COTE D’IVOIRE: More Births Attended By Skilled Attendants

Fulgence Zamblé

ABIDJAN, Sep 6 2010 (IPS) – As she leaves the community health centre in Abobo-Baule with her newborn baby, Abiba Tahoué is doubly satisfied.
It was a difficult labour, but 32-year-old Tahoué is happy with the quality medical care she received from the midwives. Secondly, the bill for delivery here in this clinic in a northern suburb of the Ivorian capital Abidjan was the equivalent of eight dollars, as compared to the $20 or $45 she would have been charged at a large public hospital or private clinic.

I was a bit apprehensive when we arrived. People say midwives mistreat patients during birth because many of them were not well trained, Tahoué explained to IPS. My first two births took place at home to avoid having to go through that torture. But this time I knew there were risks, so I chose a health centre and I was not disappointed, she admits.

In the maternity ward, other women awaiting deliveries carefully observe the comings and goings of midwives. Some pregnant women worry when arriving in the delivery room while others are optimistic.

I followed all the health guidelines during my pregnancy. Prenatal visits and vaccinations are up to date. The monitoring was conducted properly. There is no reason for things not to happen smoothly, Catherine Tanoh, 34, told IPS. This is Tanoh s second pregnancy.

Her midwife, Monique Kouamé, agrees. When the patient receives proper prenatal care, we have no difficulty in childbirth, she told IPS.
Kouamé, like the four other midwives in the maternity ward, attends training sessions on pregnancy and childbirth monitoring nearly every three months. However, she acknowledges that there still are deaths in childbirth due to haemorrhages. But we see only five cases a year, as opposed to ten or so in the past.

According to Kouamé, this is because, there pregnant women who you need to keep under a tight reign. When we run into them in neighbourhood, we take the opportunity to remind some of them of their upcoming visits. Because there are some who tend to forget their appointments.

In a report on the Millennium Development Goals published in August , authorities claimed that births attended by trained personnel were increasing in Côte d Ivoire. From 45 percent in 1994, the rate rose to 56 percent in 2009 and should reach 60 percent in 2014.

The larger share of this increase comes from southwest Côte d Ivoire, where midwives serving in different maternity units in the region, assisted some 22,000 births out of the total of nearly 26,000 in 2009, present at 7 percent more births than they had been in 2007.

The country has seen the mortality rate for children under five fall to 15 per 1,000 births in 2010, according to the report, and could fall below 10 per 1,000 in 2014.

We must now ensure access to hospitals for a larger number of people. Because in some rural areas either the medical staff is nonexistent and the buildings decrepit or horrible road conditions limit community access, said Fanta Traoré, a midwife from Soubré in southwestern Côte d Ivoire.

Laciné Diaby, Development Director at the Ministry of Planning and Development, noted during the presentation of the report that the indicators are improving, but not fast enough. He said the political and military crisis that has gripped the country for nearly eight years now has prevented significant investment in the health sector.

In order to achieve the MDGs in this area we would need to increase budgets for to training public health agents, and especially budgets supporting maintaining a number free services, the report suggests. The health budget is now about $230 million U.S., less than five percent of the national budget, according to the ministry.

These measures are necessary because of the risks faced by women during unassisted childbirth. According to Joseph Bi Vroh, director of the Reproductive health and family planning programme, the impact of the lack of qualified medical assistance is already huge in Côte d Ivoire.

Eighty per cent of maternal deaths are due to haemorrhage (36.1 percent), difficult labour (20.3 percent), postpartum infections (4.8 percent) , abortion complications (14.8 percent) and hypertension (18.2 percent), according to the Vroh s programme.

Sixteen women die due in childbirth-related complications in Côte d Ivoire, says Vroh.