Maternal and infant mortality rates

Two very important statistics in assessing the overall health of a society are the number of maternal deaths – that is, the death of a woman while pregnant or within 42 days of the termination of pregnancy ‒ and the rate of infant mortality, defined as the number of infant deaths for every 1,000 live births. These markers indicate that the maternal and child health situation in Guyana has been sadly lacking for more than a decade.

According to the Centre for Disease Control and Prevention (CDC), which has been partnering with Guyana on health-related issues, particularly on HIV infected persons, the infant mortality rate is a staggering 38 deaths for every 1,000 live births. Although other international statistics have Guyana’s infant mortality rate at 30/1,000 it still means that this country holds the dubious distinction of being ranked in the top worst 100 countries with respect to infant deaths during childbirth.

Between 1990 and 2015, the United Nations Children’s Fund (Unicef) recorded Guyana’s Maternal Mortality Ratio – the rate of maternal deaths per 100,000 live births – at 171 in 1990 and fluctuating upwards to 229 in 2015. Guyana’s Chief Medical Officer, Dr Shamdeo Persaud has said that Guyana records an average of 18,000 pregnancies annually of which the average number of actual maternal deaths per year is 16.

For a country whose population has hovered at just about three quarters of a million for decades, these numbers are pretty depressing. Guyana has signed on to the achievement of the World Health Organisation’s list of 8 Millennium Development Goals, of which the improvement of maternal health is number 5. It is clear that this country still has a way to go towards achieving this particular MDG.

Just this August 2017, we reported on the death of a 43-year-old woman and her unborn child at the Georgetown Public Hospital. Barely a week prior, a 17-year-old succumbed at the same hospital after a caesarean section birth – considered more hazardous a procedure than vaginal delivery but currently a procedure that carries an extremely low rate of maternal mortality, according to the National Center for Biotechnology Information in Bethesda, Maryland.

As Maternal Mortality Rates are falling worldwide and appear to be rising in Guyana, it is more than obvious that drastic measures need to be taken to preserve life, which is the main function of the medical system. High rates of maternal and infant mortality carry negative economic and social impacts for the society as a whole, and unimaginable grief and psychological side effects and financial issues for the affected family. In a country where there is a paucity of trained professional counsellors and counselling itself is still a relatively new concept as practised by a few state-run agencies, the effects of maternal and infant mortality will invariably eat away at the emotional fabric of the families and caregivers involved, and have a negative impact on society as a whole.

Over the years many of these deaths have made the news and exposed the Georgetown Public Hospital to the scrutiny and harsh judgement of public opinion. However, as with the two cases of the deaths in August 2017 referenced above, the Board of the hospital sought to deflect public criticism by launching internal enquiries into the deaths. In Guyana, a Commission of Enquiry seems to be the most effective way to bring a matter to a close without having to take any corrective or punitive action whatever against those involved. The same is true at the level of internal inquiries, so it is highly unlikely that those launched by the Georgetown Public Hospital into the deaths of the 43-year-old mother and the 17-year-old mother will lead to any public explanations or any specific action to correct what must be a deeply ingrained problem that has not been adequately addressed by the management for many years now.

What seems to be missing in the management of state and public agencies in Guyana is accountability: responsibility for the performance of all resources under one’s control and being answerable to a higher authority for deficiencies in achieving the stated goals. Whether the running of state agencies is goal driven is difficult to assess as no one is made to answer for obvious failures and outright mismanagement by these agencies.

A look at the website of the Ministry of Public Health, http://www.health.gov.gy, shows three “featured projects,” namely, Chronic Disease Control, Mental Health Unit, and Maternal and Child Health Unit. Of the three, only the Mental Health Unit has a Mission Statement and a basic strategy outline on the website. Clicking the link to Maternal and Child Health reveals no information whatsoever.

Of course, this does not mean that there are no detailed strategies for the achievement of a marked improvement in maternal and child health in Guyana, but it certainly means that the general public is kept out of the loop in this the Age of Information, where toddlers are wielding iPads and Smartphones, but our government agencies have poorly designed websites loaded with outdated and/or useless information. Yet, quoting the Guyana Chronicle of August 14, 2017 on government’s efforts to reduce maternal mortality, it reads, “Government continues to put a series of measures in place to bring the numbers down, but said all must get involved if Guyana is to achieve the target set out in the 2030 Sustainable Development Goals (SDGs).”

There is obviously a serious disconnect on the part of those holding accountability for the delivery of proper maternal and child health services if public participation is being touted without easily accessible statistics and information being made available online.

Hiding behind secret unpublished inquires and waiting for public interest to wane is a recipe for the continuing increase in maternal and infant mortality rates in Guyana.

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