23 August 2001
Over four years ago a national system was put in place to investigate every maternal death - that is, a death that occurs during pregnancy, child birth or within six weeks of confinement. As a result of this, the Health Department is developing a much better picture of what causes these deaths and this, in turns, leads to action to rectify some of the shortcomings in maternity care.
The initiative is the most extensive national assessment of the quality of maternal care yet undertaken in Africa.
At the head of this monitoring system is the National Committee on Confidential Enquiries into Maternal Deaths. This is an expert panel that examines comprehensive reports on the deaths that occur and forms an opinion on the cause of death. The credibility and expertise of members of the committee are critical to the success of the system.
The Committee published a report every year, revealing causal patterns in maternal deaths, analyzing the data and pointing out what this implies in terms of action to make pregnancy and childbirth safer.
The second Committee completed its two-year term of office earlier this year. The Minister of Health, Dr Manto Tshabalala-Msimang, today attended a special meeting in Benoni to acknowledge its contribution and to welcome those who were recently named to take over the job.
"I feel great to be standing here today, reflecting on the progress made so far with the notification and confidential inquiry into maternal deaths in our country," Dr Tshabalala-Msimang said.
"We know that maternal mortality or the 'neglected tragedy' is still the leading cause of deaths amongst women of reproductive age in all developing countries," the Minister said. She added that for every maternal death, another 30 women suffered severe illness during pregnancy or childbirth.
"While most pregnancies and births are uneventful, all pregnancies are a risk. About 15% of all pregnancies develop a potentially life-threatening complication that calls for skilled care."
The Minister pointed out that the monitoring system was not working equally well in all provinces. In some areas very few maternal deaths were reported. The Minister indicated that she was not convinced that there were "no 'neglected tragedies' in these areas". Instead, she suspected the neglect was compounded by non-reporting.
In 2000, the five top causes of maternal deaths - collectively accounting for 87% of all maternal deaths -- were:
Presently, the overall rate of maternal deaths in South Africa is at least 150 per 100 000 live births. Some estimates would put it as high as 260 per 100 000 live births.
Although complications arising from abortions continue to feature, there has been a decline in the number over the past three years, probably due to increased access to safe termination of pregnancy.
"Although the information gathered from the confidential enquiries process outlines the tragic magnitude of the problem, we are now in a better position to plan and implement best practices that will save the mothers of this country from these tragedies," Dr Tshabalala-Msimang said.
"I therefore would like to thank all members of the Committee for making yourselves available to serve. Your dedication and commitment to promote and improve the health of mothers and women of this country is remarkable."
There is an overlap between outgoing Committee and the new Committee. Five members will be serving another term to ensure continuity, including chairperson Professor Jack Moodley, an obstetrician from KwaZulu Natal.
The new 24-member committee will serve a three-year term and comprises obstetricians, midwives, an anaesthetist and several senior officials of the Department with expertise in women's health, HIV/AIDS and research/monitoring.