that of far too many South African women and the children
who have to grow up without their mothers. South Africa is an upper
middle-income country that is achieving low-income country success when it
comes to maternal health. According to World Health Organisation (WHO)
statistics, South Africa shares a position in the top forty worst maternal
health countries in the world, with countries such as Ethiopia, Haiti, Liberia
and Niger. Far too many mothers are dying before or after giving birth.
of a country’s mothers has profound development impacts. The Millennium
Development Goals (MDGs) include a goal on the reduction in maternal mortality
(MDGs 5). A reduction in the deaths of mothers contributes to the achievement
of almost all other six MDGs, including the eradication of poverty and hunger
(MDG 1), achieving universal primary education (MDG 2) and reducing child
mortality (MDG 4). Healthy mothers allow a country to maximise its available
human capital and, over the longer term, assist in reducing poverty. Maternal
health is also an indicator of the strength of a country’s health system and
provides early signals of wider health system problems.
mortality in South Africa almost doubled between 1990 and 2008. (1990 was the
year when the MDGs were set). Data on births in hospitals, however, indicate
that the turning point may have been reached in 2010 with maternal deaths in
hospitals starting to decline in 2011. This improvement follows the
implementation of the policy on the provision of ARV-treatment to all
HIV-positive pregnant women with a CD4-count of 350 or lower in 2009/10.
more than 40% of maternal deaths in South Africa are caused by non-pregnancy
related infections, mainly HIV/AIDs and tuberculosis (TB), 28% of mother’s
deaths are due to bleeding (haemorrhaging) and high blood pressure. Data
collected in hospitals indicate that 40% of the causes of maternal deaths are
preventable, with the majority of deaths due to bleeding and high blood
pressure being preventable.
mothers’ deaths are an equal loss to society. However, it is deaths due to
preventable causes that we should be worrying about as they signal the strength
of the health system. South Africa is a country where pregnant women have free
access to healthcare and well-developed health policies and protocols form the
backbone of the system. The maternal mortality rate is the outcome of both the
supply and demand for healthcare services.
explanations for poor health outcomes tend to focus on the supply of health
services but perspectives and experiences of the users of health services also
matter. Some women are not accessing the health system or not accessing it
early enough and it is important to understand whether this is because they
can’t or choose not to. If they are choosing not to, the underlying reasons
have to be found and addressed. Some of the factors influencing women’s access
to services may be due to the quality or acceptability of services provided.
Unfortunately the available data in South Africa does not yet allow us to fully
answer these questions.
performance in maternal health asks of policymakers and the researchers who
advise them to take a step back and systematically identify why health services
may not be of a sufficient quality or quantity or why health system users are
not accessing the system. It is our task to keep on digging until we have a
more comprehensive understanding of what goes wrong in the health system. And
then find the answers. Otherwise we are failing our mothers and their