Ipas > South African doctor looks for faces, factors in maternal deaths

South African doctor looks for faces, factors in maternal deaths

December 22, 2005

At age 10, while working in the garden at a mission hospital in his native South Africa, young Eddie Mhlanga had a seemingly impossible dream: He wanted to care for people as a physician.

(An audio interview with Mr. Mhlanga is available at the end of this article.)

Once Mhlanga achieved that goal, he wanted to become a surgeon. But when he returned to his home Limpopo province and that same mission hospital as a young doctor, he saw there was a vast need for child health and obstetric services across South Africa and especially its rural areas.

“We had a lot of emergencies, such as motor-vehicle accidents and assaults, but I found that problems in obstetrics and child health [were a lot more life-threatening]. You needed to do something right there to save the patient.”

Dr. Mhlanga has gone on to become one of South Africa’s leading advocates for women’s rights to reproductive health care, including abortion. From 1995 to 1999, he directed the Maternal, Child and Women’s Health and Nutrition unit of the Department of Health. Today, he is the deputy head of obstetrics and gynaecology at the University of KwaZulu-Natal, Durban. He was also recently named to Ipas’s board of directors.

Dr. Mhlanga is a member of the National Committee for the Confidential Enquiry into Maternal Deaths (NCCEMD) in South Africa. In early 2006, the NCCEMD will release its report on the third audit on maternal deaths in South Africa.

Maternal deaths are defined, by the 10th revision of the International Classification of Diseases (ICD-10) as “a death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”

Like many developing countries, South Africa reports high levels of maternal death; in the period 1990-2004, its government reported a ratio of 150 maternal deaths per 100,000 live births. The World Health Organization estimates an even higher adjusted figure of 230 deaths per 100,000.

While statistics give an idea of the problem’s scope, they shouldn’t obscure the human tragedies they describe, said Mhlanga.

“Every death of a woman is a major event. People need to stop and say, ‘What happened?’”

In 1997, the South African Ministry and the Department of Health mandated that the country undertake a comprehensive review of maternal deaths in the country’s about 200 public hospitals. As the director for Maternal, Child and Women’s Health and Nutrition, Dr. Mhlanga and his team were tasked with initiating the process.

Under the audit policy, when a woman dies in such a facility, staff involved in her care must complete a form that explains the circumstances of her treatment and death. That collaborative process encourages staff to ask if they, the woman or the community might have done anything differently to prevent the death.

Once that process is completed, the form is sent to the provincial health department. It’s then forwarded to an assessor who scrutinizes the information and may ask more questions. The assessor issues a set of confidential findings (they cannot be used as evidence in a legal case) that go to the NCCEMD. If the hospital erred or the assessor and national committee conclude there is room for improvement, the hospital will be informed, though individual staff will not be identified.

The emphasis on problem-solving, not punishment, helps address issues and build staff capacity, said Mhlanga. The South African audit process has been replicated in Swaziland, and Mhlanga has visited Namibia and Rwanda to discuss implementing similar systems in those countries.

In South Africa, the last maternal death audit (1999-2001) showed that the leading cause of maternal death was nonpregnancy-related infections, many of them stemming from HIV/AIDS.

Though infections have risen as a cause of death for women of childbearing age, Mhlanga said there’s been a “phenomenal” decrease in abortion-related deaths since the audits began in 1998. After the approval and implementation of the 1996 Choice on Termination of Pregnancy Act, the South African Department of Health reported that abortion-related deaths dropped by about 90 percent.

For Mhlanga, who is a devout Christian, that decline is a blessing. He’s watched a nurse colleague die from septic abortion (in which an abortion or miscarriage is following by a uterine infection that spreads to the blood).

That life-changing experience, which he describes here in audio , reaffirmed his belief that women don’t have to die due to lack of appropriate services and reproductive choice. What women are looking for, Mhlanga said passionately, is the freedom to choose and the freedom not to be judged — whatever choice they make.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258