Safe Motherhood and the "Conspiracy of Silence"

Interview with Director of MaterCare International, Part I

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ROME, DEC. 5, 2002 ( Millions of Third World women suffer death or serious injury from treatable and avoidable complications surrounding childbirth. Yet many Western nations and medical organizations have shown far more interest in contraception and abortion, than in saving and improving the lives of mothers.

For an update on the problem, ZENIT interviewed Dr. Robert Walley, the Newfoundland-based executive director of MaterCare International, following the organization’s annual meeting in Rome. The second part of this interview will appear Friday.

ZENIT: It has been 15 years since the World Health Organization’s Safe Motherhood conference in Nairobi. How much progress has there been?

Walley: Certainly there has not been enough progress. It is an international disgrace that mothers in poor countries, at the beginning of the 21st century, should be experiencing unimaginable suffering, due to a scandalous lack of effective care during pregnancy and childbirth which is resulting in 600,000 dying annually.

Mothers are dying alone in small villages a few at a time, commonly from hemorrhage, obstructed labor, pregnancy induced hypertension and — yes, we must realize — even from induced abortions. However, these deaths represent the tip of the iceberg.

It is estimated that for every death, 30 more suffer long-term damage to their health, for example, from obstetric fistulae arising as a consequence from neglected obstructed labor. The result is that the baby dies and, because of damage to the bladder and rectum, the mother becomes incontinent with regard to urine and-or feces, and thus becomes a complete outcast and is treated worse than a leper by her husband, family and society, simply because she is wet and offensive to them.

Such mothers suffer pain, humiliation and lifelong debility if not treated. There are estimated to be 2 million mothers with the condition, mostly in sub-Saharan Africa; 50,000 to 100,000 are added each year. The tragedy is that most of this mortality and morbidity is preventable with proper maternity care, and obstetric fistula can be treated surgically, but at present there are not enough trained doctors, nurses or adequate facilities.

The 1987 Safe Motherhood Conference in Nairobi first drew attention to this tragedy experienced by mothers and issued a call to action. The response from the international community so far has been insufficient, and the reason for this inaction, according to UNICEF, is a «conspiracy of silence» and a «lack of initiative,» to which must be added a lack of compassion and political will and a reliance on abortion and contraception to the exclusion of emergency obstetrical care.

The U.N. Charter of Human Rights states that the right to health care is basic. The Beijing Conference on Women identified 12 critical areas of concern, one of which was the right of women to the «highest attainable standard of physical and mental health.» It is time for the international community to invest in the needs of the millions of women in developing countries who wish to become mothers and to stop discriminating against them.

Q: What types of care does your organization’s work bring to Third World women?

Walley: We are introducing programs which consider the needs of mothers, [such as the] West African Maternal Health project. Begun in 1998, this demonstration project is located in the Diocese of Sunyani, in a rural area of Ghana, West Africa.

MaterCare has developed an essential obstetrical care service for a rural area consisting of programs designed to improve the survival of mothers by training traditional birth attendants — TBAs — who are responsible for 70% of all deliveries, to recognize and refer high risk mothers to our district hospital, using a pictorial antenatal card; by improving the care given to mothers in rural maternity centers by nurse/midwives using a labor partograph; by introducing a safe and efficient means of transporting mothers with obstetrical emergencies to the district hospital; and by providing a maternal blood transfusion service.

We believe that this model can be used in any developing country, and we have been asked to consider developing these programs in Sierra Leone and East Timor.

A basic research program is under way to evaluate an oral, effective and inexpensive method of managing postpartum hemorrhage, one of the main causes of maternal mortality. If these studies prove successful, the final objective is to develop protocols for the use of misoprostol by traditional birth attendants, who do most of the deliveries in life-threatening situations, when medical help is not available. We think it could be a major breakthrough in preventing maternal deaths.

A West African Regional Birth Trauma Center is being developed in the Archdiocese of Cape Coast, Ghana, which will provide treatment and rehabilitation programs for mothers with obstetric fistula, and will have a special interest in training doctors and nurses in their surgery and nursing management. Other centers are needed in other parts of west Africa including again Sierra Leone and Rwanda.

A training CD has been developed for surgery and nursing for obstetric fistula. It is available free of charge to doctors and nurses in areas where fistulae are common. We tried to provide emergency obstetrical care in East Timor, but were denied access by the U.N. administration because we would not provide abortion and sterilization programs. We explained that we did not provide these services as they were irrelevant to mothers who are bleeding to death, or are in obstructed labor. We also pointed out that we do not treat rheumatoid arthritis either!

I must point out that there is no international organization that provides emergency care for refugee mothers. Médecins sans Frontières does excellent work in front-line areas, as does the International Red Cross. We believe that there is a place for such an organization as ours, since half of all refugees are mothers, most are young and it is fairly easy to calculate the numbers who are pregnant and who face possible pregnancy complications in addition to bombs, guns or natural disasters. MCI is trying to develop itself to fill a vacuum.

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