March 17, 2003

Tanzania reduces maternal death rate, but big urban – rural gap remains

Tanzania has reduced maternal deaths by up to 72 per cent over the past 10 years. A seven-year long study carried out in the country showed that in 1992/93, the death rate stood at 134 per 1,000. But by the end of the decade, this had fallen to 37 per 1,000.

In Dar es Salaam, the country's largest city, the goal set by the Safe Motherhood Initiative in 1987 of bringing down maternal mortality by 50 per cent was exceeded, with the city bringing its rates down by 72.3 per cent. The study showed a sharp difference between women who stayed longer in school and those who dropped out. It also showed that differences in income made a significant difference in whether a pregnancy was safe or not. The study also points out that lack of proper documentation in many parts of the country makes it hard to reach conclusions about the real levels of maternal mortality.

The study was carried out in three regions of the country - Dar es Salaam, Hai district in Kilimanjaro region and Morogoro in central Tanzania. The results also seemed to support the view that outlawing abortion only led to more women dying from the practice through seeking the services of quacks.

Since the World Bank, the United Nations Population Fund and the World Health Organisation launched the Safe Motherhood Initiative in 1987, Dar es Salaam reduced the number of women dying from maternal-related causes by 72.3 per cent. It was followed by Hai district in the Kilimanjaro region, which achieved 40.8 per cent, while Morogoro district achieved 39.5 per cent. "Based on an analysis of maternal mortality rates, the goal of reducing maternal death rates by 50 per cent during the 1990s was accomplished in Dar es Salaam," said the report. Reductions may also be occurring in the rural sentinel areas, but more observation time is required to determine whether they are statistically significant."

The statistics show the impact that poverty can have on health. Dar es Salaam has a higher proportion of better educated and relatively more affluent people, hence its achievements. It is followed by Hai, which is one of the more developed rural regions of Tanzania, while Morogoro reflects the performance of the poorer parts of the country. Education was found to be the single most important determinant of whether a woman went through with a pregnancy successfully or not. Spending just one more year at school gave a mother a 63 per cent higher chance of going safely through a pregnancy than a school dropout. However, not all the deaths quoted in the research were directly linked to maternal causes.

Nevertheless, direct maternal causes accounted for 67.3 per cent of recorded deaths among women in Dar es Salaam. This was followed by Hai district with 79.1 per cent of deaths directly relating to maternal causes, and Morogoro with 87.9 per cent. Unsafe abortion played a significant part in these deaths, although economic and educational background also mattered. Morogoro again bore the brunt of the statistics with 29 per cent, while Hai had 22.7 per cent. HIV/Aids and tuberculosis accounted for 50 per cent of cases involving women in their 20s. In Hai, the report says, malaria played the major role while it came second to Aids in Morogoro (The East African, Nairobi)

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