Global organisations, including the World Health Organisation (WHO) and UNICEF, have declared, based on data they have gathered and compiled, that maternal mortality has declined by 38% between 2000 and 2017, though they agree that the incidence is still unacceptably high. It is estimated that 295,000 women died during and after childbirth in 2017, down from 451,000 in 2000. But while UNICEF called it “significant progress”, the WHO was much less exuberant, noting that most maternal deaths are preventable since medical professionals and others are well aware of what is needed to prevent or manage the complications that result in death. The WHO has a point.
In Guyana, the incidence of maternal mortality has moved from 231 per 100,000 live births in 2000 to 169 in 2017. But the families of women like Akeisha Richardson, Alexis Syfox, Vanessa Amsterdam, Nikacia Allen and Liloutie Khamis and others who died during or after childbirth post 2000 would fail to see this as an accomplishment as would many other right-thinking folks. So too would the family and relatives of Karen Reid who died in June this year, along with her baby.
Ms Reid was 40 years old, pregnant with her sixth child and had high blood pressure. She definitely had what the WHO referred to as complications, but they could have been managed and therefore Ms Reid’s death was preventable. Based on the information this newspaper received from her relatives, Ms Reid was given one or more doses of Cytotec (misoprostol) after being admitted to the New Amsterdam Hospital with high blood pressure. Cytotec has been linked to several maternal mortalities in Guyana over the years but is still being used.
A paper published in the Journal of Perinatal Education, states, “the off-label use of Cytotec (misoprostol) to induce labor and soften the cervix is an excellent example of an unnecessary intervention that is not supported by research”. According to the paper, “The Freedom to Birth—The Use of Cytotec to Induce Labor: A Non-Evidence-Based Intervention”, the original manufacturer of Cytotec had publicly warned against its use in obstetrics and gynaecology. It warned that the possible side effects of the medication included “hyperstimulation of the uterus, uterine rupture, fetal bradycardia, amniotic fluid embolism, death of the mother, and death of the child”.
However, the American College of Obstetricians and Gynecologists, which had already widely recommended widespread use of Cytotec to induce labour, openly disagreed with the manufacturer, stating that the drug was effective, but perhaps more studies needed to be done as the problems seemed to occur mainly when high dosages were administered. The same journal carried the report of a study done on 276 women, which deemed Cytotec to be “safe”, although noting that it is not approved by the Food and Drug Administration for this purpose.
It would appear that Cytotec works well some of the time and at other times it causes death. There could be varying reasons for this, including if the pregnant woman it is being administered to has an underlying condition. A study conducted on 276 women some years ago cannot count as an effective way to determine the true efficacy of Cytotec. Therefore, every time a health care professional administers it to induce labour, he or she is basically playing eenie meenie miney mo with the lives of that woman and her unborn child.
Why is Cytotec still being used? Well one of the reasons is that it is very cheap. In the US, the tablet cost around 50 cents each when purchased in a pharmacy with the use of a prescription for its original purpose, which is to treat Duodenal Ulcer. When sold as part of what is termed an ‘abortion kit’, the price goes up. Hospitals buying misoprostol in bulk are bound to be paying just a fraction of that cost, which they no doubt mark-up significantly when used on patients. Obviously, the low cost of the drug is a huge determining factor in its continued use in low income countries as well. The underlying factor is that it is more about the money and less about caring, really caring for people’s health.
Meanwhile, we should laud the fact that Guyana has been doing some spending on health facilities. In July, the Yvonne Jacobus Maternity Waiting Home in Annai, Region Nine, which was built at a cost of $17 million, was officially commissioned. According to the Department of Public Information (DPI), it can house seven mothers at a time. And just last month, the $3 million renovation of the Skeldon Hospital Maternity Ward was completed. This upgrade was done by way of a public-private partnership between the Public Health Ministry, the Florida-Guyana Hope Incor-porated and Guyana-Florida Hope Incorporated. In addition, the Maternity Unit of the Georgetown Public Hospital Corporation will soon benefit from a $50 million expansion that will increase bed capacity among other things.
It must be noted, however, that none of this spending will equate to fewer maternal deaths without the concomitant patient care. The illegal use of Cytotec is far from the only issue. Many women have also experienced mistreatment during childbirth, including physical and verbal abuse, discrimination and procedures to which they do not consent but endure because they have no choice. If there is to be a reduction in maternal deaths, there must also be more emphasis on the care in healthcare.
