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HEALTH-BRAZIL:
NGOs Push to
Avoid Preventable Maternal
Deaths
Mario Osava
SAO PAULO, (IPS) - The
death of a woman in childbirth
is a horrific blow to a family
preparing for what is meant to
be a joyous event, the arrival
of a new life. In Brazil, the
loss is made even more painful
by the fact that over 90 percent
of these deaths are preventable.
Carmem Carneiro, a journalist in
the southern Brazilian city of
Porto Alegre, is still grieving
the death of her daughter
Marina, who died while giving
birth in March.
"Her death has torn the whole
family apart," said Carneiro,
who is also the mother of five
other children. Her 19-year-old
son is currently receiving
psychiatric treatment to deal
with the loss, and her youngest
son, 17, went to live in another
city because "he just can't cope
with his sister's death."
Another of her sons has fallen
into a deep depression, but
refuses to seek treatment.
Marina's pregnancy was
progressing normally until she
developed high blood pressure
and the foetus stopped growing.
Her doctor was incapable of
properly interpreting an
ultrasound scan and an emergency
caesarean ended in preeclampsia,
haemorrhaging, multiple organ
failure and ultimately, death.
The baby girl delivered through
the caesarean after 34 weeks of
gestation weighed just 1.6
kilos, but survived nonetheless,
Carneiro told IPS.
Maternal mortality is not a
significant cause of death among
women in Brazil compared with
others, like cancer. Deaths in
childbirth only number around
3,000 annually in this country
of 184 million, but they have
dramatic repercussions and
seriously affect families and
loved ones, remarked Dr. Ana
Cristina d'Andretta Tanaka, a
professor at the University of
Sao Paulo and an expert on
maternal mortality.
For the most part, these are
"preventable deaths of young
women," caused by complications
during pregnancy, childbirth and
the 42 days following delivery
(the six-week period known as
the puerperium), the specialist
explained at a workshop held
this week in Sao Paulo by the
Women's Health Network (RFS) to
raise awareness of this issue
among reporters.
Among those whose lives are
indelibly affected by maternal
mortality are the children born
in the deliveries that prove
mortal to their mothers.
Marina's husband felt that "his
life was ruined," but has now
devoted his life to caring for
their infant daughter, Manuela,
recounted Carneiro. But despite
the joy brought by this new
member of the family, Marina's
death continues to be a source
of almost unbearable suffering,
"and only time can help to ease
it."
In addition to the sense of
mourning, however, Carneiro said
she also feels a deep anger,
"because losing a daughter this
way is unacceptable."
In the meantime, she is seeing a
psychologist and taking
anti-depressants "to at least
appear to be strong, because my
other children need me." And she
has channelled her pain into
advocacy work on maternal
mortality.
The RFS, which links together
some 250 women's groups,
research centres and
non-governmental and trade union
organisations, is seeking to
create "greater visibility" for
this issue through seminars,
publications and work with the
media, said the network's
executive secretary Fátima de
Oliveira.
Reducing the maternal mortality
ratio by three-quarters, by the
year 2015, is one of the targets
set as part of the United
Nations Millennium Development
Goals (MDGs) adopted by the
international community in
September 2000, which also
include reducing child mortality
by the same proportion.
The goals use 1990 figures as
the baseline for comparison, but
even in this case, it will be
difficult to meet these targets
by 2015 in many countries,
because maternal mortality is
either decreasing at a very slow
rate or has in fact levelled
off, as is the case in Brazil.
The maternal mortality ratio (MMR)
is measured in terms of the
number of maternal deaths per
100,000 live births, and not in
accordance with the number of
pregnancies, since this is a
statistic considered impossible
to calculate.
The MMR in Brazil in 2002 was 54
deaths per 100,000 live births,
reported Tanaka. But, she added,
this figure is clearly an
underestimate, because doctors
rarely report maternal mortality
as a cause of death. The real
rate could be double, said the
expert, a member of the National
Commission on Maternal
Mortality, who added that
underreporting of these deaths
is a worldwide phenomenon.
The official MMR has remained
stable at roughly 50 per 100,000
since the late 1980s, although
it has in fact increased
slightly in the last two years,
Tanaka noted.
That is far lower than the
worldwide average of 254.4
deaths per 100,000 live births,
and also the South American
average of 138.6, but much
higher than the ratios found in
Europe (an average of 9.9) and
particularly Canada, where there
are only three maternal deaths
for every 100,000 live births,
she commented.
In Latin America and the
Caribbean, it is estimated that
23,000 women die from
complications in pregnancy or
childbirth every year.
Tanaka said the obstacles to
improving the MMR in Brazil and
the reasons behind the increase
registered in recent years
include problems of organisation
in public health care services,
the poor training of doctors and
the overuse of caesarean
sections, which currently
account for 40 percent of all
deliveries. The maternal
mortality rate is seven times
greater when delivery is by
caesarean, said Tanaka.
The most frequent direct causes
of maternal deaths are high
blood pressure, which often
leads to eclampsia,
haemorrhaging, infections and
complications from miscarriages
and abortions, in that order,
although close to 10.5 percent
of cases are due to "indirect"
obstetrical problems like
diabetes, heart disease and
other pre-existing conditions
aggravated by pregnancy.
Maternal mortality as a result
of induced abortion is rarely
reported, since abortion remains
illegal in Brazil. In these
cases, the already dramatic
repercussions of any death are
worsened by feelings of shame,
guilt and social censure, said
Tanaka.
In almost all of the 3,000
deaths caused by complications
in pregnancy and childbirth
every year, there are "guilty
parties" involved, because over
90 percent of these deaths are
preventable. The issue is not a
"new" one in Brazil, where
hundreds of state and local
committees with community
participation have been
established to address the
problem since the 1980s, and a
national pact for the reduction
of maternal mortality was signed
in 2004.
In order to more effectively
boost awareness and social
involvement, the RFS plans to
create a National Association of
Families of Victims of Maternal
Death, which will provide
counselling and support for
members while promoting public
debate aimed at overcoming the
prevailing sense of fatality
with regard to maternal
mortality, through which these
deaths are viewed as "natural"
or as "the will of God."
The issue of maternal mortality
reflects social inequity in
Brazil, said Tanaka, who noted
that the media and politicians
treat it as "something of little
importance," as opposed to
infant mortality, for example,
because its victims are
primarily poor women, and
particularly Afro-descendants.
Many of these deaths are a
consequence of the increasing
priority placed on economic
concerns in medical practice,
leading to an increase in the
number of caesarean sections
performed because of their
greater profitability,
especially at night and on the
weekends, when doctors can
charge an additional 30 percent,
said gynaecologist Thomas Gollop.
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