JIS News

Reproductive Health Epidemiologist, Professor Affette McCaw-Binns, has said that there is growing cause for concern about the number of indirect causes of maternal death in Jamaica.
Speaking to JIS News, the Professor said that pre-existing medical conditions in women that are exacerbated by pregnancy, have contributed to the number of indirect causes of maternal death. “In Jamaica, more common problems in our setting are conditions like HIV, heart and sickle cell diseases,” she said.
She noted further that, “as we are keeping women alive through good quality care during their childhood and adolescence, they are now considering [late] childbearing and these women have particularly high risk of developing problems. (They) need special care during their pregnancy.”
Women, Professor McCaw-Binns stated, had an important role to play in helping to reduce indirect causes of maternal death, especially with respect to obesity as “all of the deaths from cardiac disease and diabetes and 60 per cent of the deaths among hypertensive women, were among women who were obese.”
She advised that overweight women, who are intending to get pregnant, should go on a weight management programme and reduce their weight prior to conception as this will make a remarkable difference in the outcomes observed. “Our lifestyles have changed and we have to change how we behave,” she pointed out.
Maternal death, as defined by the World Health Organisation (WHO), is the death of a woman during pregnancy or within 42 days after the termination of pregnancy. This is irrespective of the duration and site of the pregnancy. It is caused or aggravated by the pregnancy or its management, and is therefore not a death that is accidental or incidental.
WHO makes a distinction between direct maternal death, which is the result of a complication of the pregnancy, delivery, or their management, and indirect maternal death, which is a pregnancy-related death in a patient with pre-existing or newly developed health conditions.
Jamaica, while classifying maternal deaths into direct and indirect causes, also considers coincidental deaths. “It is an important issue as these are deaths not attributable to pregnancy and currently include accidents, violence and other medical problems such as advanced cancers, where the women happen to get pregnant because she just was not paying attention to her family planning, while she was very ill,” she explained to JIS News.
Commenting on initiatives to reduce direct maternal deaths, Professor McCaw-Binns said that the Ministry of Health was making efforts to intervene with better training, and improving access and quality of care for mothers.
“We have seen a 24 per cent decrease over the last 20 years in deaths from hypertension and we have seen a 36 per cent decline in deaths from haemorrhage, but one of the things that is bothering us is that there has been an upturn in deaths from abortion,” the Professor lamented.
“The problem with this upturn in abortion is the fact that the pattern is very different, whereas with other conditions, the incidents of deaths increase with maternal age. We see what we call a J-curve for abortion with the deaths being highest among adolescents and older women,” she added.
In the meantime, Jamaica has been monitoring maternal deaths, including those classified as coincidental deaths since the mid-1980s. In fact, Professor McCaw-Binns noted that a maternal mortality surveillance system is in place, which aims to learn from missed opportunities in terms of saving a mother from poor maternal outcomes.
“It is our objective that all maternal deaths should have a post mortem investigation so that we can determine clinically, the cause of the mother’s death. We also need to know that it is not only the clinical problem that killed her, but also about the social factors that may have contributed to her death, so the public health nurse will visit the family to find out what were her problems,” she pointed out.
There is also a need to ascertain if the health problems of the deceased were identified and if she was educated about the problem sufficiently by the health team. “We need to get all this information so that we can fix the problems.this is why we want their families to cooperate with us when we come out to get information on those deaths,” the Professor said. Jamaica’s maternal mortality rate is 95 deaths in every 100,000 live births.