The maternal mortality rate (MMR) in Australia is 1 in 10 000. In Singapore, it is 1 in 8000.
In nearby Papua New Guinea, the lifetime risk of a mother dying during pregnancy remains 1 in 20.
With some of the worst maternal mortality statistics in the world on Asia’s doorstep, and with the target year for the Sustainable Development Goals (SDG) approaching, the time has come for the Asia-Pacific region to critically reflect on how to respond to consistently dire statistics with an effective coordinated response that aligns with the SDG agenda.
Since 2000, the fifth Millennium Development Goal (MDG) has sought to improve maternal health through a) a reduction by three-quarters, between 1990 and 2015, of the maternal mortality rate as well as b) universal access to reproductive healthcare by 2015. Globally, improvements were made over this period, with a halving of the global MMR, a reduction in maternal health complications, as well as acknowledgement of the need for adequate maternal health education.
Papua New Guinea has, however, defied the trend with one of the most consistently poor maternal and infant mortality rates in the Asia-Pacific. If Papua New Guinea’s MMR had achieved the MDG target reduction stipulated in Goal 5.a., then the MMR would have been 98 deaths per 100,000 live births. Instead, from 2008-2012, it sat at approximately 703 deaths per 100,000 live births. This number indicates a failure by the international community to adequately address the underlying local issues.
Although it is a complex issue, the primary obstacles to reducing maternal mortality in Papua New Guinea include the inaccessibility of adequate maternal health care facilities and the lack of sociocultural awareness of the difficulties women endure during pregnancy and childbirth. One of the most devastating facts about MMRs is that the majority of deaths can be prevented.
“Mothers are continuing to die at a rate that is an injustice given just how preventable some of these deaths are…” (Dr. Mitchell Hendel, Burnet Institute).
Preventable health complications for Papua New Guinean mothers include postpartum hemorrhages, obstructed labor-induced sepsis, and fistula. The frequency of these conditions is exacerbated by the sheer inability of mothers to access an ‘instrumental delivery’ – a vacuum and forceps-assisted vaginal delivery. These complications also affect the life expectancy of the infant.
Most infant deaths are attributable to infection or premature births where immediate and sufficient newborn care is not provided. Hendel states that only 40 percent of women in PNG are delivering with a skilled birth attendant, and thus up to two thirds of preventable infant deaths could be avoided. Simple steps within the first half an hour of life – such as drying the newborn and placing it on the mother’s stomach to regulate its body temperature and stimulate an immune response – are often neglected in favor of other erroneous practices, such as placing newborns in bacteria-laden bassinets.
Women are more likely to just attend one antenatal appointment rather than deliver a child in a hospital. The stipulated MDG target of “all births being attended by a skilled birth professional” was met in PNG in only a mere 53 percent of births that took place. When it comes to the delivery, most mothers prefer to birth in their village. According to Australian PNG-based obstetrician, Dr. Barry Kirby, this can be attributed to confusion as mothers do not know when they are due, nor are they willing to leave their village to traverse kilometers of difficult terrain to access the nearest clinic.
Many communities dismiss the need for a hospital-delivery if the mother is deemed fit during an antenatal appointment. Emphasis needs to be placed on educating families that a bill of health during a mother’s second or third trimester does not equate to an easy birth. And even if these factors do not deter a woman from a hospital delivery, they still need to pay the equivalent of A$5.00 ($3.60) to the hospital – a sum beyond the reach of many.
Ultimately, high rates of overall disease in mothers compounded with misinformation about maternal health practices hinder the ability of health practitioners and birth assistants to provide women with a basic level of maternal health care. Moreover, health practitioners are constantly rectifying misinformed cultural taboos such as the degradation of women who vocalize pain during delivery or the perception that it is inappropriate for a man to be involved during a delivery.
Policy reform and action aimed at targeting the primary health problems that contribute to individual maternal deaths need to occur with the utmost urgency and co-operation. Efforts from the non-profit sector have so far seen improvements in the Milne Bay Province. The provision of “baby bundles” (baby baths consisting of newborn essential kits and the A$5 delivery fee) to mothers who give birth in hospitals encourages mothers to travel from their village to a health clinic.
On a political level, there has been some discourse on the issue. In 2014, Peter O’Neill, addressed parliament about the dangerous misconceptions about contraception, stressing its importance in reducing maternal mortality. “These implants can be removed any time, when they want to start up a family…”
Now that the Millennium Development Goals have offered a platform for insight into health concerns, the Sustainable Development Goals should be directed at engaging local communities, politicians, and the international development sector in areas that currently don’t get adequate attention. Together, they should work to address the outstanding cultural issues that impede the provision of effective maternal healthcare in Papua New Guinea and to ensure that every woman enjoys the basic right to a safe delivery.
Georgia Eccles studies a Bachelor of Medical Science/Bachelor of Development Studies at the Australian National University, Canberra. In addition to her studies, Georgia is currently working with Femili PNG and The West Papuan Development Company.