Factors Contributing to Maternal Mortality, the Neglected Tragedy in the Post - Conflict Transition:

Abstract

Despite the significant effort in reducing maternal mortality by improving maternal health, the effective implementation of the reproductive health services remains a challenge in South Sudan. Thousands of women are dying all over the world especially in developing countries from preventable pregnancy related deaths. In South Sudan the maternal mortality ratio is estimated at 2,030 per 100,000 live births and in Twic County, there is limited information to determine the wider scale and the burden of maternal mortality. The maternal mortality situation remains a burden and the main cause remains unclear. This gap necessitated this study in Twic County. This was a cross sectional study conducted to find out the factors contributing to maternal mortality in Twic County. The specific objectives of the study were: To determine the socio- cultural factors affecting the health seeking behaviors of pregnant women in Twic County. To find out the prevalence of non-institutional maternal mortality during pregnancy and child birth in Twic County, to examine the cause of death among women of child bearing age of Twic County and to establish the relationship between ANC attendance and maternal mortality. The study was conducted covering Twic County using the SMART Methodology (24x16) and from the 204,905, 384 participants were selected using the most conservative estimation as contended by Amin (2005: 259). The results showed, maternal mortality is high in Twic County. Cultural beliefs about pregnancy and child birth were found to be the main factors contributing to maternal death. 72% of the pregnant women receive local treatment at home and most of that treatment about 53.4% is being provided by the traditional healers. 50% of pregnant women in the community believed elderly women were the only decision makers and consider them to be experts in issues related to pregnancy and child birth. When a comparison was made for maternal mortality during pregnancy, delivery and immediately after delivery, 28.9% of the women died during pregnancy. Most of the death occurred at home and majority of the women who died were between the ages of 15-25 years. The association between ANC attendance and maternal mortality was that women who did not attend antenatal care were 5.5 times more likely to die during pregnancy and child birth compared to 3.5 times among women who had attended antenatal care services (95% CI 3.5- 5.5, P<0.001) which is statistically significant. Evidence showed that majority of the women who attended Antenatal Care, 50% attended only once. It was found out that there were many cultural beliefs associated with pregnancy and child birth affecting the health seeking behaviours of pregnant women especially on maternal care services in Twic County. It was recommended that men and the community leaders should address the cultural beliefs affecting the health seeking behavior of pregnant women mainly through being more involved in issues related to pregnancy and child birth instead of leaving the decision making to the elderly women. This should also involve community leaders and the local authority to formulate regulations that would seek to abolish cultural practices that contributed to the death of pregnant women in Twic County.