BY MARTYN NAMORONG
A boy without a father is a boat that sails without a rudder; without a mother, the situation is much worse: he is a castaway – Thai proverb
THE WORLD HEALTH Organisation defines maternal mortality as:
….the death of a woman during pregnancy, childbirth, or within 42 days of the completion of the pregnancy, independently of the duration and the site of the pregnancy, due to any cause related to or aggravated by the pregnancy or related care, but not by accidental or incidental causes
Currently more than 1,500 women and girls die each year in Papua New Guinea as a result of being pregnant. The maternal mortality ratio stands at 773 per 100,000 live births. In addition, it is known that for every woman who dies in pregnancy or childbirth, 60 others sustain some form of disability.
PNG is a signatory to the United Nations Millennium Development Goals, of which goal number 5 declares that member states will reduce maternal mortality rates by three-quarters between 1990 and 2015.
In many ways, maternal mortality rates are a good litmus test of the way society treats its women. In PNG, women take care of much of their family’s needs. Thus maternal mortality rates indicate whether, in return, the family and the rest of society take care of women’s needs.
In 2009, a Ministerial Task Force setup by the Health Minister highlighted (page 9 of its report, see below) that there will be no change in maternal mortality rates even in a perfect health system unless the population is willing to access healthcare.
Interestingly, the Task Force also found that the healthcare costs associated with deliveries were a significant deterrent to seeking professional care. The Task Force wrote on page13 of its final report:
Concerns about the costs of services and seeking care delay timely care. Evidence from submissions and research conducted at the time of the introduction of user fees for hospital care show:
There is a perception that service costs will be high
For many, especially the poor and the remote, there is a high opportunity cost of Accessing care such as transport costs for woman and guardian, food whilst away from home, work at home not done or needing to be paid for (garden, caring for the other children).
User charges do discourage women from seeking maternal care services
Shortages of medical supplies mean families must purchase required drugs and supplies even in government services.
The issue of cost is significant if one revisits the Task Force’s statement on page 9 of its report. It states in bold font:
There will be no change in outcomes unless the population is willing and able to access the services provided
Thus, one can argue that there will be no change in outcomes unless the population is willing and able to pay to access the services provided.
There are many critics out there who will be very unsympathetic to women who fall pregnant and cannot afford the healthcare costs. Well that’s fair enough if one does not want to see a drop in maternal mortality rates.
We now come to the question of why we have to pay for such life-saving care. What does that say about us as a society if we treat our women as such?
Much of the accurate data about the country comes from the mid 1990s. It is also known that many social indicators have deteriorated since the mid 1990s. What single event has changed the way government runs its business since the mid 1990s?
In 1995 the World Bank introduced its structural adjustment program for PNG. The user-pays system for healthcare is a product of that flawed system.
Our mothers pay for deliveries because the World Bank said so and thegovernment sold its soul to the banks. Now, the government’s own report states that women are dying because those fees prevent them from seeking professional aid at health facilities.
One way to start the ball rolling on reducing maternal mortality is to abolish the fees women have to pay for antenatal and perinatal care. Indeed, it is the quickest thing to do.
Report by the Ministerial Task Force on Maternal Mortality - http://www.unfpa.org/sowmy/resources/docs/library/R149_DOH_PNGUINEA_2009_Ministerial_Taskforce_report_final_version_3.pdf
Confessions of an Economic Hitman - http://www.bibliotecapleyades.net/archivos_pdf/confession_economichitman.pdf
Read The Namorong Report here - http://medicmangi.blogspot.com