Panorama: Dead Mums Don't Cry

There is an old African saying that a pregnant woman has one foot in the grave. Too true.

This programme successfully highlighted the important, global, obstetric causes of maternal deaths—eclampsia/preeclampsia, obstructed labour, unsafe and illegal abortion, haemorrhage, and infection.

It described a week in the professional life of Dr Grace Kodindo, obstetrician in N'djamena, the capital city of Chad. She is committed and engaging, and we followed her through joy, anger, frustration, and despair.

Women in Chad have a lifetime risk of pregnancy related death of 1 in 11; the equivalent figure for the United Kingdom is > 1 in 5000. Half a million women a year die in pregnancy, 99% in low income countries. The real scandal, and the source of Dr Kodindo's frustration, is that many of these deaths could have been prevented by simple and inexpensive measures.

As a 16 year old convulsed with eclampsia, we heard that there is no magnesium sulphate in the country—a cheap and effective treatment. What is available must be bought first by relatives, including catheters and intravenous fluids. Evidence based medicine gives way to poverty based medicine.

A 12 year old girl is admitted with sepsis after an illegal abortion. She had been transported by local taxi with several other passengers. Her mother frets about finding the money for antibiotics. Some days later, the girl is dead.

Millennium development goal number five is the reduction of maternal mortality by three quarters by 2015. Countries like Chad are miles away from achieving this.

Figure 1.

Dr Kodindo with a baby she has delivered in a Chad hospital

Credit: BBC

Honduras is one low income country that has improved its maternal death rates and Dr Kodindo was transported by the Panorama team to see what was different there. Contraceptives were freely available. Traditional birth attendants (TBAs) were trained to refer when necessary. Ironically, the partogram (developed in Africa) was used to identify obstructed labour in Honduras (but not in Chad). Most importantly, there has been political commitment to decrease maternal deaths. As the man from the United Nations said, things will not get better while it is not “women and children first” but “women and children last.”

Oil has been discovered in Chad and money should follow. The health minister was challenged aggressively about the current situation. She, not unreasonably, pointed out that cultural changes did not occur overnight. It was difficult to tell if she was the victim of complacency, or of journalistic editing.

The filming verged on the intrusive at times, but carried weight by showing the human faces behind the statistics. Among many poignant moments was the visit to the grave of an 18 year old mother. The cause of her death was unclear. It occurred in a rural area of Chad. It went uncounted and unregistered. A mound of sand, covered by some vegetation, marks the grave. Soon it will flatten and disappear—unrecognisable to all but her family and friends as the last resting place of a young woman.