The 28th May marks the International Day of Action for Women's Health. This year, the global conversation around women’s health takes place amidst a wave of extreme abortion bans sweeping across the US. The move has sparked outrage among celebrities and politicians alike, with some going so far as to propose a sex-strike until the law is reversed. The unfortunate truth of the matter, is that sexual and reproductive health services for women, including maternity care, has always been a political battlefield. The result is that HIV/Aids remains the leading cause of death for women of reproductive age, 800 women die every day from preventable pregnancy-related causes, and more than 225m women who want to prevent or delay pregnancy lack access to modern contraceptives.
Most pregnancy- and childbirth-related deaths are caused by complications resulting from severe bleeding after childbirth, infections acquired during delivery, high blood pressure during pregnancy, and unsafe abortions. Women with HIV are more likely to contract infections during pregnancy, which is why in South Africa infection is one of the main risk factors for maternal death.
Adolescents are at particularly high risk of pregnancy-related death in low- and middle-income countries, like South Africa. In fact, complications during pregnancy and childbirth are the leading cause of death for young women between 15 and 19 years of age, and adolescent girls under the age of 15 are at higher risk of pregnancy-related death than any other group of women. These deaths could be easily avoided if young women and adolescents had access to contraception, safe abortion services, and adequate maternal health care.
Nonetheless, 2.5m girls under the age of 16 give birth in developing countries every year, and 3.9m girls under the age of 19 undergo unsafe abortions. This is particularly concerning in South Africa were many girls and young women report that their first sexual experience was coerced, often at the hands of an older man.
Fortunately, in South Africa, the rate of women dying during pregnancy and childbirth is falling, due mostly to the changes in treatment programmes for HIV positive pregnant women. However, while there are fewer deaths related to HIV and bleeding in South Africa, deaths related to high blood pressure during pregnancy have increased. These deaths are all-the-more tragic because they can be easily prevented through access to proper antenatal care, and skilled care during and after childbirth.
In South Africa, mechanisms have been put in place to streamline referral routes for pregnant women with high blood pressure. The National Health Department has also increased the number of antenatal visits during the last three months of pregnancy so that changes in a woman’s condition can be detected and treated sooner. To improve antenatal care, the department has also begun intensive training for healthcare professionals which include simulation of emergency situations. Maternal deaths have decreased by about 30% in areas where this training has been conducted.
The close link between skilled care, maternal health and newborn health cannot be overlooked. The World Health Organisation (WHO) estimate that about 2.7m newborn babies died and a further 2.6m were stillborn in 2016. Many of these deaths could have been avoided if both mother and baby had access to proper care, including delivery by c-section, where necessary.
But while maternal care and mortality has received much attention during the last decade, several non-pregnancy related health matters are also included in the MDGs and deserve attention. In South Africa prevention and management of women’s cancer needs urgent improvement. We are proud that cervical cancer prevention programmes now include HPV vaccination at schools, but screening services are hugely lacking and implementation of policies differ widely between provinces. A lot more can and needs to be done to improve access to cancer prevention and care services.
Violence against women is widespread in South Africa. This violation of human rights affects both women and their communities and is another aspect of women’s health which needs urgent attention.