By Mathias Aboba-Bolgatanga
Whilst Ghana?s efforts towards achieving the Millennium Development Goals targets for maternal and child mortality reduction have been commendable, more pragmatic measures for accelerating the achievement of these targets are in urgent need. This is the strong observation of the Regional Director of Health Services for Upper East Region Dr. John Koku Awoonor-Williams.
Dr. Awoonor Williams made this observation in an interview in Bolgatanga while speaking on efforts the region has made towards increasing access to comprehensive reproductive health services.? He said as part of measures towards the achievement of the MDG 5 and women health in general it was important to improve access to appropriate information and health care services for women and girls to empower them to assert their right to decision regarding pregnancy and child bearing.
He revealed that unsafe abortion continues to rank high among major causes of maternal mortality and said the Upper East Region has taken steps to provide skills and empowerment training for midwives to provide family planning and post abortion services in the bid to reduce the deaths of women and girls resulting from incomplete abortion and related dangers and complications.? The training came through a partnership program with the American College of Nurses and Midwives under an initiative known as the ?Brown Bag Project?.
Midwives are an integral part of frontline health officers whose work touches heavily on maternal health. By their training they are skilled and have the responsibility of providing care and support for women during pregnancy (antenatal), conducting normal deliveries and providing postnatal care services including caring for newborn and infants. Their roles also involve identifying and referring pregnancy and labor cases that demand specialized and complex medical procedures for attention at the appropriate facilities. There are more than 4000 midwives in Ghana as against the little over 2000 physicians.
Whilst acknowledging the limited scope of midwives training hence their narrow capacity in a wide range of obstetric procedures and drug application, Dr. Awoonor-Williams indicated that the present situation in which midwives provide ?the majority of antenatal, delivery, and newborn as well as postpartum care ?in Ghana especially in lower level facilities and in rural areas in the face of acute shortage of physician gynecologists, and poor referral system calls for more dynamic interventions to minimize the effect of the capacity gaps. He said under the current circumstance midwives, working in peripheral and understaffed facilities constantly have their knowledge and skills over stretched as they are forced to handle emergency obstetric cases that would otherwise be undertaken by physicians. This sometimes leads to unintended results and with far reaching implications for both patients and practitioners.
He said rather than refer a woman or girl who is bleeding torrentially from incomplete abortion or other less complex but potentially dangerous birth complication only for her to die en route to a qualified physician due to poor referral system midwives in the region have been trained to perform MVA and other procedures to save the lives of women in such circumstances.
Dr. Awoonor-Williams said while the causes of maternal mortality remain a mix of both direct and indirect causes the effort targeting the capacity needs of midwives aims to minimize institutional weaknesses which contribute to maternal mortality.
In his opinion providing comprehensive training for midwives and empowering them to deliver a package of critical maternal and child health services with minimum support or back up from medical doctors is necessary at this point in time.
He said with maternal mortality figures still unacceptably high in Ghana and with acute shortage and regional in balance in the distribution of physician gynecologists and medical assistants, tackling the training needs and skills gaps of midwives would yield long term benefits in the improvement of family live and reduction of maternal mortality in the country.
Dr. Awoonor revealed that building the capacity and empowering midwives in the provision of reproductive health care including comprehensive abortion services will save the lives of more women and girls.
He argued that continued improvements in the skills of midwives as key members in the maternal health workforce must be placed as a fundamental priority noting that even though the standards of midwifery training in the country is high critical areas of concern in the corpus of skills they require have been identified hence the need to take quick steps to put in place a well fashioned and regular in-service training and onsite coaching scheme. Such a measure he hinted is necessary so as to prepare midwives adequately to save the lives of more women. He insisted that such intervention is relevant and should be pursued at all cost even if it requires profound health policy change. ?If we can do this it will place midwives in the country in wide range of settings to meet current expectations and demand?.
In a related development, the Medical Director of the Bolgatanga Regional Hospital, Dr Peter Baffoe, has hailed the midwives training and empowerment initiative in the region. He said the training program which benefitted 20 (twenty) midwives across the region and four from the Regional Hospital was an important intervention which is yielding great benefits.
According to him, midwives at the hospital now provide comprehensive abortion services. They have also introduced family planning services desks at both the gynecology and maternity wards as part of efforts to make the services more friendly and convenient. Dr Baffoe disclosed that hitherto, these services were only available at the reproductive and child health (RCH) unit situated at a separate block within the hospital and all women who needed the services were referred there. He conceded that the creation of family planning desks at more areas at the hospital has contributed to improve access to reproduction health care and services.
A senior midwife and the ?In-charge? of the gynecology ward at the regional hospital Madam Winfred Pogdaa Ali when contacted commended the authorities for the initiative. She said the training has equipped and empowered them to work extra hard to save the precious lives of women and girls. She pointed out that despite steady improvement in family planning acceptance the rate of unplanned pregnancies are still high, unfortunately however huge stigma and other limitations on abortion force some of the victims to resort to desperate measures the dangerous outcome of some of which end up at hospitals and other health facilities in the region. According to Pogdaa, in the past when these cases were reported at the hospital midwives could only attempt remedial measures to stop bleeding pending the availability of a qualified doctor to carry out the necessary intervention to save the victim.
Today the story is different as Pogdaa put it ?Now when a woman is rushed in here and found to be bleeding from incomplete abortion some of us have the competence and confidence to assess the situation and when it is find out that the case is within our capacity we undertake the necessary intervention to save her. Since I undergone the comprehensive abortion training I have saved the lives of many women and girls who otherwise would not have made it if they have had to wait for several hours and sometimes days due to the absence of a doctor? she disclosed.
On the creation of family planning desks at the gynecology and maternity wards at the hospital, Madam Pogdaa said the move has made family planning services convenient and more accessible to most women. She revealed that when the services were only available at the RCH unit a lot of women and young ladies who do not want to seek family planning services publicly found it difficult to visit the unit however they find it much easier to visit the GYNEC or maternity wards as they could do so under the pretext of seeking other medical services or visiting a friend or relative on admission.
It has also made it much easier for midwives to counsel and instantly provide family planning as part of post natal and post abortion services. For Pogdaa and her colleagues expanding the roles of midwives through essential training and empowerment save the lives of more women and girls who otherwise would not have made it in the face of limited availability of physician gynecologists in Ghana.
In the past two decades maternal mortality figures in Ghana has been on the decline with statistics showing a drop from 740 per 100, 000 live birth in 1990 to 350 per 100, and 000 live births in 2010. This notwithstanding, there are what some experts call justifiably bitter concerns which are believed to be stalling the country?s rate of progress. Some of them include the prevailing low rate of family planning acceptors, the high rate of unsafe abortion, poor medical referral systems, limited availability of qualified physician gynecologists and other health officers, poor road network and inimical traditional practices and culture associated with pregnancy and child bearing among others.
For many the combined effect of these and other factors account for the deaths of some 287, 000 women around the world annually with majority of the deaths occurring in Sab Saharan Africa including Ghana and putting the country and others signatory to the 2000 UN declaration to reduce maternal mortality to 180 per 100, 000 live birth by 2015 under enormous pressure.
Comprehensive reproductive health services remain limited in Ghana and international as well as local reproductive health rights advocacy groups have been working hard to break the barriers to free access to information and services that empower women and girls to take well informed decisions regarding pregnancy and child bearing. One such group is the Global Doctors for Choice (GDC), a Physician Advocacy group with presence in South American, Africa and other parts of the world.? In Ghana GDC works through a network of trained physician advocates to eliminate reproductive health related factors that contribute to maternal mortality.