Objectif 5 : Améliorer la santé maternelle

Glimmer of Hope on Maternal Mortality Reduction in Africa

The latest available information gives a glimmer of hope on maternal mortality in Africa, where it declined overall between 1980 and 2008.

However, the slow progress rate is not enough to achieve the goal by the target date.

The 5A target is to reduce the Maternal Mortality Ratio (MMR) by three-quarters between 1990 and 2015.  A recent study by the UK physicians magazine, The Lancet, suggests MMR has reduced significantly in the world, including Africa.

Certain factors may substantiate the claim: a rising average age of first marriage; lower average family size; greater use of condoms because of HIV/Aids, and a rising divorce rate in Africa.

Other factors are higher per capita income, better nutrition and greater numbers of girls completing primary education.

The Lancet data shows declining trends in MMR across all sub-regions, although the rate is high compared to the developed world.  Central Africa has the highest MMR of all African sub-regions, even though the ratio declined rapidly between 2000 to 2008.

MMR is lowest in North Africa, followed by East Africa, Southern, and West Africa.

On the subsidiary target of proportion of births attended by skilled health personnel, which is key to maternal deaths, World Health Statistics (WHO, 2010) indicates significant improvements in many African countries.

Of 52 countries with data, seven reported 90% of births attended by a skilled health   professional, while the WHO average for Africa (excluding North Africa) is 47%, with 38 countries ranking above that figure.  There were 19 countries where the figure was below 50%, and Ethiopia was the only country to report in single digits.

Some countries are acting to improve the situation.  Nigeria has expanded its national midwifery program, and in early 2010 assigned over 2,800 midwives to rural areas.

On the subsidiary target of contraceptive prevalence rates for married people, most African countries are unlikely to achieve the target as only ten countries have reached a contraceptive prevalence rate above 50%.   North African countries reported the highest rates while West Africa reported the lowest.

One of the goals is to drastically reduce adolescent birth rates, but the results so far are mixed.  North Africa reports the lowest rates, while the adolescent birth rate is highest in Niger, Chad, Mali and Mozambique, which are among the poorest countries in Africa.

WHO reports the regional average birth rate at 118 per 1.000 girls aged 15 to 19, with 22 countries recording a rate above the average.  The figure for Chad is 193 and for Mali it is 190.  By contrast, it is four for Libya and Algeria, six for Tunisia, 18 for Morocco, 27 for Egypt and 30 for Burundi.