Date: 13/02/2003
Source: Northern Cape Provincial Government
Title: Peters: Northern Cape Pregnancy Education Week


SPEECH BY THE NORTHERN CAPE MEC FOR HEALTH, MS DIPUO PETERS, AT THE PROVINCIAL LAUNCH OF PREGNANCY EDUCATION WEEK, Wrenchville Community Hall - Kgalagadi Cross-Border District, 13 February 2003

Programme Director
Mayor of Gasegonyana Municipality
Speaker of the District Council
All Members
Distinguished Guest
Ladies and Gentlemen

Firstly, I would like to thank all of you for honouring this occasion with your presence. This shows the commitment you have in ensuring that your reproductive health status is improved. It gives me courage to continue striving towards improving the health of all our people in the province.

This year marks the fifth anniversary of the birth of Pregnancy Education Week in our country with the theme "Pregnancy Education makes a difference".

I think people are asking themselves "Why pregnancy education week?

"What is so special about pregnancy that we should have a week dedicated to pregnancy education?"

Pregnancy is a special time. It is a special journey every pregnant woman should enjoy. It is not an exclusive journey for women but also for their partners, families and communities.

However, some women are not privileged to travel this pregnancy journey, but it is also important for them to give sisterly support to others who can travel this journey.

Amongst those who travel through this journey, some do not reach their destination at all. They leave us along the way.

Some reach their destination, that is, they reach full-term and deliver their babies, only for their babies to be born dead, or die soon after birth.

Others, having survived pregnancy and childbirth, are often left with permanent disabilities and are scarred for life. The suffering goes beyond the physical, and affects the ability of women to undertake their social and economic responsibilities, and to share in the development of their communities.

The tragedy is that the women who die, die not from disease, but during the normal life enhancing process of procreation. This should not be allowed to happen.

We as human beings have an obligation to protect women's right to life when they go through the risky process of giving life.

Pregnancy education is one of the mechanisms that can be used to effect this obligation.

Every year in our country women die from pregnancy related causes.

Why is this so?

In most instances poverty is the underlying cause. This leads to various conditions, including anaemia (weak blood). The other cause is failure to attend antenatal care regularly as stipulated by our nurses.

Ladies and gentlemen, antenatal care is provided free of charge. However, some pregnant women do not use this effectively. The reasons for this under-utilisation are not known.

I am convinced, though, that lack of information is a contributing factor. We need to improve the way we provide information, so that people can benefit from these and other services.

One way of addressing this problem is to empower women with quality information that will enable them to make informed choices and decisions.

In Kgalagadi District we have six clinics offering this service, staffed with well-trained and competent midwives; hence we can proudly say that in Kgalagadi to date has not recorded a single maternal mortality case.

Ladies and gentlemen, since the African National Congress came into power, Government has initiated an investigation into why women die during or after pregnancy.

According to the latest report released by the National Committee on Confidential Inquiries into Maternal Deaths (NCCEMD) the "big five" causes of death during pregnancy are complication of hypertension conditions in pregnancy, AIDS, obstetric haemorrhage, pregnancy related sepsis and pre-existing medical conditions.

Most of these deaths can be prevented if we all, that is, community members and health workers, join hands in making sure that we protect pregnant women. If a complication is identified, either in the community or the health facility, we must seek help promptly, so that we do not have a mother or a baby dying.

The report also shows that we, health workers and community members, have all contributed to some of these deaths. In almost half of all the cases, there was a missed opportunity for preventing the death.

On the women's or community side, the problems were mainly: not attending for antenatal care, delay in seeking help, self-induced abortion, home birth and refusal of professional treatment.

On the health workers' side, problems were: delay in transport and referral of problems, not recognising a problem on time or making a wrong diagnosis.

We have since moved quickly to train our health workers and continuously encourage them to change these practices or behaviours.

We also wish to encourage our women and their partners to book in early at our clinics. To ensure that they regularly honour their antenatal care appointments, so that any abnormalities can be detected before labour.

We also discourage home birth and wish to advice our people to make use of our facilities and health professionals stationed at them, in doing that we will be protecting our unborn babies.

We also encourage our people to make necessary transport arrangements or call our ambulances for assistance. Failure to that will result in placing the mother and unborn child at risk.

For those couples and single mothers in Kgalagadi who fall pregnant and realise that it was a mistake, we advise you to present yourself at the nearest health facilities for the termination of the pregnancy (TOP).

TOP is legal in South Africa and is rendered for free in all public institutions, so it advisable that we desist from back-street abortion to avoid unnecessary loss of life.

