Lowe Porter…We would have developed local plans with our teams on the ground to be more strategic at the service delivery level (Photo: Naftali Jr.)
Senior health officials have identified delayed treatment at health facilities and lack of knowledge among pregnant women about warning signs during pregnancy as the two main factors behind Jamaica’s maternal mortality rate rising to alarming heights.
But the Department of Health and Human Services says it has implemented measures to address the issue.
Dr Julia Lowe Porter, director of the Family Health Bureau at the Department of Health and Human Services, highlighted the issue while pointing to the department’s Population Health Status Report from 2000 to 2022. The report showed that the maternal mortality rate reached a high of 211.3 deaths per 10,000 live births in 2021 due to the impact of the COVID-19 pandemic.
The figure would fall to 156.7 in 2022, but still be more than double the Sustainable Development Goal benchmark.
“Globally there is a target to get the maternal mortality rate to 70 per 100,000 live births but Jamaica’s numbers are not good. There has been an upward trend over the last 20 years. There have been fluctuations but if you take a step back and look at it there is a concern that there is an overall upward trend,” Dr Lowe Porter told the Jamaica Observer.
“Based on our analysis of the trends and the numbers, our situation shows that we have a delay one issue, which is patients not being aware of the problem. So it’s a population awareness issue. And then delay four is a health facility issue. We have an issue at the facility level in terms of how the health system responds to the patient’s situation once they access the facility,” Lowe Porter said.
He explained that many factors at the health care level contribute to the high rate, including a shortage of skilled medical staff to deal with complex pregnancy emergencies, inadequate resources and equipment, and inadequate diagnosis by medical professionals.
She added that in complex cases, patients are sometimes referred to other hospitals, with transport times delaying treatment and increasing the chance of death.
Lowe Porter… We would have developed regional plans with our teams on the ground to be more strategic at the service delivery level (Photo: Naftali Jr.)
Lowe Porter said bleeding after childbirth and a shortage of blood in health facilities were also contributing to the high maternal mortality rate.
“We know that during the COVID-19 outbreak, the situation has deteriorated exponentially for staff, including nurses, midwives and skilled midwives who manage the primary care clinics and antenatal clinics where we screen pregnant women,” she told the Sunday Observer.
“There is an extreme shortage of nurses and they are under strain. I know there are missions being organised to recruit staff from other countries which the ministry is looking at to help fill this shortage,” Ms Lowe-Porter said.
The report further states that Jamaica’s neonatal mortality rate (the death rate of newborns) has increased from 9.2 deaths per 100,000 in 2000 to 14.6 in 2021. During the same period, the infant mortality rate increased from 13.2 to 17.7, while the under-five mortality rate increased from 16.4 to 19.0.
Commenting on the increases, Lowe-Porter said: “Infant mortality and under-five mortality include neonatal mortality, so these two rates are affected by neonatal mortality. It’s not necessarily older children dying, it’s newborns dying.”
Asked about the reasons for the increase, she explained that it was due to respiratory and cardiovascular diseases during labour, birth and delivery, as well as maternal medical conditions that affect the child.
“For example, it is important to note that one disease that falls into this category is respiratory distress syndrome, which can occur in premature births. This speaks to our country’s ability to manage babies born with serious illnesses. Premature births pose a very high risk and require significant specialist doctors and facilities to avert deaths,” she explained.
Sepsis (infection in the blood and throughout the body) and meningitis were also identified as factors leading to increased newborn mortality.
Minister Lowe Porter acknowledged that Jamaica’s declining birth rate and rising maternal and infant mortality rates are a cause for concern and that his ministry is working to address the issue.
“We were meeting our birth rate target, which is a replacement fertility rate of 2.1 and now it’s at 1.9, but births are falling,” she said.
“Maternal mortality has actually remained fairly stable except during COVID times, but this is a ratio, so if you compare maternal deaths to live births, you can see that the ratio is trending upwards. This is concerning and is reflected in the maternal mortality rate trending upwards year over year. That’s why we are accelerating our response at this time,” she explained.
The response involves the Ministry currently hosting a series of maternal and child health forums across the island to assess trends in collaboration with local health authorities.
“We would have developed local plans with our teams on the ground to be able to be more strategic at a service delivery level to address the nuances that we have identified in each local health authority,” Lowe Porter added.
He said the ministry was planning an antenatal care and health campaign that would run for 15 months to raise awareness among mothers of the signs of pregnancy complications.
Lowe Porter noted that the Ministry of Health recently completed the Programme for Reduction of Maternal and Child Mortality (PROMAC), which aimed to strengthen health systems as well as implement a coordinated programme of infrastructure and equipment improvement, capacity building of health workforce and public education targeting the area of maternal and child health.
“We want to see the outcomes of this project, see where the needs are and evaluate all the other inputs around infrastructure, staffing and training through this project to determine the way forward,” Lowe-Porter said.
