May 17, 2009
Op-Ed Columnist
This Mom Didn’t Have to Die
By NICHOLAS D. KRISTOF
BO, Sierra Leone
On this trip through West Africa with my “win-a-trip” contest winner, I was reminded of one of the grimmest risks to human life here. Despite threats from warlords and exotic disease, it’s something even deadlier: motherhood.
One of the most dangerous things an African woman can do is become pregnant. So, along with the winner of my contest for college students, Paul Bowers, I have been visiting the forlorn hospitals here in West Africa. According to the World Health Organization, Sierra Leone has the highest maternal mortality in the world, and in several African countries, 1 woman in 10 ends up dying in childbirth.
It’s pretty clear that if men were dying at these rates, the United Nations Security Council would be holding urgent consultations, and a country such as this would appoint a minister of paternal mortality. Yet half-a-million women die annually from complications related to pregnancy or childbirth without attracting much interest because the victims are typically among the most voiceless people in the world: impoverished, rural, uneducated and female.
Take Mariama, a 21-year-old pregnant woman with a 3-year-old child living in a village here in southern Sierra Leone. Mariama started bleeding one afternoon before we arrived, but her family had no money and was reluctant to seek medical care. When she was already half-dead, she was finally taken into the government hospital in Bo.
She was off-the-charts anemic, but there was no blood available for a transfusion. In that situation, the woman’s relatives are checked to see if they are of the same type and can give, but Mariama was accompanied only by her mother, who was too fragile to donate blood.
The only obstetrician, serving an area with two million people, was away, so nurses suggested that in the absence of a transfusion, Mariama receive a plasma expander for her blood. But that would have cost $4, and Mariama and her mother had no money at all.
So Mariama continued to hemorrhage right there in the maternity ward. At 1 a.m. the next morning, she died.
“We did our best to save her,” said Regina Horton, a nurse-midwife at the hospital. “But we had no blood.”
I’ve seen women dying like this in many countries — on the first win-a-trip journey in 2006, a student and I watched a mother of three dying in front of us in Cameroon — and it’s not only shattering but also infuriating. It’s no mystery how to save the lives of pregnant women; what’s lacking is the will and resources.
Indeed, Sierra Leone is now making progress with the help of the United Nations Population Fund, which is renovating hospital wards, providing free medicines and trying to ensure that poor women don’t die because they can’t pay $100 for a Caesarian section. The Bush administration cut off all American funds for the U.N. Population Fund, hobbling it, but this year President Obama has moved to restore the money. Other organizations that are focused on this issue include the White Ribbon Alliance for Safe Motherhood, CARE and Averting Maternal Death and Disability.
A bill introduced in Congress in March — the Newborn, Child, and Mother Survival Act — would establish American leadership in this area. But it has attracted pathetically little attention.
If the lives of women like Mariama were a priority, there would be many simple ways to keep them alive. For example, they could routinely be given anti-malarials and deworming medicine during pregnancy to flush out parasites. They should also receive daily iron tablets to overcome anemia, and a bed net. All this would cost just a few dollars and would leave pregnant women far less likely to die of hemorrhages.
Caesarian sections are necessary for perhaps 1 in 10 births worldwide, but village women put their trust in traditional birth attendants (partly because the attendants also perform genital cutting on girls, creating a bond). Doctors and nurses often are harsh and contemptuous toward uneducated women so that patients stay away until it is too late. If doctors and nurses had as good a bedside manner as the birth attendants, hospitals would be better used and lives saved.
Still, one sees the — limited — progress in Mabinti Kamara, who is 25 and went into labor in her village. When an arm came out, it was apparent that the fetus was sideways, so the birth attendant pushed hard on Mabinti’s abdomen to complete the process.
On Mabinti’s fourth day of labor, she was finally taken to a hospital in the city of Makeni, where a surgeon found that she had a ruptured uterus. The surgeon removed the dead fetus and repaired the uterus. Mabinti then lay on her bed in pain, disconsolate at losing her child. Still, the maternity ward was filled with women like her. Just a few years ago, they all would have died. They are reminders that women can be saved in childbirth — but only if their lives become a priority.
