Source: The Swazi Observer
Swaziland is among 11 countries that have failed to make any progress in the past years towards meeting one of the eight Millennium Development Goals (MDGs).

The country is struggling to meet MGD5, which relates to the improvement of maternal health. The two targets for assessing MDG 5 are reducing the maternal mortality by 75% between 1990 and 2015 and achieving universal access to reproductive health by 2015.

The countries that have not made any progress include Chad, Botswana, Cameroon, Congo, Guyana, Lesotho, Somalia, South Africa and Zimbabwe. The countries are likely to miss the MDG target unless accelerated interventions are put in place.

This is according to the Trends in Maternal Mortality between 1990-2010 report, released by the United Nations. 

The report contained new estimates by the WHO, UNICEF, UNFPA and World Bank.

UNFPA Resident Representative Dr. Hassan Mohtashami presented the new estimates during a stakeholder meeting.

In this category Swaziland has been classified with the likes of Chad and Somalia who have extremely high Maternal Mortality Rate (MMR) in the world which is over 1 000.

The report also reveals that the Sub-Saharan African region by far has the high ratio of MMR. In this region one in 139 women risk death when pregnant or any cause related to or aggravated by the pregnancy while in the world the ratio is one in 180.

In the Sub Saharan Africa region there are 162 000 maternal deaths yet in the world there are 287 000 deaths.

In developing countries which Swaziland fell under, the incidents of deaths among pregnant women is one in 150.

According to the report, two countries accounted for one third of global maternal deaths - India and Nigeria.

The methodology used in the survey was that the countries were grouped into three groups. Group A were those which had a reliable civil registration.
group B were those with other types of data and the third set were countries that did not have data. Swaziland was classified under the second group that did not have reliable civil registration.

MMR issue beyond ministry of health

AT least 67.3% deaths are AIDS related in maternal deaths. 

This is according to the Trends in Maternal Mortality report for the period 1990-2010.

UNFPA Resident Representative Dr. Hassan Mohtashami said the issue of maternal mortality was not an issue of the ministry of health only, but was beyond as there were a lot of factors influencing the matter. 

He listed transport as one of the factors, saying it was more of a political issue.

He said between 1990 and 1995 Swaziland was on the right track as the MMR was stable but it started increasing tremendously due to the issue of HIV. Around 2005 the number of maternal deaths was at 420 but it has since gone down at it stands at 320. 

The lower estimate of MMR in Swaziland is 160 while the upper one is 670.The number of maternal deaths in Swaziland is 110. 

The study revealed that in the Southern Africa region Swaziland was the third highest after Namibia and South Africa. The lifetime risk in Swaziland is that one woman out 95 risked death during pregnancy.

In Mozambique the risk is one woman out of 43.

In developed countries like Sweden the lifetime risk is one woman in 14 100.

World Health Organisation (WHO) Dr Owen Kaluwa said the estimates were important for countries and stakeholders to use for reference, advocacy and to inform development to accelerate progress in maternal.

SD among countries where 10% of MMR are HIV related

SWAZILAND is not only making zero progress in attaining the MDG5 but is also among the countries in Sub Saharan Africa where 10% of maternal deaths are HIV related.

The report says Sub-Saharan Africa had the largest proportion of maternal deaths attributed to HIV at 10% while the Caribbean had the second largest at 6%. 

For some countries in Southern Africa, such as Botswana, Lesotho, Namibia, South Africa and Swaziland, MMR increased from the year 1990 to 2000, mainly as a result of the HIV epidemic; in these countries, the MMR is now declining as antiretroviral therapy is becoming increasingly available.

The report states that for countries with high HIV prevalence, the pandemic had become a leading cause of death during pregnancy and the postpartum period.

There is also some evidence from community studies that HIV-positive women have a higher risk of maternal death, although this may be offset by lower fertility. 

It is thus important to address the issue of incidental and indirect maternal deaths among HIV-positive women, in estimating maternal mortality for these countries.

Without HIV, according to the estimates, the MMR for sub-Saharan Africa would be 450 maternal deaths per 100 000 live births instead of 500. 

Eighteen countries have a proportion of maternal deaths attributed to HIV of 20% or more: Swaziland (67.3), South Africa (59.9), Namibia (59.4), Botswana (56.4), Lesotho (41.5), Zimbabwe (38.8), Ukraine (31.7), Zambia (30.7), Malawi (29.3), Mozambique (26.8), the Bahamas (26), Gabon (25.8), Uganda (25), Thailand (21.9), Equatorial Guinea (21.8),Kenya (20.2).

All these five countries have attained the 2001 UN General Assembly Special Session (UNGASS) goal of providing antiretroviral drugs for preventing mother-to-child transmission to 80% of pregnant women living with HIV. 

• Swaziland