MICHAEL MYNHARDT: Post-partum haemorrhaging a neglected global crisis that requires urgent solutions

It is unfortunate that much of history can be so doggedly characterised by the division between those who have and those who have not.

Luckily, somewhere amid multiple world wars and the globalisation of our world, the individual, and not their wealth, has risen in prominence. The emphasis placed on the individual is partly to thank for the steady progress made in improving the lives of the poorest and most vulnerable in society.

Sadly, much of the inequities facing our world have been hundreds of years in the making (if not more), thus requiring a severe structural and systemic approach to rectify them. 

South Africans know this well: despite the end of apartheid, deep-rooted systemic problems around economic participation remain a challenge for our society, with attempts at tipping the scales resorting to systemic-level interventions in response.

But that’s just one level of inequality - albeit a profoundly and historically unjust one.

At the intersection of wealth and gender lies a second and equally upsetting truth: those living in poverty have worse health outcomes than their relatively wealthier peers; but women living in poverty face even worse outcomes than their male counterparts – and poor mothers tend to have even worse health outcomes among women, largely due to the elevated risk of death during childbirth.

HEALTH SHOULD NOT BE DICTATED BY WEALTH

In an ideal world, access to health interventions should not be dictated by wealth, but rather by need, and the need clearly lies at the feet of mothers living in low- or middle-income countries (LMICs) who go without access to literal life-saving interventions.

According to the World Health Organization (WHO), a woman dies in childbirth every two minutes. In 2020, 95% of all maternal mortality took place in LMICs, with two-thirds of all such deaths occurring to sub-Saharan African mothers.

But even more distressing is WHO’s finding that most of these tragedies were, and remain, entirely preventable.

In their words, we are bearing witness to a neglected global crisis that is uniquely affecting women from the global South. 

In modern-day Africa, four major maternal mortality factors remain prevalent – these include postpartum haemorrhage (PPH), sepsis, eclampsia, and thrombosis.

PPH is particularly concerning, as 25% of all pregnancies will result in PPH worldwide. Its frequency and impact in Africa is staggering: each year, about 14 million women experience PPH, resulting in about 70,000 maternal deaths.

As with maternal death figures, nearly all PPH-related deaths take place in LMICs, and in mirroring the larger trend, also primarily affects sub-Saharan Africa and South Asia, accounting for 80% of all deaths.

However, even among women who survive PPH, the after-effects may be felt for a lifetime, including PTSD and cardiovascular disease. 

ADDRESSING THE CRISIS

Addressing PPH effectively hinges on improving access to essential medicines such as tranexamic acid (TXA), oxytocin, and misoprostol.

By expanding the availability of these treatments, we can significantly reduce the mortality rates associated with PPH. However, a new player in this field, heat-stable carbetocin, presents a particularly promising advance and opportunity for Africa.

Unlike oxytocin, which necessitates a stringent cold chain that can be challenging to maintain in regions with infrastructural deficits, heat-stable carbetocin offers a more practical solution.

This innovation could overcome the logistical hurdles often faced in distributing life-saving medications across the African continent, where gaps in cold chain infrastructure are prevalent.

The opportunity to manufacture affordable, high-quality PPH medicines – like carbetocin –  locally on the African continent cannot be overstated.

This shift could dramatically enhance accessibility and affordability, addressing a critical need in the region.

However, despite all the good work and support from organisations pushing the entry of generic manufacturers to produce quality-assured, cost-effective PPH treatments, such as Unitaid, Africa will still need to rely on Africans and itself.

This is not because we are beyond accepting much-needed assistance, but because we want long-term solutions that become part of the health ecosystem for good.

LONG-TERM SOLUTIONS FOR AFRICA, BY AFRICA

South Africa is lucky in that we have a Women’s Month, South African Women’s day, and International Women’s Day.

Some of the most common criticism lobbed against days such as these (from all sides) is that they are, in fact, just that: days. Little, some argue, comes from their place on the calendar.

One day, I hope that these days won’t be important. The epoch when women’s day fades away should be one in which women’s hard-fought struggles are won.

Not just for women, but for our mothers, sisters, aunts, daughters, grandmothers, friends, the stranger on the train, or the women who wanted nothing more than to have a healthy childbirth. 

Until then, these days are for celebration and the fight to achieve the UN’s Sustainable Development Goal of reducing maternal deaths, not just for the haves, but for those who have not.

Michael Mynhardt is the CEO and Co-Founder of MMH & Partners Africa.