Johannesburg, 4 September -- Almost half of the 600,000 pregnancy-related deaths recorded worldwide occur in Africa which has only 12% of the worlds population, and only 17% of the global annual births, says a discussion paper to be reviewed at a roundtable of African health and development experts and officials scheduled for Thursday in Johannesburg. 
"The main direct causes of maternal mortality in the African Region are haemorrhage during pregnancy, delivery and after-delivery complications (25%); sepsis (15%) unsafe abortion (13%); pregnancy-related hypertension (12%); and obstructed labour (8%)…the indirect causes include malaria, anemia, tuberculosis and HIV/AIDS

"Africa is the only region where there has been no improvement in maternal deaths for more than a decade. Indeed, the average maternal mortality ratio has increased from 870/100 000 live births in 1990, to 1000/100 000 live births in 2001", says the paper, prepared by the World Health Organization (WHO) Regional Office for Africa based in Brazzaville, Congo.

The paper lists some of the major barriers to appropriate obstetric emergency care (EOC) in the African Region. These include:

• frequent shortages or lack of medications, essential supplies and equipment; 
• inadequate blood transfusion services; 
• inefficient laboratory support services; 
• inadequate staffing, shortage of appropriately trained personnel and lack of staff supervision; 
• shortage of operating theatres for obstetric emergencies, resulting in delays in surgical interventions; 
• weak policy on delegation of authority for the management of obstetric emergencies, and 
• mismanagement of obstetric complications as a result of staff incompetence, negligence or poor attitude. Timely access to appropriate obstetric emergency care (EOC) could avert 75% of these deaths, according to the paper, which enumerates the delays on the pathway to appropriate care in the Region.

These are: delay in seeking care in health facilities, delay in reaching appropriate health facilities, and the delay between a pregnant woman's arrival at a health center and the facility's response in providing appropriate care.

It also identifies three key interventions for accelerated maternal mortality reduction: prevention of unwanted pregnancy and the management of unsafe abortion, promotion of skilled attendance in pregnancy and childbirth, and improvement of access to referral care when complications arise.

It adds that improving access to emergency obstetric care would involve addressing the barriers to quality EOC at all levels through: equitable distribution of services; availability of adequate and skilled personnel coupled with delegation of authority and supportive supervision, and the creation of an enabling environment that promotes staff commitment and morale as well as client utilization.

The roundtable is being held on the sidelines of the 53rd session of the WHO Regional Committee for Africa, WHO's Governing Body in the Africa Region, taking place from 1 to 5 September.

Discussion points during the roundtable will centre on:

• steps to be taken in establishing and sustaining a comprehensive emergency obstetric care system; 
• increasing awareness of the magnitude of maternal and newborn morbidity and mortality at community, national and international levels; 
• skills development for health professionals; 
• appropriate allocation and use of resources; 
• the components of an obstetric emergency preparedness and response plan at community and facility levels, and
• the possible strategies to strengthen the role of the community in ensuring women's access to skilled attendance during childbirth.

For further information, please contact

Samuel T. Ajibola
Public Information and Communication Unit 
World Health Organization - Regional Office for Africa 
P.O. Box 6, Brazzaville, Congo. 
E-mail: ajibolas [at] afro.who.int
 Tel:+ 47 241 39378; Fax: + 47 241 39513
In Johannesburg: 072 722 5680