MDG 5, HUMAN RIGHTS, AND MATERNAL HEALTH IN AFRICA
labor, which are responsible for eight percent; 43 and HIV/AIDS which cause
6. 2 percent of the deaths. 44 Other factors, including sepsis, embolism, and
ectopic pregnancy, are responsible for 17. 1 percent. 45 The good news is
that most of these deaths can be prevented through a wide range of
interventions such as proper nutrition, access to adequate health services
(including antenatal and postnatal care), scaling up availability of SHP, and
essential drugs and equipment. Paradoxically, these goods and services are
in short supply in the very countries where the need is greatest – and that,
regrettably, is the bad news. Take the availability of SHP in the region as
an illustration. There has been only a marginal improvement, from forty-two percent in 1990 to forty-six percent in 2009 – a four-percent gain in
nineteen years. 46 Since the uptake of the services of SHP significantly
impacts MMR (high uptake equals a decline or vice versa), lingering access
difficulties signals trouble ahead. 47 But recent development shows that
embracing innovative solutions to the identified problems can mitigate the
impact of limited availability of SHP as well as other challenges. It is to
these challenges that we now turn.
One of the areas where innovative response could immediately yield
results is hemorrhage, which alone is responsible for nearly thirty-four
percent of maternal deaths in Africa, more than one third of all other causes
combined. 48 The introduction of misoprostol for treatment and prevention
of post-partum hemorrhage (PPH) (excessive bleeding after childbirth) in
some African countries presents a remarkable opportunity to begin making
inroads into this problem, 49 particularly in rural settings where SHP is in
acute shortage and most deliveries occur at home. Misoprostol – “the most
discussed and researched drug in sexual and reproductive health since the
early 1990s” – holds great promise for reducing the number of PPH-
46. See MILLENNIUM DEVELOPMENT GOALS REPORT 2011, supra note 39, at 5-6.
47. MMR is unequally distributed across the region. Countries such as Namibia and
Senegal enjoy substantially lower maternal deaths compared to Niger, Sierra Leone and
Somalia. See WHO, WORLD HEALTH STATISTICS 2011 58–70 (2011).
48. Khan et al., supra note 42, at 1066.
49. Misoprostol is not a new drug and has been used in many middle to high income
countries, where it is registered as a gastric ulcer drug but used ‘off label’ in these countries
for preventing and treating PPH. Martha Campbell & Melodie Holden, Global Availability
of Misoprostol, 94 INT’L. J. GYNECOL. & OBSTET. S151, S151 (2006). In January 2006,
Nigeria became the first country to register the drug for PPH prevention and treatment. Id.