As part of preparation for my work in Uganda, I’ve done a lot of research on maternal mortality. I’ve got a very wonky post coming up on a few different sites about it, but I also wrote something more personal, which is below.
I was born in a modern hospital – one with all of the bells and whistles that a modern economy can buy. A spotless operating theater staffed by an expert obstetrician and dedicated nurses, chock full of the latest, greatest sterile surgical instruments and technology; a drug for every conceivable complication or concern; NICUs and incubators and ventilators and monitors, all beeping and whirring with the signs of tenuous life.
I was born in a modern hospital five weeks early, identical twin brother at my side. Not because my mother was tired of carrying two babies around, though she was, but because she was sick and didn’t have a choice, at least not a good one. She had toxemia, what we now call pre-eclampsia – a condition that, if left untreated, leads to eclampsia, which often leads to post-eclampsia – what we now call “death.”
“Curing” pre-eclampsia – thus preventing it from becoming eclampsia – is straightforward: administer magnesium sulfate (also known as Epsom salt in its non-pharmaceutical preparation) or get the baby (babies) out, which involves inducing labor or performing a caesarian section. Inducing labor is typically done with a prostaglandin; a c-section is, of course, serious surgery. My mother opted for a c-section, the expert clinicians operated in the sterile room with the sterile instruments, and out we came.
I was born in a modern hospital five weeks early, identical twin brother at my side, and I was born sick. Early, tiny newborns often are. My parents and brother went home, and I went to the NICU, with its incubators and ventilators and monitors, all beeping and whirring with the signs of my tenuous life.
Because of the incubators and ventilators, the drugs for every conceivable complication and concern, the sterile surgical instruments, the expert obstetrician and dedicated nurses, the spotless operating theater, I got to go home, too. Thanks to being born in a modern hospital – one with all of the bells and whistles that a modern economy can buy – I survived.
That was twenty-five years ago. If my mother was instead a citizen of Uganda, there’s a much higher chance none of us would have survive – whether the procedure was done twenty-five years ago or today. Not my brother, not my mother, not me.
Forget the NICU, the ventilators, the incubators, the monitors – a sick, fragile me probably wouldn’t make it that far anyway. Forget the c-section – even if an obstetrician was available when my mother was in labor, the supplies for a safe procedure may not be. Forget even the induced labor – misoprostol is not included on the Essential Drug List, and it’s often out-of-stock.
So pre-eclampsia becomes eclampsia; my mother has tonic-clonic seizures that could be ameliorated by magnesium sulfate – except the hospital is probably out of that, too. It’s left to fate, or God. If she survives the procedure, there may be no oxytocin to prevent post-partum hemorrhage, which, with eclampsia and sepsis, is directly responsible for 60% of all maternal deaths worldwide.
Even if there is oxytocin available, it’s slightly more likely than not that no one will be there to administer it: only 42% of births were attended by skilled health personnel in sub-Saharan Africa in 2010.
Mothers-to-be die every day in Uganda because they lack the most basic interventions; because they lack the most basic standards of care. To survive, they don’t need a modern hospital – just a few basic, cheap things. And still, mothers die because they don’t have them.
All of which applies to Uganda – a country that is doing better than 35 others as of 2010 (graph below, with the United States added for comparison):
This juxtaposition can lead to a bad place, one far more hospitable to cynicism than hope, defensiveness than progress. But there is cause for hope; while Uganda today is a worse place to be an expectant mother than the United States, it is a much better place to be an expectant mother than it was twenty-five years ago. Progress is slow, but it is sure. As a global community we will fail to achieve our goal of reducing maternal mortality as much as we’d hoped by 2015, but still we will succeed in saving hundreds of thousands of lives; we will succeed in ensuring that hundreds of thousands of children will have mothers to teach them right and wrong, justice and prejudice, and how to listen to their better angels.
But, even as we recognize the lives saved, we must hope, and struggle, for a world where this largely-preventable travesty occurs as often in Chad as in Estonia. To do so will require great focus, sustained funding, and no small amount of political will. But it is one of the somethings we can do.