Maternal health: there is cause for optimism.

Maternal health is a major health priority for international agencies, the African Union, and the South African Government. In 2000, all United Nations (UN) member states agreed to substantial improvements in maternal health, defined by Millenium Development Goal 5 (MDG5), which includes the specific target of reducing maternal mortality by 75% between 1990 and 2015. While many countries are making progress, maternal mortality in South Africa (SA) has significantly increased during this time. Data from the 2007 Community Survey suggest that maternal mortality in SA, rather than showing evidence of reduction, may have The SA National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD) reports, which analyse institutional maternal mortality, have shown an increase in maternal deaths, from the first report in 1998 to the latest triennial report covering the years 2008-2010. [8] HIV infection is the major cause of the large increase in maternal mortality. The national antenatal prevalence of HIV remains at around 30%, and is largely unchanged from 2004. Non-pregnancy-related infections in HIV-positive women are the single most common cause of maternal mortality, accounting for over 40% of all maternal deaths. However, even if deaths from HIV/AIDS are removed from the total, maternal mortality would still be higher than expected for a middle-income country with good health infrastructure. [6] For other countries in sub-Saharan Africa with high maternal mortality, resource limitations are a major constraint for healthcare delivery. However, in SA maternity care is free and the per capita health budget is the highest in the region. Avoidable factors, missed opportunities, poor quality of care and the lack of training of front-line healthcare workers have all been found to contribute to maternal deaths from all causes. Despite all of these issues, there is good cause for optimism. SA has the largest antiretroviral treatment (ART) programme in the world, with 2 million people on highly active antiretroviral therapy (HAART) today. Prevention of mother-to-child transmission (PMTCT) has evolved through several major policy changes since the national programme began in 2002, when single-dose nevirapine in labour was the only available treatment. The latest national guidelines from April of this year state that all HIV-positive pregnant women are to start HAART, irrespective of CD4 + count. There are approximately 280 000 HIV-positive pregnant women a year, [8] so strategies for rapid scale-up of ART services for pregnant women are in progress. Women not eligible for ongoing HAART, according to the national …