A drop in mother mortality

The local mother mortality rate is dropping, but not as much as required, experts feel.
Alisbeth Romey, a 16-year-old mother living in the city of Matanzas, over 100 kilometers east of Havana, had her baby born by caesarean section in early March 2013.

«It was the most terrible experience of my life,» the teenage mother told SEMlac.

I initially went on a diet and soon started to suffer from high blood pressure. I spent a week after delivery at an intensive care unit,» she recalled.

Some figures

According to data of the Ministry of Public Health (MINSAP), the rate stood at 21.4 deaths every 100,000 live births in 2013, as compared to 21.5 a year earlier.

The main causes of death included hemorrhages, infections, miscarriages, and gestational hypertension.
The rate goes up, however, when indirect causes of death like anemia and parasitic, respiratory and circulatory diseases are considered.

In this context, the overall rate reached 38.9 deaths every 100,000 born alive last year, as compared to 33.4 in 2012.

Dr. Miriam Gran, a biostatistics specialist and member of the team that puts together the Cuban Health Yearbook, indicated that the main causes of death cover 74 percent of cases.

Elizabeth Gaínza, a family doctor in El Cerro, a municipality in Havana, said that many pregnant women do not give up smoking, drink alcohol, and do not take vitamin supplements as recommended.

Sonia Águila, a specialist working at the Eusebio Hernández Obstetric Hospital in the capital city, stressed that there are no official statistical data about morbidity to amend protocols, as required.

Her article A strategy for mother mortality reduction was published by the Revista Cubana de Obstetricia y Ginecología in June 2012. She addressed issues like inadequate healthcare staff training to identify pre-conceptional and general reproductive risks, poor pre-natal care quality, and late ectopic pregnancy diagnosis.

«The so-called Cesarean Section Committee is not working properly, and there is no compliance with the pre-eclampsia, eclampsia and abortion protocols,» she emphasized.

Dr. Evelio Cabezas had expressed similar concern in 2009, in the article Mother mortality: an issue to be addressed, which was also published by the Revista de Obstetricia y Ginecología.

«Our mother mortality rate is one of the lowest in Latin America, but is still far away from that of developed nations,» he noted.

Next steps

Reducing mother mortality is the fifth Millennium Development Goal (MDG), as established by the United Nations in 2000. They will be reviewed in 2015.

This goal is not likely to be met here, said the Third Country Report on MDGs in Cuba (UN website).
The main reasons for non-compliance include teenage pregnancy, nutritional deficiencies, and financial constraints.

The second part of the goal (sexual and reproductive health services) will definitely be met,» it added.
«The MINSAP morbidity and mortality reduction program was given a new boost a couple of years ago,» said Dr. Roberto Álvarez, head of the mother and child care program (PAMI).

«Pre-natal care covers 10 controls; four of which involve gynecology and obstetrics specialists,» he told SEMlac.

He highlighted the need to strengthen the program, ensuring sexual and reproductive health education in all stages of life, with special emphasis on adolescence.

«The main causes of mother mortality and morbidity are being further investigated and protocols are being updated,» he announced.

A global problem

World mother mortality has dropped by 45 percent since 1990, a joint report by UNFPA, WHO, UNICEF, the UN Population Division and the World Bank indicated.

Around 290,000 women died in 2013 as a result of pregnancy- and delivery-related complications, as compared to 500,000 in 1990.

Entitled Trends in mother mortality (1990-2013 period), the text said that several Latin American and Caribbean countries have been making headway along these lines. The number of deaths has moved from 17,000 in 1990 down to 9,300 last year (a 40-percent drop).

While Uruguay, Chile and Peru have made considerable progress, Bolivia, Honduras and Haiti continue to confront major challenges.

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