Safe motherhood in Tanzania

20 World Health • May-June 1992 WHO Interview Safe motherhood .. in Tanzania She is the lawyer, the doctor, the cook -she is everything! "Previous/~ it would have been unimaginable for a leader from a women 5 organization to participate alongside medical doctors 1 Today issues of health are not only issues for the doctors, but issues for everybody. " N o one knows exactly how many women die in pregnancy and chi ldbirth . WHO estimates their number at 500 000 each year, 99% of them in the developing countries. It is in Africa that the risks are highest. The Safe Motherhood Initiative aims to reduce globally maternal deaths by at least half by the year 2000. What effect will such an effort have on the lives of women in Africa? Kate Kamba, Secretary-General of the Union of Women of Tanzania, explained it to World Health during a WHO meeting on safe motherhood. Safe motherhood covers all aspects which contribute to make women safe during the hazards of pregnancy and delivery. Some groups are more at risk than others, specifically girls under the age of 15 or women in their mid or late forties. Another aspect is the complications that arise during pregnancy and delivery because of the Jack of awareness on the part of the mothers on how to manage themselves during pregnancy. For example, almost 60% of maternal deaths are caused by anaemia. During pregnancy, you have to feed both yourself and the fetus. Whatever you eat, the fetus is not going to be sympathetic to you: unless you supplement your diet, the baby will take everything and you will be left with nothing! It is very important that during pregnancy you have enough fruit and vegetables, and when necessary- through a doctor or pharmacist - some iron tablets as well to supplement what you are eating. Anaemia occurs because women are not actually aware that they need to eat a special diet. Sometimes they cannot afford to buy fru it and vegetables for the whole family; and, because traditionally in Africa women are the last ones to eat, they would consider themselves greedy if they were the only ones eating fruit and vegetables . This is a big handicap. Also, because of economic hardships , women traditionally undertake many laborious activities and do not take rest. This uses up a lot of their energy, because they work right up to the time of delivery, instead of having some hours- or at least minutes - of rest each day, especially during the last months of pregnancy. World Health • Moy-June 1992 Education breeds awareness Of course, there are some parts of Tanzania that are better off, and this depends on the level of education. In some areas, like the Kilimanjaro region, the local people have increased their education standard up to secondary level. So in these areas you find women who are quite enlightened on how to take care of themselves. Of course they have some cultural inhibitions, but if you compare this region to some of the very remote areas, you will find that people there are not even aware of the risks . Although they produce a lot of food crops, they have the highest malnutrition. They don ' t even eat vegetables - only pulses and maize meal -as there are no fruit or vegetables except during the wet season. The Union of Women of Tanzania has branches at village level, with representatives at the district, regional and national levels. We hold meetings and workshops where we bring pregnant women together for training so that they can train others. We also provide them with some reading material to take away and keep for further use. We invite people from the Ministry of Health to attend our meetings and provide education. Family planning and health issues are on the agenda of all our meetings. Opportunity for immunization What we normally try to tell the women is that, when they are pregnant, they should attend a maternal health clinic. Secondly, they must be immunized because they don ' t know when they are going to deliver- whether at home or in hospital. Thirdly, we insist that they should rest. This needs a lot of community participation because, in most cases, the husbands don't understand; they think that the women have to go on doing things. We keep on telling such women that to rest is their right. It is also important that they we insist on family planning. We also train them to grow fruit and vegetables in the backyard gardens. I really believe that this initiative is going to have a very big impact. Previously, it would have been unimaginable for a leader from a women's organization to participate alongside medical doctors! But there is a need for intersectoral coordination. This means that issues of health are not only issues for the doctors but issues for everybody. Educate a mother and you educate a family When you talk of the community, you talk of the woman and the father. But to make the Safe Motherhood Initiative successful, when you go into the household at the community level- the family level- it is the mother who is the key person because she is the manager of the home. She is the lawyer, the doctor, the cook- she's everything! So, if you educate the mother, you educate the whole family. 21 In our country, we have the human resources but we don't have the money. However, we can use the brains of the women to prevent rather than cure, because if we talk in terms of curing, we can' t manage. The mother and the child form a generation, so if we know how to protect them, we will have a healthy nation. People who are healthy are people ready to face anything - they are resistant to most of the problems which nature has put in the way of good health. • Ms Kate Kamba was inteNiewed by Ruth Landy of the Division of Health Education at the World Health Organization in Geneva. Her address is Ofifi Kuu Ndogo, S.L.P. 1473 Dares Salaam, Tanzania . shouldn't have too many children. So Regular Follow-up of each pregnancy helps prevent dangerous complications.