Losing Mothers: Navigating Maternal Mortality Challenges
By Ava Paton & Katie Sanagan
This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.
In the shadows of the Global North’s progress, a haunting reality continues to persist — maternal mortality, a stark reminder of the biased disparities that continue to afflict low-income countries. Despite a global decline in the maternal mortality ratio (MMR) from 2000 to 2020, Africa remains trapped by a maternal health crisis, with a staggering 69% of the total maternal deaths occurring within its boundaries (IAHO WHO 2023). Amidst the global discourse of Global Health, a deafening silence envelopes this crisis; the mothers, the silent warriors of life, are being forgotten and left behind. We can no longer say that maternal mortality stems from factors like postpartum hemorrhaging, pre-eclampsia, pregnancy-related infections, or unsafe abortions — we must come to terms that thousands have died and will continue to die due to the structural systems made, that disproportionately affect marginalized populations. These deaths are not an inevitability of becoming pregnant but are attributed to the lack of equitable access to healthcare, persistent gender inequalities, and the socio-economic disparities perpetuated by structural systems that accentuate the maternal health crisis. Acknowledging this reality compels us to address and dismantle the root causes embedded in our societal structures, fostering a world where every child-bearing person, regardless of their geographical location, ethnicity, or location, can access the care and support they deserve during pregnancy and childbirth.
In the African region, the Maternal Mortality Rate (MMR) reached 545 deaths per 100,000 live births in 2020. This figure becomes even more pronounced when compared with a developed country like Australia, where the MMR is as low as four deaths per 100,000 live births (WHO 2023). These disparities demonstrate the importance of addressing various social, economic, and environmental factors that hinder the success of appropriate maternal care in Africa. Notably, most of these deaths are preventable if they receive the right care at the right time. Therefore, the social determinants of health such as income, education, and environmental exposures, as well as lack of access to high-quality health care and an adequate amount of healthcare workers, equipment, and medication (WHO 2023) are to blame. Specifically, this is apparent in South Sudan, where the essential medicine readiness for saving the lives of mothers is extremely low, at an appalling 14%. South Sudan also suffers significantly with 1223 deaths per 100,000 live births, which makes it the country with the highest rate in Africa. The situation is further exacerbated by a 3% availability of emergency obstetric care services, compared to Zambia’s 95% (UNICEF 2023). Possibly the most alarming is the density of doctors per 10,000 people in South Sudan, currently at two doctors, which is an insufficient number for the population. Ultimately, poor health-seeking behaviour and long distances to health facilities have strongly contributed to the extremely high MMR in South Sudan.
Collectively, we designed a visual narrative to accompany our research on the complexities of the disproportional system of maternal mortality in Africa. From left to right, top to bottom, we will describe what the collage symbolizes to us — but it is important to note that there is not one specific way to interpret the collage.
A placenta, symbolic of life-giving and birth, embodies the dualities of life and loss that emphasize the inherent connection between maternal mortality and the act of giving a piece of yourself to your child (Canva 2023). Capturing mothers in motion not only symbolizes their inherent resilience and strength but also poignantly reflects the journeys they undertake to reach the nearest health clinic (Canva 2023). Following a woman in labour, emphasizing the universal nature of labour childbirth, that does not discriminate based on colour (Desrus 2011. Moving towards the top right, a deliberately blurred image of a mother holding a baby signifies the tragic separation of a mother and child, amidst a mother dying at childbirth (Paton 2023). The outline of Africa, with a focal point on South Sudan, emphasizes the geographical disparities in maternal mortality rates — it is a crisis that disproportionately affects LIC (Canva 2023). The empty shoes represent the void left by the loss of a mother, a reminder of their absence in raising the child they just brought into the world (Canva 2023). The bottom left is a distressed mother cradling her newborn child, capturing the emotional toll of being pregnant and having to give birth (UNICEF 2023). The empty hospital-grade bassinets symbolize a loss of security the child now faces without a mother, as well as the unstable health system, that lacks clinics, doctors, equipment etc. within Africa) (Canva 2023). Finally, a pregnant mother in the bottom right corner, shows her strength, challenging the narrative, and calling for a future where mortality is not a foregone conclusion (Reports 2017). This composition serves as a visual plea, using collective action to address the inequities that persist in maternal healthcare, that biasedly affect low-income countries, especially the African continent.
Confronted by these harrowing statistics, it is simple to forget that each data point represents an entire life, and thus a unique story of a mother’s journey that has been cut short. It is imperative that we no longer remain passive observers; we must collectively engage in dismantling systemic barriers to maternal healthcare. Let us rewrite the narrative, ensuring that no more lives are taken from the colonial-imprinted system that the Global North has created. Every child-bearing person must have accessible and adequate health care, no matter where they are from.
World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 2000 to 2020 WHO, Geneva, 2023
References
CANVA: Design Studio App. CANVA. (n.d.). https://www.canva.com/
Desrus, B. (2011). 2011 - Juba, Republic of South Sudan - Labor. Benedicte Desrus Photoshelter. Retrieved from https://benedictedesrus.photoshelter.com/image/I0000l_iWIiztYxE.
Maternal Mortality. (2023, February). UNICEF. https://data.unicef.org/topic/maternal-health/maternal-mortality/
Mutabingwa, L. N., Koubemba, A. G. N., & Wango, M. M. (2023, March). Maternal mortality: The urgency of a systemic and multisectoral approach in mitigating maternal deaths in Africa [Infographic]. https://files.aho.afro.who.int/afahobckpcontainer/production/files/iAHO_Maternal_Mortality_Regional_Factsheet.pdf
Procreate® – sketch, paint, create App. Procreate. (2023). https://procreate.com/
Reports, S. (2017, November 30). Maternal mortality in South Sudan. BORGEN. https://www.borgenmagazine.com/maternal-mortality-south-sudan/
WHO. (2023, March). Analytical fact sheet - World Health Organization. IAHO. https://files.aho.afro.who.int/afahobckpcontainer/production/files/iAHO_Maternal_Mortality_Regional_Factsheet.pdf