Properly-Equipped Health Facilities Needed to Address Maternal Mortality in Ivory Coast

By: Nina Benedicte Kouassi, Key Correspondents

When Tanoh Marie felt the first contractions she understood that her delivery time was near. As a mother of two already she knew about such things.

With the help of her sister-in-law Adjoua Kan, she made it to N’Zianouan rural health centre to deliver. Both women live in M’Brimbo, a small village 185 km from Abidjan. 

“When we got to the rural health centre, the midwife said the baby was not doing well. He was coming by his feet so they could not go ahead with normal delivery and she said that we should go to Tiassalé. Marie said that the pain due to labour was too much for her,” Adjoua Kan remembered.

With a car borrowed from a local village, the women got to Tiassale hospital. Unfortunately health workers there could not assist with the delivery. “Marie had started bleeding,” Adjoua said, “and the doctors there said she was too weak to deliver. They put us in an ambulance and told us to go to Yopougon teaching hospital in Abidjan where they would surely be able to help her deliver.”

“But when we got there, there were no beds available and we were told to go to Treichville teaching hospital instead. She died just as we reached the hospital. My sister-in-law and my nephew died because there were no beds… no beds,” Adjoua said wiping her eyes.

Maternal mortality in Côte d’Ivoire

There is an African proverb that says that every woman who gives birth has one foot in her grave. This is certainly true in Ivory Coast. According to Unicef West and Central Africa office, women in the region are 470 times more likely to die from pregnancy and childbirth complications than a mother living in the industrialized world.

The risk of maternal death is even higher for women living with HIV. According to gynaecologist Dr Kacou: “Pregnant women with HIV die at much higher rates than women without HIV. The risk of pregnancy-related death is six to eight times higher for HIV positive women than their HIV negative counterparts. 

“HIV increases maternal mortality directly from the progression of the HIV disease itself, and indirectly through higher rates of sepsis, anemia and other pregnancy-related conditions.  HIV is also a major indirect cause of maternal mortality by an increased susceptibility to opportunistic infections such as Pneumocystis carinii pneumonia, tuberculosis and malaria.”

Maternal deaths, preventable deaths

The World Health Organization says that most of the maternal deaths in Ivory Coast are preventable, and the healthcare solutions to prevent or manage complications are well known. Women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth.

Unfortunately not all the women in Ivory Coast have access to skilled care. Skilled care is defined as quality care during pregnancy, childbirth and the postpartum period as well as the infant being looked after by trained personnel who are supported by an enabling environment such as having the necessary equipment, supplies, medicines and infrastructure. 

For Ablan Dorine, a mentor to HIV positive mothers, most women - especially those living with HIV - lack skilled care during pregnancy, labour and postpartum. She said: “In rural and remote areas, there is a lack of skilled health workers.  Facilities lack equipment like gloves, beds and mama kits.  Sometimes women in labour have to walk or are carried to remote health facilities. Their relatives are also sometimes asked to buy equipment before being assisted. Women living with HIV are among the most vulnerable. Only last month a girl died in the delivery room as her husband was buying the caesarean kit. She was 18 and HIV positive.”

Ama, who is nine months pregnant and living with HIV, feels that this situation is very bad and is likely to affect her decision whether to have other children. She said: “In my village, you are only a woman when you give birth. But when I look at my status, I just pray for everything to go well. I am thinking that this will be the riskiest day of my life because anything can happen.”

Equipping and strengthening health systems

With such a situation, Ivory Coast will fall well short of the Millennium Development Goal target for maternal mortality reduction (MDG 5) and the objectives of the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA). 

Investing in and strengthening health systems, including ensuring access to health services, is one of the solutions. Midwife Tizraut Adou thinks a lot can be done in this regard. 
She said: “Giving life should be a natural thing. We can prevent maternal deaths. We just need to ensure every birth is attended by a skilled health worker. We need to ensure our health facilities are well equipped. No woman should die when giving life.”

Nina Benedicte Kouassi lives in the Ivory Coast and is a member of the Key Correspondents network which focuses on marginalised groups affected by HIV, to report the health and human rights stories that matter to them. The network is supported by the International HIV/AIDS Alliance.

Photo via Nell Freeman for the International HIV/AIDS Alliance.

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