Birth Rights Welcome to Birth Rights. This presentation is about maternal health in the West African country of Ghana. Maternal health means the wellbeing of women during pregnancy, childbirth and the time just after giving birth. Motherhood should be a rewarding and fulfilling experience for families. However it is associated with suffering, ill health and even death for far too many of the world’s women. In 2010 approximately 1,000 women died every day from pregnancy-related causes, a number that has declined by only 2.3% per year since 1990. However there is also good news. This presentation looks at the case studies of 2 new mothers and 1 midwife in Ghana to learn about the improvements that have taken place there since maternal healthcare was made free in 2008. You’ll then be asked to think about what still needs to be done to reduce maternal mortality, meaning deaths during pregnancy and childbirth, even further. Photograph © Abbie Trayler-Smith / Oxfam, 2011 1

Where is Ghana? Maps from http://commons.wikimedia.org/wiki/File:LocationGhana.svg Ghana is located in West Africa. In 1957 Ghana made history by being the first country in sub-Saharan Africa to win independence from colonial rule. It currently has a population of almost 25 million people and is ranked 135th out of 187 countries on the United Nations Human Development Index (source: http://hdrstats.undp.org/en/countries/profiles/GHA.html) This presentation tells the stories of Cecilia the midwife and two new mothers, Selina and Adumporka. The arrows show the two regions where these women live. Selina lives in the capital city of Accra, located on the southern coast of Ghana. Cecilia and Adumporka are from the dry and rural north of the country, approximately 400 miles away. 2

Millennium Development Goal 5 In 2000, the 192 countries belonging to the UN agreed to work together to achieve the 8 Millennium Development Goals (MDGs) by 2015. Goal 5A – to reduce the number of women dying in childbirth by 75% Goal 5B – to give all women access to health care during pregnancy In 2000, all 189 member countries of the UN agreed to work together to achieve the Millennium Development Goals (or MDGs) by 2015. There are 8 MDGs altogether, aiming to dramatically reduce global poverty and improve health, education and the environment. MDG 5 aims to reduce maternal mortality by three-quarters of its 1990 levels by 2015. The current rate of decline is around half of that required to achieve MDG5 Currently almost 360,000 women die each year during pregnancy and childbirth. Almost all of these deaths occur in sub-Saharan Africa and Asia. Most of these deaths are preventable. If mothers had access to free, good-quality basic healthcare and affordable medicines, then they would be much more likely to survive giving birth. (Sources: Change the World in 8 Steps, Oxfam Education GB 2008, WHO website http://bit.ly/aVPGXB 2010) 3

Ghana and the UK: the facts Chance a woman will die in childbirth during their lifetime 1 in 66 1 in 4700 Health care for pregnant mums in Ghana was made free by the Ghanaian government in 2008 As a result after just one year 433,000 additional women received health care in hospitals and clinics. To meet this demand the number of nurses in the country has doubled since 2008 Despite this impressive improvement Ghana still faces challenges. There are around 10 times more nurses and midwives per 10,000 people in the UK than in Ghana. And the lifetime chance a woman will die in childbirth is 1 in 66 in Ghana compared with 1 in 4,700 in the UK. Just think for a moment about this difference – it’s so big it can’t be shown to scale on the slide This presentation will now look at 3 individual women’s stories to examine what Ghana has achieved, what still needs to be done to meet the MDG5 target of cutting maternal deaths by three-quarters and how we can help. The number of nurses and midwives per 10,000 people 10.5 103 Sources: ‘State of the World’s Children, UNICEF, 2011: WHO statistics (whois) (2100) 4

Meet Cecilia – the nurse midwife We’re now going to hear the stories of three women. The first is Cecilia Addah, a trained midwife from Navrongo in northern Ghana. FIRST READER TO READ: “Bringing a child into the world is so wonderful, so amazing, so nice. I am Cecilia Addah. I am a nurse midwife and I’m 51 years old. I am the only midwife serving 60,000 people and three community clinics. I have a lot to do… it’s 24 hour service. When I’m lying in bed at night I wonder will I get a call, has a woman come in labour? We want zero maternal mortality, we don’t want any woman to die in childbirth” Photograph © Abbie Trayler-Smith / Oxfam, 2011 5

Meet Selina – the mother The second story is about Selina Fletcher, a 30 year old mother living 400 miles away in Ghana’s capital Accra SECOND READER TO BEGIN READING: Even though she cannot read, Selina had heard that healthcare for pregnant women is now free. So she went straight to the hospital with her best friend Sarah once she knew her baby was on its way. This photo shows Selina on her way to the delivery ward. Photograph © Abbie Trayler-Smith / Oxfam, 2011 6

