Maternal Mortality in Papua New Guinea

Maternal mortality continues to be a burden in Papua New Guinea (PNG), one of the many Pacific Island Countries (PICs) home to about 9 million citizens [1]. Over the years there has been a regression in its burden, however, at a rate of approximately 215 deaths per 100,000, it is still particularly high, especially in comparison to developed countries such as its most immediate neighbour, Australia at about 7 per 100,000 [2]. Due to the numerous factors influencing its public health service delivery such as missing or poor road networks, geographical remoteness, inadequate healthcare centers, lack of workforce, and administrative management issues, many preventable deaths occur each year [2]. These challenges have led to the establishment of non-government organizations and pledges by governments to improve quality access to health so that maternal mortality may be reduced [3].

Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to, or aggravated by, the pregnancy or its management but not from accidental or incidental causes [2]. Maternal mortality ratio (MMR) is therefore defined as the ratio of maternal mortality divided by the number of live births [2]. This is expressed as number of deaths per 100,000 live births [2].

Each year about 289,000 women die from maternal mortality [2]. The global MMR is about 216 deaths per 100,000 live births [2]. Most maternal deaths, about 85% to 98%, are often preventable and occur in low- and middle-income countries [4]. As mentioned above, 215 deaths per 100,000 live births occur annually in PNG according to WHO [2]. However many data estimates range anywhere from 98 to 733 deaths per 100,000 [5].

According to an article, PNG has one of the highest MMR and infant mortality rates (IMR) in the Asia-Pacific region [1]. Most maternal deaths in PNG are commonly caused by obstetric hemorrhage (30%), sepsis (5%), embolism (15%), eclampsia (14%), and abortion (7%) [1]. Aside from clinical causes, a report released by the PNG government identified additional issues such as the public’s low confidence in the health system; prevention services provided were not being utilized or accessed; the unimpressive improvement of rural health over the last 30 years; government administrative issues; and the need for policy setting for maternal health as important factors in the elevated figures in PNG [4].

The report further stated that special attention was needed by groups identified in PNG who were either marginalized or had special needs that were at higher risk of MMR [4]. These included: i) women who had children at extreme ages, either too young or too old; ii) women who had more than 5 pregnancies or less than 2 years apart; iii) women who were chronically ill during gestation; iv) women challenged by living far from services, extreme poverty, illiteracy, or geographically; and v) women who were socially vulnerable (e.g. those living with HIV/AIDS, survivors of sexual and gender-based violence, and the disabled) [4].

Despite the high maternal mortality ratios in PNG, there have been positive changes over the years [5]. In 2016, an article published online documented the trends in maternal and perinatal mortality in one of the government hospitals in Papua New Guinea [5]. During the period of 2009 to 2014, it was revealed that, even though the in-hospital maternal mortality ratio was still high, there was a significant decline of over 50% from 24/2598 (924 per 100,000) in 2009 to 12/3217 (373 per 100,000) in 2014 [5].

MacroTrends also released similar results documenting a steady decline from 249 per 100,000 to 145 per 100,000 from 2000 to 2017 [6]. These figures are still especially high, in comparison to neighbouring PICs [2], [6].

Addressing maternal mortality in PNG has many challenges ranging from lack of services, inadequate healthcare centers, shortage of workforce, and poor administrative management [2]. The insufficient health services to remote locations have resulted in nearly 45% of mothers delivering outside of health facilities in PNG [1]. There were also estimates that only about 28% to 39% of births were attended to by skilled birth attendants [1].

These high figures garnered enough attention and in 2009, the PNG government formed the Ministerial Taskforce on Maternal Health to guide the development of the 2011-2020 National Health Plan with Maternal Health as one of top its priorities [1], [4]. Integral in its concept was the strengthening of maternal health services through the introduction of Community Health Posts with dedicated midwifery staff to assist with antenatal care and referral [4].

Presently, there is still much needed to be done to improve healthcare service delivery [1]. It has become clear that the availability, accessibility, affordability, and quality of care must be addressed in order to see positive results [1]. The challenge is getting relevant parties to cooperate efficiently [2].

Research, data collection, and effective interventions are needed especially in a complex environment such as PNG where there is a significant shortage of workforce [2], [1]. It is therefore paramount that a continued partnership between the government and NGO groups be maintained and proper planning and execution be carried out so that maternal mortality may no longer pose such a heavy burden in PNG.

References

[1]

G. Robbers, J. P. Vogel, G. Mola, J. Bolgna and C. S. Homer, "Maternal and newborn health indicators in Papua New Guinea – 2008–2018," Sexual and Reproductive Health Matters, pp. 52-68, 2019.

[2]

A. T. Dennis, "Reducing Maternal Mortality in Papua New Guinea: Contextualizing Access to Safe Surgery and Anesthesia," Anesthesia & Analgesia, vol. 126, no. 1, pp. 252-259, 2018.

[3]

"Minister pledges to reduce high maternal and newborn mortality," World Health Organization, 28 February 2019. [Online]. Available: https://www.who.int/papuanewguinea/news/detail/28-02-2019-minister-pledges-to-reduce-high-maternal-and-newborn-mortality. [Accessed 21 February 2021].

[4]

"Ministerial Taskforce on Maternal Health in Papua New Guinea," National Department of Health - Papua New Guinea, May 2009. [Online]. Available: https://www.health.gov.pg/pdf/Ministerial%20Taskforce%20Report.pdf. [Accessed 21 February 2021].

[5]

J. W. Bolnga, M. Morris, J. Aipit and M. Laman, "Trends in maternal and perinatal mortality in a provincial hospital in Papua New Guinea: a 6-year review," PNG Medical Journal, vol. 59, no. 1-2, pp. 34-37, 2016.

[6]

"Papua New Guinea Maternal Mortality Rate 2000-2021," MacroTrends, 2021. [Online]. Available: https://www.macrotrends.net/countries/PNG/papua-new-guinea/maternal-mortality-rate. [Accessed 21 February 2021].