Site of life; Sight of death

DEATH AMONG GUYANESE MOTHERS LINKED DIRECTLY TO GIVING
BIRTH fell steadily between 2003 and 2017, the most recent year
www.aroundtheregions.com has been able to access official figures.
In 2003, maternal mortality (mothers dying after giving birth) was 226 deaths for every 100,000
live births. By 2015 it rose slightly to 229 above the Caribbean region (175), Latin America (60)
and world averages (216).

Progress was achieved however, and by 2017, that figure dipped encouragingly to 169, the last year
for official accessible figures available to this media house.
But the death of Vanessa Sahadeo earlier this year, reignited an age-old debate in the country
about the state of the public health system, the competency of its healthcare workers, and the
role of pregnant women and their families in helping protect them from losing their lives in
the bid to give birth.
Retired nurse and midwife, Y. Sam, in a letter to the Editor of a daily local newspaper earlier
this year, recalled Dr Neville Gobin who was the then Head of Guyana’s Maternal Mortality
Review (MMR) Committee expressing confidence in 2019 that the body could reduce
maternal mortality “to near-zero”.
According to the ex-healthcare professional, Dr. Gobin believed near-zero deaths of mothers
could be reached in Guyana by strengthening and improving the competence of medical staff
nationwide; and sharpening their ability to spot and manage complications early in
pregnancies.
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Sam reminded us that Dr Gobin, in 2019, linked maternal deaths in Guyana to three issues,
viz, the fault of the care provider; flaws in the healthcare system, and failures by the patient
themselves.
Former healthcare-worker Sam in her letter made two profound observations which resonate
deeply with this media house: the first is that maternity must no longer be inextricably linked
to mortality; and the second is that maternal wombs must not “morph into neonatal tombs”.
Maternal death and maternal mortality ratio are not interchangeable terms or concepts.

The World Health Organization (WHO) defines maternal death as "the death of a woman
while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the
pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from
accidental or incidental causes."
Maternal mortality ration on the other hand, is the number of maternal deaths per 100,000
live births. It is used globally as a yardstick to measure the quality of medical care available
in a country.
Grenada has the lowest maternal mortality ration in the Caribbean, according to official
figures available to this media house, with 25 per 100,000 live births. This is followed by
Barbados with 27; Cuba with 36 and Antigua and Barbuda with 42.
The maternal mortality ration in Trinidad and Tobago is 67, Bahamas, 70, Jamaica, 80 and
the Dominican Republic, 95. The death ration climbs into three figures in four Caribbean
countries: St Lucia, 117; Suriname, 120; Guyana, 169 and Haiti an astonishing 480. The latter
is only Caribbean country whose maternal mortality ratio is not only above the global figure
of 211, but is more than two times higher.

A 2018 study, the ‘NATIONAL GENDER EQUALITY AND SOCIAL INCLUSION (GESI)
POLICY FOR GUYANA’ conducted under the auspices of the then Ministry of Social
Protection (now Ministry of Human Services and Social Security) noted that “Guyana has not
made progress toward achieving Millennium Development Goal 5A (Reduce the maternal
mortality rate by 75% between 1990 and 2015) due to continuing challenges in the health
sector.”
“Women’s specific health concerns include sexual and reproductive health spanning across
issues such as maternal mortality, breast and ovarian cancer, girls limited access to feminine
hygiene products, and information access – especially in rural and Hinterland areas,” the 82-
page document observed.
It said Guyanese women, regardless of their age, need access to adequate health services and
the ability to make decisions about their health to “prevent unwanted pregnancies, protect
themselves from sexually transmitted diseases and reproductive health complications as well
as safeguard their health and that of their children during pregnancy.”
One cannot deny that through the years, the country’s maternal mortality ration has been
falling. This must continue, and at a faster rate and into low double digits for a start.

We need to study and emulate some strategies of the healthcare systems of Belarus, Italy,
Norway and Poland, whose maternal mortality ratio is just 2 deaths per 100,000 live births.
Or, closer home, look at the systems of our CARICOM colleagues Grenada or Barbados with
the best figures in the regional grouping.
We can ill-afford, as a nascent oil-producing state, the haemorrhaging of our cherished
female population of this small country through what retired healthcare official Sam called
“preventable” deaths.
“The prevalence of maternal deaths in Guyana is a public health crisis that demands urgent
attention and action from all of us,” Sam wrote in her missive to the editor.
Pregnant women and their spouses, families and alas, the entire nation, need to hear, afresh,
from the Ministry of Health.
And very soon!