High risk pregnancies on the rise in Mali

Pregnancies among girls as young as 12 and women in their early 40s are on the rise in Mali’s rural north, according to health workers, who say cultural mores and economic pressures contribute to the potentially life-threatening pregnancies, which often go untreated due to scant health services.

Bana Nimaga is a midwife at the Bankass health centre – 700km east of the capital Bamako – which sees the most complicated pregnancies from surrounding villages. Most of her patients have never been to a health centre, she told IRIN.

“They arrive to me in a complete state of catastrophe, so tired and worn down at the end of their pregnancy. You find the infant is on the edge of survival. [In these cases], the only legacy women leave for this world are stillborn babies.”

The director of Koulogo health centre almost 40km away, Ousmane Fomba, told IRIN that he has referred “more and more” high-risk pregnancies in these age groups to Bankass. “It is not uncommon to see 35- and 40-year-old women or 12- and 13-year-old girls pregnant.” He said that as more girls travel to work in Bamako or in neighbouring Côte d’Ivoire, early pregnancies have increased.

“And the mature expectant mothers tell us that they do not feel they can say no their husbands who demand intercourse or children,” he said. The medical director said though the centre offers family planning education, “old mentalities endure.”

In 2006 119 babies of every 1,000 live births died by age one, and more than 900 women died for every 100,000 live births in 2005, according to the government. Though the maternal mortality rate decreased by almost half in 2006, lack of access to clean water and health care still put the country in “a state of health emergency” according to the UN Children’s Fund (UNICEF).

According to a government survey, almost one in 10 newborns in 2006 did not live beyond their first year. Half of those deaths occurred during the first week of life. Fewer than half of women who gave birth did so with a trained birthing attendant and 70 percent of infant deaths happened in the home, according to the same survey in 2006.

Even for women who give birth in a health centre the situation is not much better, said the head of the Bankass referral centre, Mamadou Guindo, who told IRIN the health centre does not deserve its designation. “We do not have inpatient facilities or electricity. The only generator we have does not provide enough energy. We do not have enough [medical] materials or anaesthesiologists.”

He said the centre often must refer patients to the hospital in Mopti more than 100km away.



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