When Giving Life Ends in Death: The Face of Maternal and Infant Mortality in Zambia

I recently came across the story of a young African-American man, Charles Johnson IV, who is fighting for legislation to increase the quality of health care to reduce maternal mortality among African-American women. His own wife died after delivering a healthy baby via caesarean section. She bled to death because doctors at a very prestigious hospital in the U.S. ignored her haemorrhaging for several hours. Her name was Kira Dixon Johnson. She was very well educated and reasonably well-off and yet she became another statistic. In America, African-American women are 243% more likely to die to child-birth than their white American colleagues. Even wealthy, educated African-American women are still more likely to die in child-birth than white women. Earlier this year, tennis star Serena Williams revealed that she too had suffered a near-death experience following the delivery of her daughter due to post-delivery complications that her care-givers were not taking seriously. In America, black women are more likely to die in child-birth because of poverty and racial bias in terms of the quality of the care they receive. In Zambia, women are more likely to die in child-birth because of poverty and because of a lack of access to good quality health care.

When women get pregnant, they assume that their pregnancy will go smoothly and that nine months later both mother and baby will emerge glowing and “cherubescent” respectively. That is not the reality for hundreds of thousands of women across the world. In 2016, I was Kira Dixon Johnson. My pregnancy was complicated right from the beginning. I had placenta praevia (low lying placenta that covered my cervix completely). It meant that I bled on and off during my entire pregnancy. I would later learn that this condition is life-threatening as it meant that at any time the placenta could erupt causing me to bleed out in a matter of minutes. Added to that, I was gaining weight excessively (I later found out that it was due to fluid retention) and a few months on I began to experience shortness of breath.

My first doctor down played the seriousness of my placenta praevia and other symptoms insisting that I could more or less continue my life as normal. But because I was not satisfied with his lack of explanations and information; I was reading up on my symptoms on my own. I became so concerned at the lack of information that I was getting from my doctor that I changed doctors when I was about five and a half months’ pregnant.

My new doctor was great. She listened to me and answered my questions. On my first appointment my urine was tested and it was found that I had protein in my urine and my blood pressure was above normal, both indicators for pre-eclampsia – in addition to my placenta praevia. Eclampsia is a condition in which pregnant women experience unexplained high blood pressure. It is not stress related. It can lead to seizures and can affect internal organs either pre- or post-delivery. My new doctor put me on complete bed rest for the rest of my pregnancy which I strictly observed. There would be several occasions when I would be completely relaxed and having lain in bed all day only to be perplexed to find that my blood pressure was very high. My new doctor took a blood sample and ordered a supply of blood to match my blood type to prepare for blood transfusions in the event that my placenta praevia erupted suddenly. It proved to be a life-saving move. I was later to develop a very severe form of pre-eclampsia called HELLP syndrome which was also life-threatening.

At exactly twenty-eight weeks of pregnancy, my placenta praevia erupted and coincidentally my blood pressure was becoming uncontrollable due to the pre-eclampsia. I had to have an emergency caesarean section. My baby, Mazuba (sunshine) was born on 5th August 2016. He was small but perfectly formed. He was born underweight due to my condition at around 1 kg but fighting for his life. We both were. I was at one of the most prestigious hospitals in Zambia and yet its maternity wing did not have an infant respirator to help him breath. Mazuba died in the early hours of 7th August 2016. The fact that he was underweight had made his chances of surviving slimmer. It was one of the hardest things I have ever had to experience. I cried for hours until the next morning I was told to stop crying and remain positive otherwise I risked falling into depression which would aggravate my own condition. I had to suck it up. By then the HELLP syndrome had kicked in and my liver and kidneys were breaking down. I needed several blood transfusions.

I can point to the day I nearly died. I needed another transfusion and the hospital did not have enough blood. My mother, who is a medical doctor, managed to arrange for some more blood and that is how I survived. It took me two months to physically recover from my condition, which also included sepsis, a severe bacterial infection that I picked up at the hospital after my operation. The trauma of losing my baby and nearly dying led to me suffer post-traumatic stress disorder (PTSD) and post-partum (post-delivery) depression for a period of time. Contrary to popular belief, these conditions also affect black African people and are far more widespread than is accepted because no one wants to talk about it. I could not have gotten through it without supportive friends and family who loved and cared for me during what was a very difficult time. Like millions of mothers before me, I had to pull it together and life had to carry on.

I am alive today because I was educated enough to question my doctor, because I had enough money to go to one of the best hospitals in the country and because I was lucky enough to have a mother who is a doctor. Many thousands, if not millions, of Zambian women do not have those advantages. In Zambia, many women deliver babies at home or at health posts that are not staffed by qualified doctors and that do not have access to life-saving equipment. According to 2015 UNICEF estimates, the maternal mortality rate in Zambia is 224 deaths per 100,000 live births (a 2015 estimate). According to another 2015 UNICEF estimate, 36 babies die every day before reaching their first month. These are shocking statistics. And yet our government is paying for overinflated roads, fire engines, ambulances, cars and even jets while our women are dying trying to give life and our children are not being given a chance to live. That makes me very angry and sad – as we all should be.

December 12th marks Universal Health Coverage Day. I believe that health care should be affordable and accessible for all. I am not talking about politicised health schemes that will do little to improve the lot of Zambians. I am talking about adjusting our financial priorities by reducing expenditure and over-expenditure on non-essential items and increasing budgets for healthcare that will help increase the number of qualified doctors, medicines and facilities countrywide. We need to give our mothers and babies a fighting chance.

The author is a lawyer and civil rights activist. She is a 2014 Archbishop Desmond Tutu Leadership Fellow.

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