The United Nations Children’s Fund (UNICEF) tasked experts to investigate the depressing deaths of mothers and babies in the Upper East region and the resulting findings have sent heads into a spin.
Among the factors responsible for the gross loss of mothers and newborns in the region, alleged abuse of expectant mothers, dished out to them in several forms and rather in places where they are expected to find solace, top the discoveries made in the middle of 2016 by senior investigators at the Navrongo Health Research Centre (NHRC).
At least 16 public health facilities- 6 hospitals and 10 health centres- in 8 municipalities and districts in the region have been cited for ‘sexual’ harassments, assaults, violation of privacy and extortions among other sorts of abuse perpetrated against women in labour.
Authorities at the centre released the findings in October in Bolgatanga, the regional capital, but did not disclose the identities of the implicated facilities. The health facilities, they, however, revealed, are within the Bolgatanga Municipality, the Bawku Municipality, the Kassena-Nankana West District, the Bongo District, the Builsa North District, the Kassena-Nankana Municipality, the Talensi District and the Bawku West District where scores of women were interviewed.
“We asked the women whether they [had] been subjected to any form of abuse. Some of the women said they had been physically abused. A little more said they had been subjected to verbal abuse. And a couple of them [mentioned] sexual abuse. We are not talking about a rape or a physical form of sexual abuse. Even verbal abuse that is of a sexual nature is sexual abuse,” Dr. John Williams, a Chief Medical Officer at the centre and Principal Investigator for the research, disclosed at a stakeholders’ conference held in the regional capital for public dissemination of the findings.
Denied access to toilets after deliveries
Whilst some facilities do not have toilets, a number of those who have are strictly denying maternity patients access to the privies, the centre reported.
“Even though we know that the service for pregnant women is basically supposed to be free, the reality is that certain things are often not available and they have to pay for them. Seven out of ten were asked to purchase an item for delivery.
“There were no maternity toilets. In one facility, there was a toilet but patients were not allowed to use it. Anytime they came to deliver, they were asked to buy chamber pots and, then, they were asked to pay a cedi to an orderly to go and dispose of the [waste]. And from our observation, the general appearance of [some of the facilities] was not very good,” Dr. Williams stated.
Privacy violations, shoddy documentations
The investigators also highlighted a horrifying environment of some maternity wards where midwives care too little about the privacy of women in labour.
“We expect that when women come to the labour ward, it shouldn’t be possible for somebody else to hear what they discuss with the midwives. That is the auditory privacy. But what we noticed was that most of the time when the midwives are talking to the women, other people nearby can hear what is being said. So, there is not enough privacy.
“For the visual privacy, you are talking about other women or other people seeing the nakedness of other women. It shouldn’t be possible for that to happen. In a ward there could be several women in various stages of labour and they can see the other women’s body parts. When we assessed, most of the facilities fell below 20% in terms of privacy,” the Principal Investigator remarked.
Documentations in the maternity wards, the investigations also show, are not taken more seriously than a mere letter stenciled under any footwear. And for the investigators, there is no worse form of courting calamity than leaving the medical record sheets of a woman in labour blank until there is a sudden lawsuit.
Dr. Williams explained: “Things have to be documented properly. Very often, there is no problem because for most women who have just delivered and everything is fine, they go home and that’s the end of the matter. But the problem comes when an incident occurs: the woman dies or something happens; and, then, people start looking into the matter and they realise that a lot of things are missing and it becomes an issue. For legal and other purposes, there is a need for proper documentation. When lawsuit comes, the first thing they go and look at is the records. If you say ‘I examined the woman at this time’, where is the evidence- and they are caught napping because they haven’t written anything.”
Abused women abandon ruthless facilities
A number of women, the study concludes, have cut ties with the same facilities that needlessly aggravated their childbirth pains. Such women may not seek medical attention at any other health facility anymore and may consider some alternatives that could pose serious threats to them and their newborns.
“Most of the facilities are still such that they do not have processes for identifying [and] reporting abuse. Women who had delivered in a certain facility were asked a direct question- based on your experiences in this facility, would you come back here? And 17% said no, they were not very happy with certain things; so, they won’t come back. Maybe they would go to another facility; maybe they would stay at home. A woman may decide that she won’t return to where they mistreated her and that may lead to her death because she makes a wrong decision, because she is afraid of the consequences of poor privacy,” Dr. Williams noted.
