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Understanding the High Maternal Mortality Rates in Lesotho: Causes and Solutions

26 June 2024 by Limpho Sello

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Mothers in Mokhotlong bring their children for vaccinations.

South Sudan, Somalia, and Lesotho have the highest maternal mortality rates in the East and Central African region.

Lesotho’s United Nations Population Fund (UNFPA) Sexual Reproductive Health and Rights Coordinator, Blandina Motaung, explained that South Sudan ranks first, followed by Somalia, with Lesotho in third place.

Motaung said: "The common question we always face is: What is happening in Lesotho? Unlike those countries in conflict, Lesotho is not, so what is causing these issues?”

Since gaining independence from Sudan on July 9, 2011, South Sudan has descended into a bloody seven-year civil war. Similarly, Somalia has experienced prolonged conflict, from the Cold War to civil war, state collapse, clan wars, and famine, enduring nearly two decades of war.

A 2021 study into the impact of war on maternal health indicates that armed conflicts severely strain health systems, constraining efforts to reduce maternal and child mortality.

“Our analysis indicates that armed conflict is associated with substantial and persistent excess maternal and child deaths globally, and with reductions in key measures that indicate reduced availability of organised healthcare.

“These findings highlight the importance of protecting women and children from the indirect harms of conflict, including those relating to health system deterioration and worsening socioeconomic conditions,” concluded authors of Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000–2019.

Despite not being in conflict, Lesotho faces a high maternal mortality rate of 566 per 100,000 live births, raising a frequent question about why Lesotho’s maternal mortality rates are comparable to those of war-torn countries.

“The answer to this frequently asked question is that Basotho women do not follow prenatal care/ANC, safe delivery practices, and postpartum care to enhance maternal health,” Motaung said during a two-day capacity-building workshop for health journalists in Lesotho.

The workshop, organised by the UNFPA, was held in Maseru on June 11-12, 2024. Motaung, one of the speakers, shared, “Even when pregnant women follow those comprehensive approaches, there are issues with the quality of care.”

66-year-old ‘Mamolelekeng Ntšasa is a village health worker in Tsoelike, Ha-Letaba, Qacha’s Nek.

“As community coordinators, we always advise pregnant women to start attending ANC clinics as soon as they miss their periods, despite the challenging terrain and long distances from some villages to health facilities,” Ntšasa explained to Uncensored News on June 24, 2024.

She added: “We aim to prevent unnecessary child deaths. Since our expanded training, we have seen fewer deaths compared to previous years, especially among children.”

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Slight maternal deaths increase

According to the Maternal Mortality Regional Factsheet, in 2020, eight African countries were estimated to have a very high rate of maternal mortality, ranging between 500 and 999 deaths per 100 000 live births.

“These are Central African Republic (835), Guinea-Bissau (725), Liberia (652), Lesotho (566), Guinea (553), Democratic Republic of the Congo (547), Kenya (530) and Benin (523),” read the factsheet.

The report noted that between 2017 and 2020, Sao Tome and Principe witnessed a 12 percent increase in its maternal mortality rate.

“Other countries with a slight increase in their maternal mortality rates include Lesotho, Madagascar, Malawi and Rwanda.”

But why has Lesotho recorded a slight increase in maternal deaths? Motaung attributed this to hemorrhage, hypertensive disorders, and infections as the leading causes of maternal mortality.

She emphasised the need for pregnant women to take blood supplements such as folic acid, calcium, and iron throughout their pregnancy as part of efforts to decrease maternal deaths.

“Every pregnant woman who goes to their routine ANC need to be tested to check their iron levels and be provided with these supplements because they assist even where one’s hemoglobin level is low, so it should stabilise somewhere,” Motaung explained.

She added: “Secondly, doctors should be able to tell how and where they (pregnant women) will need to deliver, whether under health centre or hospital in case they will need blood or whether she is battling hypertensive disorders.”

Fighting infections

Motaung further highlighted that not combating infections during pregnancy contributes significantly to the high maternal mortality rates in Lesotho.

“Infection is a critical concern, closely tied to the quality of care provided. When discussing quality of care, I emphasise that every pregnant woman should have access to essential services such as blood pressure monitoring, necessary blood tests, and meaningful interactions between health professionals and clients,” Motaung explained. She emphasised that observing a woman’s behaviour, appearance, and movements can yield crucial insights into her pregnancy health.

“During our training, we were taught to observe pregnant women from the moment they enter the door because much can be discerned from these initial moments,” she added.

Hygiene is one of the key indicators that can be observed, Motaung explained. “The way she walks can indicate the weight of her pregnancy or the likelihood of successful delivery. These observations are crucial to preventing complications that may lead to maternal mortality.”

Despite efforts, Motaung lamented that maternal deaths still occur, especially among a small population where many women die alongside their babies.

Limited number of clinicians

Dr. Nonkosi Tlale, National Sexual Reproductive Health and Rights Advisor to the Ministry of Health, highlighted critical challenges contributing to maternal and neonatal mortalities, including the shortage of obstetricians, gynaecologists, and adequately trained medical officers and midwives.

Dr. Tlale’s insights were featured in the World Health Organization Lesotho report published on December 20, 2023, following a meeting aimed at addressing high maternal and child mortality rates in Lesotho.

“Key challenges outlined by Dr. Tlale and her team include the availability of blood and blood products for managing obstetric hemorrhage, as well as other essential commodities needed for emergency obstetric care,” the report stated.

According to the report, the leading causes of mortality are hemorrhage, hypertensive disorders of pregnancy, and complications from unsafe abortions.

Seipati Motsei, National Sexual and Reproductive Health Program Manager, emphasised the urgency of reducing preventable maternal and neonatal deaths by identifying immediate action areas and seeking support from the World Health Organization (WHO).

In February 2024, Lesotho’s high mortality rate was addressed during a courtesy visit by Innocent Modisaotsile, United Nations Population Fund (UNFPA) Representative to Lesotho, to the Minister of Health, Selibe Mochoboroane, at the Ministry of Health Headquarters in Maseru.

During the meeting, Modisaotsile reaffirmed UNFPA’s commitment to supporting the implementation of Sexual and Reproductive Health and Rights (SRHR) programs, including efforts to reduce the unmet need for family planning and prevent early and unintended pregnancies.

He emphasised the importance of ensuring young people have access to information and family planning supplies to protect themselves.

Qacha’s Nek village health worker, ‘Mamolelekeng Ntšasa, stressed the importance of tirelessly working to end maternal and child mortality, which has deeply affected the country.

“We strive for good health from children to adults, working closely with communities and health facilities,” Ntšasa affirmed.

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