Reducing maternal mortality: is safe motherhood prioritised in Ghana?

The main cause of death in women of reproductive age is complications in pregnancy and childbirth. While Ghana has a relatively advanced health system and reduction of maternal mortality is a priority, maternal and child health is poor. Are efforts to reduce maternal mortality being weakened? How can these efforts be kept on track to meet this “difficult-to-reach” millennium development goal?

Each year about half a million women die due tocomplications in pregnancy and childbirth and of these, 95 percent occur inresource-poor African and Asian countries. As 2015 fast approaches, there isincreased urgency to meet the millennium development targets. However, evidencesuggests the decline in maternal mortality has been extremely slow – insub-Saharan Africa, it has decreased only 1.6 percent annually since 1990,compared with 4.5 percent in East Asia and the Pacific region. If themillennium targets are to be met, an annual average of percent is needed.

There is little evidence, especially inresource-poor countries, of effective and cost-effective safe motherhoodprogrammes which would enable policy-makers to decide how best to use andallocate resources in this respect. Ghana has a relatively advancedhealth system yet maternal mortality is high. Since the mid-1990s it hasembarked on health sector reforms, which has included the Sector-Wide Approach(SWAp) for co-ordination of development assistanceactivities by the national authorities and pooling of donor and governmentresources.

This paper by the University of Benin, Universityof Ghana and University of Aberdeen, in the UK, looks at the findings of astudy of safe motherhood programmes in Ghana, Burkina Faso and Indonesia in2003. Safe motherhood programmes and sub-national programmes in three areas ofGhana – Greater Accra, Central and Upper East – were examined. The paper makesthe following findings:

• Many funding agencies supposedly supporting safe motherhood programmesin Ghana are actually pursuing a broader reproductive health agenda. All buttwo of the initiatives examined had multiple goals, many placing highimportance on the reproductive health agenda.
• Safe motherhood programmes in Ghana are mostly donor-funded, andmany of the funders have reproductive, sexual or family planning goals. Somedonors continue funding outside of the SWap, whichcould create an imbalance in the attention paid to national targets.
• The design of programme reflects a focus on supply-side activities,maintaining a top-down approach in decision-making and creating an imbalance ofbehaviour change or community mobilisation interventions.

Evidence that the safemotherhood agenda has been diluted is inconclusive, yet the analysis shows thatit may be at risk. The current momentum of interest in maternalmortality reduction can only be maintained if there is strong awareness of thisrisk. The paper recommends the following:

• Programme planning and design needs to be good, and the link betweenprogramme components and stated policy goals must be clear to ensure that investmentin these programmes will lead to the expected outcomes.
• SWap principles could be used to ensure a better focuson key needs such as maternal mortality reduction.
• Balanced partnerships need to be created within SWap– especially by including civil society – to enable a stronger supply-demandbalance in programme design.
• More focus needs to be placed on maternal mortality reduction, butwithout jeopardising integrated approaches to improving health systems.