He stressed: “It should be possible to screen the women off. We are not saying they should build a cubicle for each person, but there should be adequate screening such that when somebody comes and she is in labour and she is exposed, at least she has her privacy. It’s a human rights and dignity issue. Every woman, however poor or however lowly she is, her dignity must be respected. Just as if the president’s wife is coming to deliver and they will ensure that she has her privacy and her confidentiality is respected, the poorest woman from any village also should be treated with dignity.”
Why the investigation was done
When a number of countries, including Ghana, failed in 2015 to meet the Millennium Development Goals (MDGs) 4 and 5- which were to reduce child mortality and to improve maternal health- UNICEF became interested in digging out the reasons those countries fell short.
UNICEF came up with a concept dubbed “Mother Baby Friendly Health Facility Initiative (MBFHI) and secured funding from the Bill and Melinda Gates Foundation to assist the failed countries to improve infant and maternal health through training programmes and provision of appropriate equipment at health facilities.
But first before the implementation of the intervention was the need to do a baseline study into what might have ushered the sovereign states into the crash. Only three countries- Ghana, Tanzania and Bangladesh- were chosen. The Ghana Health Service (GHS) in 2015 chose the Upper East Region for both the baseline study and the intervention because, as pundits put it, the region, under what has now come to be known as the “Awoonorised style of direction”, had the most trusted leadership as of that time to see to the success of the initiative.
“It began when Dr. Awoonor was the Regional Health Director. The Ghana Health Service at that time felt that there was very strong leadership for health and the region was doing very well in terms of implementing health interventions. That is why they felt that, to be able to show good results, it’s best to select a region where you are sure that the leadership will ensure that things happen the way they are meant to happen,” relayed one of the pundits.
A source revealed: “Dr. Awoonor wrote the first concept note in 2013 and, then, followed it up to the UNICEF office in New York where he made a presentation and also made a case for that work. Then, he engaged UNICEF for the grant. It took him almost 2 years. It is a 3-million-US-dollar initiative. It was about to start when he left the region.”
Navrongo Health Research Centre commended
The eight municipalities and districts where the investigations were carried out have been grouped into what the experts say is “intervention districts” and the “comparison districts”.
The Bolgatanga Municipality, the Bawku Municipality, the Kassena-Nankana West District and the Bongo District are the “intervention districts” because the MBFHI, which is expected to last until 2017, is scheduled to take place there.
The other four areas- the Builsa North District, the Kassena-Nankana Municipality, the Talensi District and the Bawku West District- will not see the MBFHI intervention within the same period. But they will be closely monitored by the investigators within the same period for developments on the wellbeing of mothers and babies.
They are referred to as “comparison districts” because the investigators at the NHRC, at the close of 2017, are going to use the cases of maternal and infant deaths (if there are any) in those areas to measure the impact or success of the MBFHI intervention in the other cluster of districts. It is expected that the impact will be positive and great such that the intervention will be replicated in several more places and those who have cut ties with the health facilities that once were unfriendly towards them will, through the gains made, return and reunite.
Meanwhile, government has commended the Navrongo Health Research Centre for the investigations and asked the citizenry to collectively make the initiative a success.
“I commend the Navrongo Health Research Centre for its work on the project. The centre is not only living up to its important mandate in healthcare delivery in Ghana, but also adding to knowledge and development. With a baseline survey on the critical areas of quality of care for mothers and newborns, it should serve as impetus to our collective efforts. The findings should serve as useful information for reflection and greater desire to see the project succeed in the best interest of our communities and families,” the Upper East Regional Minister, Albert Abongo, said at the stakeholders’ conference that also saw UNICEF officials from New York, Senegal and Ghana in attendance.
According to UNICEF, Ghana every year has 28,000 maternal deaths, 25,000 newborn deaths and 17,000 stillbirths- adding up to 70, 000 deaths within 12 months.
“We have now 17,000 fewer children dying each year than we had in 1990. But still we have 6 million children dying before their fifth birthday each year. Six million is a huge number and it calls for our attention. The baseline assessment findings [should] give us exact knowledge on which nuts and bolts need to be fixed in our region,” Dr. Nabila Zaka, Senior Advisor for Maternal and Newborn at the UNICEF office in New York, told the gathering.