At Risk – Women And Children! by Shireen Sedres (featured in latest edition of Chalkline)

Despite excellent maternal and child health policies in South Africa, implementation is weak and South Africa is only one of a few countries in the world where mortality in the under-5 year age group is increasing, says USAID on its website.
The challenges we face in South Africa are enormous: Most young South Africans living with HIV and Aids are female and young South Africans are beset with a high rate of adolescent pregnancy, as well as high prevalence of HIV and sexually transmitted infection (STI).
“Women’s Health is one of the priorities of the Western Cape department of Health and maternal health is part thereof,” says Faiza Steyn, Director: Communications at the Western Cape department of Health.
“The service and skills level at our Western Cape Midwife Obstetrics units and clinics compare fair to national and international standards and as much as possible practical advice is shared with all patients.”
The department believes that the various health care needs of pregnant woman should be addressed to ensure a healthy outcome for both mother and baby. “Among others we focus on diagnosing the pregnancy and providing good antenatal care, i.e. good medical and general history taking; risk screening and referral to appropriate level of care; performing relevant screening tests; assessing maternal and foetal condition at each visit and follow up visits as “per level of care where the patient will be managed.”
“We also address further contraceptive needs, discuss maternal and infant feeding, provide general health education about pregnancy and provide care during the labour process and postnatal period.”
Steyn explains that the department routinely performs an enquiry into all maternal and perinatal deaths as part of the national confidential enquiry into maternal deaths irrespective of the cause of the death. “This is part of a national process with the aim of reducing maternal and perinatal deaths.”
“At a facility level morbidity and mortality review meetings are held where maternal and perinatal deaths are audited, discussed and corrective actions taken. This is all part of a national confidential process and no details relating to cases can be shared, unfortunately.”
Steyn adds that although it is not mandatory for nursing staff at the units and clinics to complete continuous learning and training, all are encouraged to do so and in-service training is continually arranged on topics related to midwifery.
There is a special focus on HIV/Aids at these units and clinics and it is addressed in the initial screening process of patients. “Counselling and testing is done and patients are managed accordingly and appropriate health/lifestyle education is given,” says Steyn.
Another serious health reality in the Western Cape is the prevalence of Foetal Alcohol Syndrome (FAS). “As part of the history taking and initial screening done on pregnant women, information is taken around alcohol use and then appropriately counselled.
“Various clinics in the high-risk areas have health education programmes around FAS and some districts have forged partnerships with relevant NGOs and researchers to implement intervention programmes focusing on prevention of FAS.”
Steyn says the Western Cape department of health continuously focuses energies and resources on new initiatives to set the province apart from the rest of the country.
“In this vein we are proud of the Prevention of Mother-to-Child Transmission (PMTCT) programme and the policy on comprehensive management of survivors of rape and sexual assault,” she concludes.