It is for this reason that Government has dedicated one week in the month of February to highlight the importance of pregnancy education, but it is not an end, but a means to a country free from maternal death.

Ladies and gentlemen, I repeat it is our responsibility to make sure that no woman dies as a result of pregnancy and/or childbirth. Pregnancy is not a women's issue, it affects all of us.

One problem that we often do not talk about, yet it has serious adverse effects on the baby is drinking alcohol during pregnancy. Alcohol causes developmental problems for the child inside the mother's womb, and after birth.

The child may be born with a condition known as Foetal Alcohol Syndrome (FAS). Such a child will have difficulties in learning and paying attention at school. As an adult, this individual may have difficulties in keeping a job and thereby perpetuate the cycle of poverty.

Government carried out studies on how common this Foetal Alcohol Syndrome is in our province. The results so far indicate that our province, the Northern Cape, has a bigger problem with FAS than was previously thought. In Kgalagadi this problem is common in our disadvantaged areas, especially amongst teenagers.

We can prevent FAS.

We must encourage women of reproductive age NOT TO DRINK.

Programme director, this call reminds of a old Tswama poem by M. Seboni - "Mosadi wa Letagwa" it goes:
Mahutsana a matlhotlha pelo
Thogo ya morafe le setshaba
Tiro tsa mosadi wa letagwa

This poem confirms the importance of mothers in our society; it defines women who drink too much as a reflection of a disgraced society "Thogo ya morafe le setshaba".

The progressive ways to encourage women to stop drinking before and during pregnancy include the following.

We must:
* Support women so that they do not resort to drinking because of social problems and educate families on the effects of drinking during pregnancy
* Make learners and young people aware of the dangers of drinking during pregnancy
* Encourage formation of and participation in FAS prevention programmes
* Encourage the formation of support groups where women who are affected will be given necessary support.

Ladies and gentlemen, the other challenge is HIV/AIDS infection and it remains a great challenge to our health, especially women and children. The challenge for us is to do all what we can to prevent the infection of our children by consistently visiting our VCT sites to establish our sero-status in order to live a positive life.

VCT encourages those who are infected to be human enough to protect others from getting infected including unborn babies. No one deserves to be infected.

However, we must accept and love those who are already infected, because they are still our brothers, sisters, mothers and children. They are still our friends.

Let us be faithful to our partners. Let us also take precautions by using condoms consistently, as condoms help prevent not only HIV/AIDS but also other sexually transmitted infections and unwanted pregnancy.

Two (2) research and five (5) non-research PMTCT sites are already operational in our province to assist pregnant women to prevent the transmission of HIV to the infant.

In Kgalagadi, Nevirapine is currently available at Kuruman Hospital and in April month we will be starting a PMTCT site for Kgalagadi simultaneously with Namakwa! district.

The review of the work at these sites has revealed that provision of antiretroviral drugs to pregnant women and their babies is not as simple and easy as we all believed. There is a lot more to it than just giving the drugs.

There is an urgent need to review our resources, both human and material. We need to have adequate numbers of personnel to implement an effective programme of voluntary counselling and testing. We must have adequate space to maintain privacy. But collectively we will triumph.

Stigma remains the major obstacle to many women taking up this programme.

We must do something about it.

Nevertheless, the Department will continue to support the existing sites as well as other sites that will come on board. The Cabinet's 17 April 2002 statement challenges us to respond to this crisis. It is a reality that we must deal with collectively.

Government cannot overcome this burden alone. There needs to be collaboration and commitment in working together with the private sector, NGOs, CBOs, the business sector and the community at large.

Ladies and gentlemen, women need to know their reproductive rights. They need to be involved in decisions that affect their reproductive health, about contraceptive choices including emergency contraception.

Women need to know about the importance of early, continuous attendance to antenatal clinics and to report early any problems that may arise during pregnancy.

They need to know about their HIV/AIDS status, options that are available for them if they are HIV/AIDS positive and how to prevent HIV/AIDS mother to child transmission.

Those women, who choose not to continue with their pregnancies because of reasons known to themselves, need to be provided with an enabling environment to make this difficult decision, and to help them deal with the decision they make. Only when women are supported and feel accepted irrespective of the decision they choose, will maternal deaths due to back-street abortions be reduced.

I believe that pregnancy education will help empower women in many ways. It will empower them with information that will enable them to recognise any danger signs during pregnancy; to express their health needs and concerns; to access and engage the health system with greater certainty and without delay; and to seek accountability from, and build partnerships with health providers and other sectors in seeking ways to make pregnancy safer.

