Sowing the Seeds of Safe Motherhood in Sub-Saharan Africa

In most areas of Sub Saharan Africa, it is expensive, dangerous, and unsafe to give birth especially when pregnancy is complicated by life threatening conditions. Safe caesarean section has a key role to play in making childbearing safer, but it costs around $300 or more, and in a continent where most people live on less than $1 per day, this is simply unaffordable to most households. Worse still, many cannot afford even the user fees charged. Additionally the public healthcare systems are run down and understaffed, often with demoralised, underpaid and poorly motivated workers, who often have to moonlight in order to supplement their wages. Poverty and inadequacies in existing healthcare services and public utilities are however not the only factors undermining safe motherhood in Africa. Governance structures are also weak and life for most people is harsh and chaotic. Religious doctrines, harmful cultural beliefs, and lack of education often reinforce women's inferior status, and the neglect that follows, especially during pregnancy, labour and puerperium combine to produce the appalling health statistics common in Sub-Saharan Africa today. For instance maternal deaths per 100,000 deliveries are close to 900, and for every 1000 children born, 100 die during the first week, and 130 weigh less than 2.5 kg at birth. Kelsey Harrison worked and researched on these issues for close to four decades and during that period published extensively in many of the most highly regarded peer-reviewed journals in medicine. This book is a selection of some of his publications in such journals as The Lancet, British Journal of Obstetrics and Gynaecology, British Medical Journal, Clinical Science and Journal of the Royal Society of Medicine between 1966 and 2010. Included in this volume is the groundbreaking Zaria Maternity Survey, which he initiated and whose results and recommendations are now being gradually accepted globally as the model for enhancing maternal health in Sub-Saharan Africa.