BIRTHRIGHTS

Birthrights Welcome to Birthrights. 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 happy time for all families and big improvements have been made recently by many countries to provide better healthcare for mothers and infants. But motherhood is sadly also often associated with suffering, ill health and even death for far too many of the world’s women. In 2014 approximately 800 women died every day from pregnancy-related causes, a number that declined by just 2.6% per year between 1990 and 2013. This presentation shares some of the good news and examines the case studies of 2 new mothers to show the improvements that have taken place in Ghana since maternal healthcare was made free by Ghana’s government in 2008. You’ll also be asked to think about the challenges that remain in reducing maternal mortality, or mothers’ deaths during pregnancy and childbirth, even further. Photograph © Abbie Trayler-Smith / Oxfam, 2011 Data source: WHO (2014): http://bit.ly/1j1wjdy

Millennium Development Goal 5 In 2000, all 189 member countries of the UN agreed to work together to meet the Millennium Development Goals (or MDGs) by 2015. There were 8 MDGs altogether, aiming to dramatically reduce poverty and improve health, education and the environment. MDG 5 aimed 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. In 2013 289,000 women died during pregnancy and childbirth and 62% of these deaths occurred in sub-Saharan Africa alone. Most of these deaths were preventable. If all mothers had access to free, good-quality basic healthcare, contraception and affordable medicines, then they would be much more likely to survive giving birth. Improving health remains a long term priority. The UN is currently implementing the new Sustainable Development Goals, designed to replace the MDGs at the end of 2015. SDG3 aims to ensure healthy lives and promote well-being at all ages while SDG10 pledges to reduce inequality within and among countries. Sources: Change the World in 8 Steps, Oxfam Education GB 2008, WHO (2014) http://bit.ly/1sgWDSB pg 22

Where is Ghana? 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. In 2012 Ghana had a population of just over 25 million people and in 2013 ranked 138th out of 187 countries on the United Nations Human Development Index. This presentation tells the stories of two new mothers, Selina and Adumporka. The arrows show the two regions that these women come from. Selina lives in the capital city of Accra, located on the southern coast of Ghana. Adumporka is from the dry and rural north of the country, approximately 400 miles away. One striking fact about many countries is that people’s life chances are different depending on where a person lives in a country. In Ghana there are big differences in life chances between the country’s regions. For example in Accra 83% of children are enrolled in primary school. In the Upper East region, in northern Ghana, the figure is only 72%. Similarly, the maternal mortality rate in the Upper East region is more than double the maternal mortality in Greater Accra (802 deaths per 100,000 live births compared with 355 deaths per 100,000 live births). Data sources: UNDP (2013) http://bit.ly/1kYwvXA, UNICEF (2012) http://uni.cf/1w9Hjss, Ghana Statistical Service (2013) http://bit.ly/1qfBAAU pps 19&36 Maps: http://commons.wikimedia.org/wiki/File:LocationGhana.svg

Ghana & the UK: the facts Chance a woman will die in childbirth during their lifetime 1 in 66 1 in 6,900 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 doubled after 2008. Despite this impressive improvement Ghana still faces challenges. In 2010 there were just over 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. However remember that these figures are for Ghana as a whole. There are big regional inequalities within Ghana. Maternal mortality in the Upper East region of the north of Ghana is more than double maternal mortality in the Greater Accra region of the south. This presentation will now look at 2 individual women’s stories to examine what Ghana has achieved and the challenges that remain. One of the women lives in the north of Ghana, in the Upper East region, and one lives in the south, in the Greater Accra region. Data sources: WHO (2014) http://bit.ly/1sgWDSB pps 31-43; World Bank (2010) http://bit.ly/1ruXmR3 The number of nurses and midwives per 10,000 people 101 9

Meet Selina – The southern mother The first story is about Selina Fletcher, a 30 year old mother living in Ghana’s capital city Accra Even though she cannot read, Selina had heard that healthcare for pregnant women is now free. So she went straight to hospital with her best friend Sarah once she knew her baby was on its way. Selina is fortunate as she lives close to Korle Bu Teaching Hospital, Ghana’s largest and best known hospital. This photo shows Selina being taken to the delivery ward. Photograph © Abbie Trayler-Smith / Oxfam, 2011

Meet Selina – The southern mother 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. She didn’t have these items. Even though Korle Bu Teaching Hospital is Ghana’s leading hospital, it doesn’t provide everything patients need. Selina’s friend Sarah left her 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 costs. If a mother is poor the items she has to bring to hospital can be very expensive. Photograph © Abbie Trayler-Smith / Oxfam, 2011

Meet Selina – The southern mother 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 that 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 were well after getting free health care from doctors and nurses. However Selina still had to pay towards medicines and a bed fee. There was also a rush for Selina to obtain a national insurance card to show the hospital staff and claim her free treatment. Although she knew about free healthcare, Selina had not completed the necessary paperwork before going to hospital. Photograph © Abbie Trayler-Smith / Oxfam, 2011

Meet Adumporka – The northern mother Adumporka is a 23 year-old woman living in rural northern Ghana. 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. The clinic is a relatively small health centre rather than a large hospital like Korle Bu Teaching Hospital. Many rural health clinics do not even have full time staff. In 2010 26% of women mentioned distance as a problem in accessing health care and 43% mentioned the lack of a doctor or nurse as a problem. 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 Data Source: Ghana Statistical Service (2013) http://bit.ly/1qfBAAU pg 39

Meet Adumporka – The northern mother 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 clinic, 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. They are similar to the items Selina had to bring to hospital in Accra. Photograph © Abbie Trayler-Smith / Oxfam, 2011

Meet Adumporka – The northern mother Adumporka and her baby returned home on the back of her husband’s motorcycle. She was fortunate her husband has a motorbike because many women in the northern Ghana have to walk many more kilometres to get to the clinic and make the same journey home on foot with their new babies. Photograph © Abbie Trayler-Smith / Oxfam, 2011

How is Ghana doing? Free health care saves lives and helps women like Selina and Adumporka to give birth safely. However every week 60 women in Ghana still die during childbirth. There are differences in the quality of health care between different parts of the country. Ghana has made good 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 60 women in Ghana die because of complications during pregnancy and childbirth. The vast majority of these deaths are preventable. The maternal mortality rate in northern Ghana is approximately double that of southern Ghana. So for women like Adumporka, who live in rural areas in northern Ghana, it can be particularly difficult to access good medical care close to their homes. Photograph © Abbie Trayler-Smith / Oxfam, 2011 Data Source: WHO (2014) http://bit.ly/1sgWDSB pg 32

The Sustainable Development Goals In 2015 the countries of the United Nations began to implement the Sustainable Development Goals (SDGs). SDG3 promises to ensure healthy lives and promote well-being for all at all ages. In addition, and importantly, SDG10 pledges to reduce inequality within and among countries. This is the first time that inequality has been explicitly targeted in a global goal. Taken together, the efforts that will be made to implement these global goals will help to further improve and even up the health care of women like Selina and Adumporka not just in child birth but through their lives. The Sustainable Development Goal (SDG) infographics are at https://sustainabledevelopment.un.org/sdgsproposal

Thank you! Thank you Photograph © Abbie Trayler-Smith / Oxfam, 2011 Terms of use Copyright © Oxfam GB You can use the resources provided for educational purposes. Please ensure that the way you use the material is consistent with all contextual information provided and credit any images used with the named author and Oxfam. All information associated with these images relates to the time and date that project work took place.