Maternal Health and Child Mortality
By Jeremy Laurance, Health Editor,
The Independent, UK

It is not much more than a corrugated iron shed but to Felicia Darkwah it is the best possible memorial for her daughter. Nana Yaa died, aged 28, in childbirth, the victim of a tottering health service, plundered by the West, unable to offer even basic maternal care.

Eight years of campaigning later, 65 year old Felicia stands in a dustblown field in eastern Accra, proudly showing off the clinic named after her youngest child. Opened last month, Felicia hopes it will help stem the tide of maternal deaths and save thousands of young women like Nana Yaa.

Around 1,000 mothers died in childbirth last year in Ghana, if you believe the Government maternal death rate of 215 per 100,000 births. Unicef estimates the true number is more than twice as high, or 100 times the rate in the UK.

Deaths in under fives in Ghana actually rose between 1998 and 2003. Infant and maternal mortality are the litmus test of a society's health. No one knows why in one of the most politically stable and potentially prosperous countries in Africa, things are getting worse.

Alima Mahama, minister for women and children, blamed a lack of resources and suggested other programmes might have to be raided.

Speaking to reporters attending a CPU course on health reporting, which focused on child and maternal mortality, she said in the Upper East region, where death rates were among the highest, a Unicef project to extend childhood vaccination, provide vitamin A supplements and bed nets had more than halved them.

"The high death rates are unacceptable because they are preventable. We have examples that show it can be done. We need to upscale them and apply them to other regions."

That could mean taking funds from HIV/Aids and re-directing them to family planning, she said.

Although the minister was reluctant to consider why death rates are getting worse, there are clues. The crumbling health service stripped of its doctors and nurses, is struggling to cope. Ghana has 1500 doctors, less than a third of the number needed, and a chronic shortage of nurses, lured abroad by large salaries.

Even if patients can find a bed and someone to look after them, they have to pay the cost. Although maternity care was officially declared free by the Government last year, most hospitals still charge, as they do for all other care.

The heart of any policy to cut maternal and child deaths begins with family planning - but here too there are problems. The number of couples helped with contraception by the Planned Parenthood Association of Ghana has more than halved - because of a dispute over abortion.

As a result, PPAG has lost its USAID funding of $700,000 US dollars a year - and with it the services of 1,300 volunteers.

Saving the lives of mothers and children is challenging enough - but policy decisions like these make it all the harder.