Juliet Cuthbert-Flynn | Partnerships, personal responsibility critical to safeguard maternal health

Every one to two minutes, a woman dies in pregnancy or childbirth – a stunning statistic that calls to all of us to stand up and take action.

Further, of the approximately 189 million women who become pregnant annually, 122 million have a live birth, three million suffer stillbirth, and 10 per cent experience maternal complications during pregnancy and delivery. Some 40 per cent suffer illness and disabilities post-delivery.

In Jamaica, maternal deaths ranged from 116.2 per 100,000 live births in 2014 to 96.7 per 100,000 in 2018. For 2019, preliminary data show that we are trending up, with some 148 per 100,000 live births. It means that we have some work to do as we seek, as a country, to deliver on the commitment to reduce the maternal mortality ratio to 70 per 100,000 live births by the year 2030, in line with the Sustainable Development Goals.

However, this is not the responsibility of a single entity or individual. It requires that the whole of society respond – from policymakers and maternal-foetal medicine practitioners, who must create the necessary enabling environment for the delivery of the highest quality of care, to pregnant women and mothers who must make it a priority to access that care.

This is especially important given what we know from the available data of recent years, which have seen a significant number of women suffer severe obstetric emergencies.

In 2019, for example, 1,125 or 3.3 per cent of the 33,462 deliveries experienced pre-eclampsia while 1,219 or 3.6 per cent experienced postpartum haemorrhaging. Pre-eclampsia and postpartum haemorrhaging are the leading cause of illness and death among pregnant women in Jamaica. In 2020, some 1,122 or 3.54 per cent of the 31,710 deliveries experienced pre-eclampsia while 1,714 or 5.4 per cent experienced postpartum haemorrhaging.

We also need to see an increase in the number of women who access antenatal care from early in their pregnancies through to delivery and post-delivery. In 2018, ten thousand one hundred and eighty-six or 45.9 per cent of women accessing antenatal services in the public-health system were doing so for the first time in the second trimester of pregnancy and 175, or 8 per cent, in their third trimester.

COVID-19 AND PREGNANT MOTHERS

We have to tackle these numbers head on, fuelled by the realities of the COVID-19 pandemic to which our pregnant and lactating mothers are not immune. There have been 40 pregnancy-related COVID-19 deaths from the onset of the pandemic to the present.

In response, the Ministry of Health and Wellness has developed, revised, and distributed interim guidelines for the COVID-19-exposed pregnant women while offering training for all levels of staff to strengthen technical and administrative support systems for optimal care.

The extension of the level of care offered to pregnant women during the pandemic has included special isolation and quarantine areas at hospitals and high-dependency services. The ministry also continues to encourage pregnant women to get vaccinated. This can be done safely at any time during pregnancy and breastfeeding.

Beyond the COVID-19 response measures, the ministry has a maternal health programme that aims to ensure that all pregnant women have access to high-quality care throughout their pregnancies. Those efforts have included the progress made under the Programme for the Prevention of Maternal and Child Mortality (PROMAC), funded by the European Union (EU), to safeguard the health and well-being of pregnant women and their newborns.

PROMAC facilitated the training of 36 doctors in obstetrics and gynaecology, anaesthetics and intensive care, and paediatrics, while another seven were trained in maternal-foetal medicine and emergency obstetrics. Forty-six nurses received post-basic midwifery training. These upskilled persons were deployed across the health regions while there have been infrastructural renovations, including the construction of several high-dependency units.

Further, the ministry has established and maintained a teenage clinic at the island’s largest maternity hospital – the Victoria Jubilee Hospital – to closely monitor teenage pregnancy while providing universal access to long-acting contraceptive methods, especially to the vulnerable adolescent population.

A National Maternal Health Committee with the responsibility to develop, revise, and implement maternal-health tools and protocols to end preventable illness and death was established. There is also ongoing capacity building for staff, with Continuous Medical Education credits awarded by the Medical Council of Jamaica.

Health centres and referral hospitals have been outfitted with radiographic and laboratory equipment, and a National Strategic Plan for Maternal and Perinatal Mortality Surveillance and Response was developed in collaboration with the Pan-American Health Organization for Jamaica for 2018-22. Recently, the National Annual Perinatal Review was implemented to disseminate maternal health information.

NEXT STEPS

In the coming months, the ministry will do more. We are putting the final touches on an intervention, modelled off the Nurse Family Partnership programme in the United States. The aim with that intervention is to promote a sense of community while creating the necessary enabling environment to support, in the first instance, first-time mothers with their physical and emotional needs.

The public will be updated on the developments with this programme, which will complement other efforts, including stakeholder collaboration to secure the resources needed to optimise care. This is to be supported by the use of behaviour change communication tools to promote pre- and postnatal care.

To succeed in these efforts requires that we work together – policymakers with clinicians, civil society organisations and partners, together with pregnant women who must seek out antenatal and postnatal care that helps to guarantee them and their newborns the best possible health outcomes.

Juliet Cuthbert-Flynn is state minister in the Ministry of Health and Wellness and member of parliament for St Andrew West Rural. Send feedback to columns@gleanerjm.com.