5455J6DQ

55-J-6-2

Maternal Mortality: The Case of Mama Sessay

The video titled “Dying to Give Birth: One Woman’s Tale of Maternal Mortality” showcases the censorious risks women face during childbirth in Sierra Leone; especially, when considering one out every eight women face a lifetime risk of dying during childbirth (Time, 2016). The latter was the fate of the documentary's main subject Mama Sessay, an 18-year-old girl who lost her life shortly after giving birth to twins; specifically, during the delivery of the second baby. While many components factored into Mama Sessay’s demise this paper will focus on the three groups of factors (Three Delays Model) stopping her from accessing maternal care, as well as the core determinants of health contributing to her delay in seeking care.

Three Delays Model

To best understand how the three delays, apply to Mama Sessay’s case, it important to first outline the notable delays, which include

1. Delay in decision to seek care due to;

· The low status of women

· Poor understanding of complications and risk factors in pregnancy and when to seek medical help

· Previous poor experience of health care

· Acceptance of maternal death

· Financial implications

2. Delay in reaching care due to;

· Distance to health centers and hospitals

· Availability of and cost of transportation

· Poor roads and infrastructure

· Geography e.g. mountainous terrain, rivers

3. Delay in receiving adequate health care due to;

· Poor facilities and lack of medical supplies

· Inadequately trained and poorly motivated medical staff

· Inadequate referral systems. (Maternity Worldwide, 2018, para, 2)

Scenario Specific Delays

Considering Sierra Leone’s maternal mortality statistics, we can deduce Mama Sessay odds for a successful delivery were not favorable; however, when taking into account the elements of delays, her odds were further reduced. Notably, Mama Sessay was forced to marry at the age of 14 and four short years found herself giving birth to twins. Thus, her age and limited educations suggest the first model delay resulted from “a poor understanding of complications and risk factors in pregnancy and when to seek medical help” (Maternity Worldwide, 2018, para, 2). Next, Mama Sessay lived in a small village; thus, we can deduce distance to health centers and hospitals, availability of and cost of transportation, poor roads and infrastructure, and geography (e.g. mountainous terrain, rivers) were factors associated with the second model delay (Maternity Worldwide, 2018). Lastly, the third model delay is attributed to poor facilities, lack of medical supplies, inadequately trained and poorly motivated medical staff, and an inadequate referral system (Maternity Worldwide, 2018).

Subsequently, when Mama Sessay began to experience delivery complications she faced insurmountable odds when considering the correlating delays. Two notable delays leading to her demise include the time lost in transportation to a delivery center and the delay resulting from an inadequately trained medical staff, as well as a physician shortage. These delays are significant given if absent Mama Sessay would most likely have survived. With that stated, it’s important to examine the core determinants of health (social, economic, and environmental factors) contributing to the identified delays.

Core Determinants of Health

The core determinants of health at play in Mama Sessay’s case include low status/forced marriage (element of culture), income (poverty), education, lack of health services, gender, genetics (coping skills), policies (accelerated medical care, infrastructure) and environmental issues, which negated fast and efficient transportation during her crises (World Health Organization, 2018). Notably, the Sierra Leone Civil War (1991-2002); literally, wiped out 1,270 primary schools; thus, eliminating educational opportunities for 67 percent of all school-aged children (Ozisik, 2015). Subsequently, when taking into account Mama Sessay’s age, we can safely infer her educational experience was disrupted due to the Civil War, thereby, leaving her with a limited understanding of both the complications and risks associated with pregnancy.

Policy Recommendations

Although unlikely, its highly advised the government implant policies that address the cultural acceptance of forced marriages, thereby, granting females the autonomy and authority to take charge of their sexual and reproductive health. Important to note, autonomy plays an integral role in the determinants of health when considering it impacts education, which is closely tied to employment and income opportunities. Therefore, in its absence, women are not afforded the opportunity to improve their well-being and circumstances, which impacts their health. Until this issue is addressed women within the region will remain at significant risk of maternal mortality. Additional recommendations include policies that afford ease of transportation in efforts to grant access to well-trained and staffed medical facilities, as well as referral policies to address issues associated with advanced care. The latter policy, if in force may very well have saved the life of Mama Sessay. Lastly, in areas far removed from medical facilities, policies that placed trained midwives in remote villages would significantly improve the maternal mortality rates given they could identify concerns the warranted advanced care. Subsequently, the implementation of said policies would unquestionably remedy some of the specific delays identified.

References

Maternity Worldwide. (2018). The Three Delays Model and our integrated approach. Retrieved from https://www.maternityworldwide.org/what-we-do/three-delays-model/

Ozisik, S. (2015). Education in Sierra Leone. Retrieved from https://borgenproject.org/education-sierra-leone/

Time. (2016). “Dying to Give Birth: One Woman’s Tale of Maternal Mortality” [Video File]. https://www.youtube.com/watch?v=c010XcmBBEQ

World Health Organization, (2018). The determinants of health. Retrieved from http://www.who.int/hia/evidence/doh/en/