Maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).

The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.

The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by three quarters between 1990 and 2015. When applying this target to Ghana, maternal mortality should fall to 145 cases per 100,000 live births. In the period 2007-2012 Ghana had a reported maternal mortality ratio of 450 deaths per 100,000 live births (this figure was estimated at 350 deaths per 100,000 by UN agencies/World Bank in 2010). As Ghana’s maternal mortality rate is three times higher than the given target, it is unlikely to achieve MDG 5 by 2015. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In the period 2007-2011 this figure stood at 68 per cent, so progress towards this target is also currently off track.

In recent times, much has been said on reducing maternal and child mortality in Ghana. Since the year 1990 Ghana has been able to reduce maternal and child mortality by half from 850 per 100,000 live births to 350 per 100,000 live births in the year 2010. Although this reduction seems to be significant, it does not reflect that of a middle income country and cannot be accepted since many more women are still dying from these deaths. The rate of maternal mortality in our country can never be compared to that of countries that are developed. Italy has a maternal mortality of 4 PER 100,000 live births and even in Italy efforts are still being made to progress further. In the year 2008, Ghana in a quest to achieve the millennium development goals, introduced the MDG Acceleration Framework since it declared maternal mortality as a national emergency. As good as it seemed we still find women are still dying in the year 2015 and, most of which are from preventable causes like hemorrhage and eclampsia.

For Ghana to be able to reduce maternal and child mortality it is very important for us to understand the issues that greatly contribute to these problems. This article is to help stake holders and the ordinary Ghanaian understand and appreciate the problem we face in our health settings and also to help find lasting solutions to the problems, especially during the post MDG period.

1. One major challenge that is faced by health professionals in our hospital is low level of education among clients who patronize health services. This makes communication with our clients a very big challenge.

Once during my clinical practice, I was supposed to interview a new client who had visited the facility. As part of the interview I asked about her last menstrual cycle and she had no idea about it. In fact, she did not even know the month we were in. This date would have helped us to calculate her due date to prevent certain problems like post date period, etc. If a woman has no idea about how her body works or functions, it will be very difficult for any health worker to help her when she has a health problem.

It also becomes very difficult for her to come to the same level with the health practitioner to discuss her individual needs, since there is a communication gap between them. This also puts an undue pressure on the health personnel as to how to make their clients understand the various instructions given to them.

2. There is also over reliance on scan and this leads to many other problems like misdiagnosing pregnant women causing them to have certain unnecessary procedures like cesarean sections, inducing labor, post date and so on. There are also cases where women come for antenatal services, before they are told their date for delivery is due.

It is very unlikely for any country to make any meaningful progress in maternal health, if educational status of women is not improved.

3. One thing that also affects the work of health worker in Ghana is that there is no proper support system in the community to enhance the work of the health professionals.

In a country like UK, they have support groups in the community, online platforms, antenatal classes for partners etc. where mums-to-be can share and learn from others’ experiences and also meet birth expects. In Ghana, besides the regular antenatal classes provided by the hospitals and clinics hardly would you would find anything within the community that helps the pregnant woman to keep fit and also to track her progress to prevent complications.

4.  Another challenge is also for the fact that after the pregnant woman has agreed to adhere to the midwives instructions, some relatives who are influential within the family coheres them to forsake the advice of the midwife and stick to locally outmoded practices that can cost the life of the woman.

5.  Also, many women do not see the hospital as a friendly environment for them to have their babies. They prefer to have their babies at home or with a birth attendant where they will have the support of family members. Many of these women complain about the attitudes of midwives in the health facilities. If women do not see the hospital facility as a safe place for delivery, it will be very unlikely for maternal and child mortality to reduce in our country.

6. It is very common to see health practitioners arguing about whether they could hear the fetal heart beat of a baby with a fetoscope or not. They are also sometimes not certain about the position of the baby, the real state of the baby, whether they are having fetal distress or not. It is high time our hospitals are equipped with modern equipment and modern tools that will help better in monitoring high risk mothers and babies. This will go a long way to prevent delays that usually result in death in our health settings.

7. Most women do not usually take decision on their health seeking behavior and this is a big challenge to the health system in the Country. Even when they face the worst complications, they will have to seek permission from their partners before seeking medical care. They even decide for these women where they will have to seek medical help. This coupled with poverty prevents many women in our country from seeking health care on time and also contributes to the high maternal and child mortality in Ghana.

Though there are few midwives and gynecologists in the country, but they are concentrated in the urban areas where there are already basic social amenities like access to portable water and electricity, good schools for their wards, good network and internet facilities, etc.

8. It is very evident in Ghana that, communities without basic social amenities hardly gets midwives and other health professionals to work there. Development in our country should therefore be evenly distributed since this can go a long way to attract health professionals and thereby help reduce maternal and child mortality in our country.

Effective monitoring is also lacking in our heath facilities. It is very common to see health workers in our country doing everything possible to create a good impression when they know that there are external supervisors coming around, but refuse to do the little things they need to do to save precious lives when they are left alone. This is a very big problem and health workers should do everything in their possible best to give out their best whether someone is watching or not. Internal monitoring should also be strengthened since it will go a long way to improve health outcomes in our facilities.

9. Industries and companies should also be interested in helping the Government to reduce maternal and child mortality. They can do so by sponsoring projects that will improve on the current health system in the Country.

10. Though there is a high incidence of maternal mortality in our country, little is usually heard about it and its effects on individuals and families. It is high time massive campaigns are made to create awareness on the issue. More education should be done on mass media on the causes and prevention. Child birth classes held within health facilities should also be very educative, such that women who attend these clinics will know about danger signs and when to report to a health facility.

Despite the many problems we face in our health system, little has been done to research into the issues that we face as a country in relation to maternal health issues. We have to understand that, our problems are different from the problems that are faced by the developed world and therefore we will need our own research to help us solve our own problems. It is therefore important for Ghana to conduct its own research and to invest into this area.

Certain protocols within our health facilities are outmoded and will have to be revised again if we really want to reduce maternal mortality in our hospital facilities.

An example is the birth position which is normally used in the hospitals. Every woman is made to lie on the back during delivery, but research has shown that this position reduces the female pelvic outlet by 30%, so why do we still hold on to it when there are other birth positions a woman can use and also better facilitates birth, like squatting, standing etc?

Women hardly know their reproductive rights and the options they can have during pregnancy and delivery. The few who know cannot even get what they want because health facilities are under resourced and understaffed. To improve maternal health in this country we need to revise certain protocols and policies within our health system.

In conclusion, it is very important for Ghana to put in much effort to reduce maternal mortality. These basic issues when taken seriously and addressed will go a long way to reduce maternal and child mortality. About half of the population in Ghana is made up of women and if issue’s that affects our reproductive health is neglected, it will have a direct effect on the economy and the true state of the nation. When a woman dies, a family is broken and consequently society will also be broken. No woman should die whilst bringing life into the into the world.