healthcare human capital

Care for pregnant mothers will pay dividend

A WALK around the northern suburbs of Johannesburg before Mother’s Day reveals what appears a rosy picture of motherhood in SA.

But the display of care and affection obscures what happens in large parts of our society. For many, becoming a mother is a grinding, if not life-threatening, experience. As advertisements gush over motherhood, there is no trace of the missing mothers who have succumbed to the effects of pregnancy and labour.

SA has one of the highest rates of maternal mortality among middle-income countries — defined by the World Health Organisation as death of a woman while pregnant or within 42 days of its end, from causes related to, or aggravated by, pregnancy or its management.

SA’s maternal mortality ratio, by the standard metric of deaths per 100,000 live births, increased from an estimated 150 in 1998 to 369 in 2001 and worsened further to 625 in 2007.

Recent figures put the rate at 140 deaths per 100,000 live births in 2013. Compare that to countries with similar per capita income levels such as Peru’s 68, Colombia’s 64, and China’s 27 deaths per 100,000 births.

This speaks to the degree of inequality in SA, with many citizens living under conditions far removed from those implied by the construct of an average income.

The leading causes of maternal death are complications related to HIV/AIDS, bleeding before or after labour, and complications related to high blood pressure. Antiretrovirals has cut HIV/AIDS-related deaths, but those related to haemorrhage, particularly after Caesarean section deliveries, are surging.

There is a pile of literature on how the health system could better implement the laudable policies put into place to deal with maternal health. As with many challenges, there is little doubt what needs to be done.

Antenatal care is free in the public health system, but research by the government and by bodies such as Amnesty International has shown that women face other barriers to proper maternal care. These include the availability and affordability of transport to reach health facilities; practices that undermine patient confidentiality and, therefore, a willingness to use the system; and lack of knowledge about maternal health.

It is not only death that we should guard against. Inequality begins in the womb, to borrow a phrase used by economist John Komlos, who studies the link between prenatal conditions and lifetime outcomes.

A much-publicised study carried out in Gambia shows how a mother’s diet at conception influences her child’s prospects over a lifetime.

In that study, a team from the British Medical Research Council tracked demographics in the village of Keneba since the 1940s.

They found that those conceived in the dry season were 10 times more likely to die in young adulthood than those conceived in the wet season.

This is the result of a stark natural experiment that arises because the food available in this community changes considerably according to the seasons.

Children conceived in the dry season, when grains dominate but there are no leafy greens, are burdened with disadvantages that become apparent only after the age of 15.

This research study adds to a body of work that shows how a mother’s nutrition affects how genes are expressed or suppressed in the foetus, with effects that last through multiple generations.

The costs of maternal mortality and of children whose potential has been needlessly stunted before birth are borne by society as a whole. The penalties include a smaller economy, lower productivity, inequality, social upheaval and crime.

Supporting all women on their journey to becoming mothers is an important step on the road towards boosting our human capital endowment as a nation.

This column was published in Business Day

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