Author: Valerie Ulai
Papua New Guinea (PNG) has the highest rate of maternal and newborn mortality in WHO’s Western Pacific Region . For every 1000 births in PNG, as many as 9 mothers and 24 newborn babies die . The rates of maternal and infant deaths are worsening particularly in rural areas .
These deaths are largely the result of preventatable or treatable conditions, such as hemorrhages, infections and pre-eclampsia, or exclampsia-a condition characterized by convulsions caused by high blood pressure in pregnant women . Likewise, the deaths of newborn infants are often due to a lack of quality care around delivery, leading to infection and asphyxia .
“PNG’s very high maternal mortality rate represents a national emergency” says the Minister for health and HIV/AIDS of PNG, Honourable Sir Dr Puka Temu in 2019. He goes on to add “This situation is unacceptable. No woman should die to give life. And every baby born is a life we should fight to save.”
A team of ministerial-level Maternal and Newborn Health Task Force convened by him in December 2018 to assess and analysis the situation in rural areas showed findings of three main reasons[1, 2];
1. Women avoid facilities: Skilled birth attendants such as doctors, midwives and nurses are essential for early identification and management of problems for both mother and baby. In the 1990s, more than half of the births in PNG were conducted by skilled birth attendants; however, the rate has declined to less than 40% in recent years. Concerns about quality of care are a major reason why pregnant women avoid health facilities. In many cases, facilities lack basics such as running water and electricity needed to ensure a safe and sanitary environment for giving birth. Many facilities did not have refrigerators for vaccines or adequate stock of essential drugs and supplies to treat common conditions. The task force, in fact, found that many staff at facilities did not know how to use essential medicines to treat haemorrhage or pre-eclampsia. Cost is another significant issue for many women, including the cost of transport and payments for services and supplies that should be free. Many women reported waiting for long hours only to be sent home and told to return the next day, further increasing travel costs. Also, road conditions are poor and air transport is scarce.
2. Fear, shame, violence and disempowerment discourage women from seeking care: Husbands, partners and families play a crucial role in the decision to seek care during pregnancy or childbirth. Many of the women are reluctant to seek care because of fear, shame and risk of violence. Cultural and traditional way of PNG does raises complex societal issues such as where there's male dominance and if the woman is not well educated she can't speak up for herself. She doesn't have much control over what she can do. So that adds on problems to pregnant women. Domestic violence has a very negative impact for both mothers and babies as women don't seek help and feel like there is nowhere for them to go.
3. Underlying these problems is a lack of timely and reliable routine health data: In six provinces, for example, the task force found that less than 40% of maternal deaths in facilities were reported. The actual figures are much worse, because deaths at home almost never get recorded. Without data, planning and monitoring progress on child and maternal health is difficult.
A research by vallely and whittaker in the rural highlands community in PNG shows that both women and men recognized the importance of health facility births, linking village births with maternal and newborn deaths . Despite this, many women chose to give birth in the community in circumstances influenced by cultural and customary beliefs and practices . Women giving birth in the community frequently gave birth in an isolated location. Traditional beliefs surrounding reasons for difficult births, including spiritual beliefs were reported along with the use of traditional methods used to help prolonged and difficult births .
Some positive trends were observed. For example, the quality of midwifery training in Papua New Guinea has improved dramatically since 2009, and the number of practicing midwives has almost tripled, which is helping to make inroads on addressing the serious staff shortage . Provincial staff interviewed by the task force also expressed a strong desire and willingness to improve the situation .
While the importance of health facility births is recognized in rural communities many women continue to give birth in the village. Identifying and understanding local customs, beliefs and practices, particularly those that may be harmful to women and their newborn infants, is critical to the development of locally-appropriate community-based strategies for improving maternal and infant health in rural communities in PNG .
The Minister for Health says he plans to use the task force findings to develop a medium- and long-term action plan for improving maternal and newborn health that is simple, specific and actionable .
Dr Mary Rose Bagita, the Obstetrician and Gynecologist at Port Moresby General Hospital said to Radio New Zealand that PNG relies a lot on donor partners to finance the health system but those working in the field don't feel the impact of that money and it can be difficult to even get medications to where they are needed . The head of aid agency ChildFund Australia Nigel Spence also interviewed said providing safe maternity care in PNG is incredibly challenging for those working in the area. "But they are challenges that can be overcome with sustained effort and sizeable investment at scale. The terrain is difficult, the accessibility is extremely difficult. At the same time there are many excellent front line health workers both professional and volunteer who are in the villages and they deserve and need so much more support” .
Nigel Spence further made known that the PNG government does have a comprehensive national health plan but it needs better administration and co-ordination to deliver health services to the whole country . This is something the people of PNG couldn’t agree more.
1. Childbirth in a rural highlands community in Papua New Guinea: A descriptive study – ScienceDirect. Available at https://www.sciencedirect.com/science/article/abs/pii/S0266613814002575. Cited 2nd March 2021.
2. More mothers dying in childbirth in Papua New Guinea | RNZ. Available at https://www.rnz.co.nz/international/programmes/datelinepacific/audio/2018647391/more-mothers-dying-in-childbirth-in-papua-new-guinea. Cited on 2nd March 2021.
3. Minister pledges to reduce high maternal and newborn mortality. Available at https://www.who.int/papuanewguinea/news/detail/28-02-2019-minister-pledges-to-reduce-high-maternal-and-newborn-mortality. Cited on 2nd March 2021.