oa South African Health Review - Maternal health : reflections on the Millennium Development Goals
Millennium Development Goal (MDG) 5 focuses on maternal health and the target for 2015 is to decrease the Maternal Mortality Ratio (MMR) by 75% from the levels in 1990. This chapter reviews the current status of maternal mortality and maternal health in South Africa. The evidence is that South Africa is definitely not on track to achieve MDG 5 and that maternal mortality has actually doubled since 1990.
The top five causes of maternal mortality in the 2005-2007 triennium remained non-pregnancy-related infections (43.7%), mainly due to AIDS, hypertension (15.7%), obstetric haemorrhage (12.4%), pregnancy-related sepsis (9%) and preexisting maternal disease (6%). The mortality rate of HIV-positive women was nearly ten times the rate of HIV-negative women, but preventable direct obstetric causes made up a significant proportion of deaths in both groups.
The recent guideline changes prioritising antiretroviral treatment for HIV-positive pregnant women will make a significant contribution to addressing HIV-related deaths if they are realised in practice. The other main priority is to improve the availability and quality of emergency obstetric care which is being targeted through initiatives such as the new Essential Steps in Managing Obstetric Emergencies training programme.
The high rates of antenatal care coverage and delivery by a skilled attendant in South Africa have not had any impact on the MMR. New indicators that are better correlated with maternal mortality in South Africa are required for planning and monitoring. The National Committee on Confidential Enquiries into Maternal Deaths (NCCEMD) is an important source of information on maternal deaths, but vital registration requires strengthening and regular Demographic and Household Surveys are required to monitor population-level process indicators.
The NCCEMD recommendations identify what needs to be done to improve maternal mortality, but have had little impact on maternal mortality over the last decade. Health system constraints that hinder implementation of the recommendations need to be overcome urgently.
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