Programme Director, this week we are also celebrating STI week with the theme; "Just the two of us" - which covers the confidentiality aspect of an individual's STI status and relationships among partners.

Tomorrow, apart from the official opening of parliament and an important address from our President, President Thabo Mbeki, there is another thing that is very important which we will be observing. That is Valentine's Day.

Valentine's Day is an established tradition usually celebrated with an exchange of gifts between two people, and signifying a declaration, proposal, or affirmation of love. The giving of gifts to the one you love is known in many cultures.

The main focus of Valentine's Day is relationships and intimacy. As this day falls within STI/Condom Week, we want to increase awareness of and understanding of what STIs are and what their symptoms are.

We want to encourage people to tell or notify their partners if they have these infections. We want to motivate all of us to seek health advice and treatment - which is available at all government clinics and health centres.

Reaching everyone with messages and interventions such as the treatment of STIs is an ongoing challenge. We have to deal with many factors that put people at risk of contracting STIs, including HIV. This includes people often being separated from their families and communities, limited recreational options within our communities, alcohol and substance abuse as well as commercial sex.

Last year as the Department of Health, we launched the "Men in Partnership against AIDS" which remains a crucial development in our prevention programmes. Within the national Partnership Against AIDS, men are one of the most significant sectors - and one that can make the greatest difference right now. I want to speak to the men that are present here today.

Broadly speaking, men are expected to be physically strong, emotionally robust, daring and virile. Men can and must unite to protect South Africa's women and children from violence, disease and rape. The rape of our women and children must stop! As men, let us protect our mothers, partners, sisters and children from these social ills.

However, we must remember that men are also vulnerable to various health risks too. With the exception of a few countries, men have a shorter life expectancy at birth than women. Stereotypes about manliness expose men to health riska, including those related to sexual and alcohol abuse.

Men often delay seeking health care for illnesses, such as STIs that could be prevented or cured and thereby, putting themselves and their partners in danger. Too often they see themselves as untouchable to illness or risk and this is reflected in the under utilisation of health services by men.

I believe that greater attention must be given to the health needs of men, including those infected with STIs.

Part of the concern is that men's behaviour put women at risk. In many communities, women are stigmatised for admitting that they have an STI. Because of fear of retribution from either their partners or the communities, some women fail to seek medical help.

In other cases, women would come to public institutions for treatment. They get effective treatment as health workers in more than 80% of our facilities have been trained in syndromic management of STI.

These women go home and get re-infected by men who either have not sought treatment or have received often less effective treatment in the private sector.

It is therefore critical that we encourage the private health sector to adopt the same approach as the public sector in treating these infections or encourage men to utilise public health facilities. You should know that the price is not the best indicator of a good quality service.

We can celebrate several successes that we had achieved in this war:
* To date Government has increased distribution of male condoms to 220 million countrywide over the past financial year;
* 1 million female condoms were distributed to 200 dedicated sites and these sites will be increased to 245 by December 2003 countrywide
* All condoms are being tested by the SABS to ensure quality control on every batch that is distributed
* We only had less than 1% stock-out rate at the 166 primary distributing sites for male condoms throughout the country.

It is often said that knowledge is power. This is undoubtedly true when it comes to STIs. Knowing how to prevent STIs, including HIV, can undoubtedly save your life.

If we build our future on knowledge - especially our youth, I believe that there is hope for the future generation. As government we will continue to provide as much information as we can to enable our people to take informed decisions about their life.

There is a government's campaign called Khomanani (meaning "caring together"), which is part of government's efforts to reduce the spread of HIV/AiDS.

The campaign encourages us to care for our own health, to care for the well-being of our partners and families, to care for our communities - and ultimately, to care for our country.

Ladies and gentlemen, everyone is at risk of infection irrespective gender, status or sexuality. But you also have a right and a duty to protect yourself and your partner from STIs.

If you suspect that you may have an STI, talk to your partner and visit your nearest clinic. Some obvious symptoms include discomfort when urinating or itching, swelling or burning in the genital area.

However, there are some STIs that do not have apparent symptoms. So if you have engaged in unprotected sex - which you should not - or you or your partner has had other sexual partners, it is best to visit your local clinic and get checked.

May I also take this opportunity to congratulate and thank each and everyone who has contributed to the organisation of this very important event, and a special thanks goes to the community members who have travelled long distances to come and hear all that we have to say regarding reproductive health.

Lastly, I sincerely hope that these initiatives will not end today but that it will continue every day because pregnancy happens every day and together we can turn the tide against STIs and HIV/AIDS.

Together we can win.

I thank you.

Released by the Ministry of Health, N/Cape - 053 830 2000