Campaign has Potential, Needs Strong Monitoring
(Johannesburg) – South Africa’s new campaign to reduce maternal mortality is an important step to address a serious problem, but accountability will be the key to making it work, Human Rights Watch said today. The campaign is aimed at reducing the number of women who die needlessly from preventable and treatable causes linked to pregnancy and childbirth.
South Africa announced its Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) on May 4, 2012. It is part of a continent-wide, African Union Commission-initiated campaign, whose theme is “Africa Cares: No Woman Should Die While Giving Life.” The campaign’s objectives include building on successful efforts and “best practices” to reduce maternal mortality, improving data collection and monitoring of maternal and newborn deaths, and mobilizing political commitment by national authorities, civil society groups, and communities.
“This campaign is very timely and speaks to the government’s commitment to make reducing maternal mortality a national priority,” said Agnes Odhiambo, women’s rights researcher at Human Rights Watch. “The challenge is to make this commitment a reality for women by making sure the many strong reproductive health policies that South Africa already has are carried out. The key to success is accountability.”
Human Rights Watch released an in-depth study in August 2011 about women’s experiences when they sought health care for pregnancy and childbirth in the South African public health system. The report, based on interviews with 157 women who sought or accompanied other women seeking maternal health services, found a complex web of mistreatment by hospital staff, neglect, and lack of accountability. Human Rights Watch called on the South African government to provide better oversight and accountability to address the recurring health system failures that contribute to poor maternal health outcomes, and to ensure that existing reproductive and sexual health-related laws, policies, and programs are implemented.
South Africa has many strong policies on maternal and reproductive health and the highest per capita spending on health in sub-Saharan Africa. However, the maternal mortality ratio is estimated to have increased from 150 to 310 deaths per 100,000 live births between 1990 and 2008, according to revised statistics published by the Health Data Advisory and Coordination Committee in 2011. The committee was formed by the National Department of Health in 2010 to address South Africa’s health data problems.
Human Rights Watch called on the South African government to improve its efforts to collect nationwide maternal health data that allow comparison and disaggregation on the basis of sex, race, age, and geographic, educational, or economic status. Such indicators are vital, Human Rights Watch said, so the government can set standards and targets, hold providers accountable for meeting them, monitor and evaluate effectiveness of health policies, and eliminate discrimination while ensuring that vulnerable communities are benefiting from health care programs.
In addition, the government should improve monitoring of access to life-saving care for women with obstetric emergencies by incorporating all the internationally agreed emergency obstetric care (EmOC) indicators into routine health management information systems.
The South African government also needs to ensure that individual health care users have access to easily understood and effective mechanisms to lodge complaints about barriers to care and to seek redress. Such mechanisms are crucial in health system reforms, including those intended to reduce maternal mortality.
The continent-wide campaign was opened in May 2009 in Addis Ababa by the African Union health ministers. So far, 36 governments have begun campaigns in collaboration with United Nations agencies, bilateral donors, and civil society groups.
“If South Africa is serious about reducing maternal deaths, it should put women at the center of this campaign,” Odhiambo said. “Ensuring there is a functional system for all women to report the difficulties they face in their homes, communities, and health facilities in receiving quality care, and acting on their grievances can help achieve this.”