Meet Selina – the mother SECOND READER CONTINUES: When Selina first arrived at the hospital she was told she should have brought a hair net, a blanket and a bottle of disinfectant with her. Her friend Sarah left Selina at the hospital and went home to ask Selina’s family for money to buy the things she needed. Everything that Sarah bought for Selina is in this bag. So even though health care is free, giving birth is not without its costs. If a mother is poor the items she has to bring to hospital can be very expensive. Photograph © Abbie Trayler-Smith / Oxfam, 2011 7

Meet Selina – the mother SECOND READER FINISHES: After 5 hours in labour Selina gave birth to a baby girl with the help of a nurse and a midwife. The baby was given an injection straight after she was born to keep her healthy. Mother and baby then spent 24 hours resting in the ‘lying-in’ ward so the midwife and doctors could check their health. They also gave Selina advice about caring for her new baby. After spending 35 hours in hospital Selina left with her new baby and Sarah to take a taxi home. Both mother and daughter are well after getting free health care from doctors and nurses. Photograph © Abbie Trayler-Smith / Oxfam, 2011 8

Meet Adumporka – the mother Adumporka is 23 year-old woman living in rural northern Ghana. THIRD READER BEGINS READING: When Adumporka knew that the baby was coming, she went to the Health Centre in Bolgatanga with 72 year old Atulepoka, a traditional birthing assistant. They walked the 4 kilometres to the clinic together. Traditional birthing assistants are encouraged to take women to clinics and hospitals to give birth rather than give birth at home. This is because clinics have more equipment and midwifes to help in case there’s an emergency. Photograph © Abbie Trayler-Smith / Oxfam, 2011 9

Meet Adumporka – the mother SECOND READER CONTINUES Here Adumporka is waiting for her husband to collect her just a few hours after giving birth. There is no space for her to rest at the clinic. When Adumporka first arrived at the hospital, she had to lie on the floor because there were no beds available. She was moved to a bed to give birth and was helped by a trained midwife and a nurse. Next to her are the items that she brought from home, such as blankets, soap and a bottle of disinfectant. Photograph © Abbie Trayler-Smith / Oxfam, 2011 10

Meet Adumporka – the mother THIRD READER FINISHES: Adumporka and her baby returned home on the back of her husband’s motorcycle. She was very fortunate because many women in northern Ghana have to walk many kilometres to get to the clinic and then make the same journey home on foot with their new-born babies. Photograph © Abbie Trayler-Smith / Oxfam, 2011 11

How is Ghana doing? Free health care saves lives and helps women like Selina and Adumporka to give birth safely. However every week 75 women in Ghana still die in labour. Ghana has made great progress since 2008 when free maternal health care was introduced. However too many women are still not getting the care they’re entitled to. Every week around 75 women in Ghana die because of complications during pregnancy and childbirth. The vast majority of these deaths are completely preventable. For women like Adumporka, who live in rural areas, it can be particularly difficult to access medical help close to their homes. Photograph © Abbie Trayler-Smith / Oxfam, 2011 12

What needs to happen ? Ghana’s government must spend more money on its free health service The UK government must commit to spending 0.7% of national income on overseas aid and help countries like Ghana to improve health Meeting the MDG5 target to reduce maternal mortality by three-quarters is a partnership between countries. Here’s how it should work. The government in Ghana should take the lead and invest its own money to improve health services and increase the number of health workers, especially in rural areas. The responsibility for providing healthcare for citizens lies with a country’s government. For its part the UK government should fulfil its commitment to invest 0.7% of our national income on overseas development assistance, often called ‘aid’. Many poor countries do not have sufficient money right now to meet the target of MDG5. Investment in ‘aid’ supports Ghana and other poor countries to improve maternal health care and meet the target of reducing maternal mortality by three-quarters. Photograph © Abbie Trayler-Smith / Oxfam, 2011 13

How you can help If you’re interested in finding out more, or want to take action by hosting an exhibition or film show asking the UK Government to commit to its promises on overseas development assistance then please come and see me afterwards. Thank you for listening. If students come forward at the end, you can give them a copy of our Youth Action Guide. Available to download from http://bit.ly/wLqaE1 Photograph © Abbie Trayler-Smith / Oxfam, 2011 14

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