AFJOG

Non-pregnancy-related infections 31 55.23 18.59 35.2 Medical and surgical disorders 17.68 18.7 14.46 17 Unknown 7.05 5.22 5.47 5.9 iMMR for all maternal deaths 115.62 146.59 100.09 121 To address the Saving Mothers’ Report findings (including the above key findings), recommendations are implemented towards assisting all the relevant stakeholders at all levels of care and governance (including national, provincial, districts, subdistricts, and facilities down to the lowest level of care) in engaging processes of action towards the reduction of the maternal mortality to SDG target of at least 70 maternal deaths per 100 000 livebirths by 2030. The following crucial recommendations were made with the assumption that every site conduct morbidity and mortality review meetings, which are minuted, actions are assigned to key individuals, and the inclusion of accountability. These recommendations include (but are not limited to) issues relating to the health system, clinical skills, and skills development: Health Systems • There’s a need for the prioritization of maternal and neonatal health services irrespective of the existing parallel programs through: I. Political commitment by NDOH & provincial departments of health in line with the International Maternal Neonatal Health Conference (IMNHC) declaration. (Commitment to SDG of achieving MMR of 70/100 000 live births by 2030 and promotion of respectful, dignified care for women in maternity services) II. Members of the Executive Councils (MECs) resuscitating and ensuring that the non-negotiables/ signal functions for MCWH are in place and function properly, ensuring that all equipment, medicines, and other consumables required to implement the maternal and newborn package of care are in place in all health facilities and service points, and to provide feedback to the Ministry quarterly. III. Financial Investment- the funding for maternal and neonatal health (MNH) services towards the top five leading causes of maternal and neonatal mortalities must be ring-fenced. IV. Heads of Provincial Health Departments to ensure the NCCEMD process functions in each province, and mandatory and accurate are data submitted timeously (Health workforce and information systems) V. Provincial leadership to ensure integration of services (HIV, COVID-19, etc.), regular monitoring and evaluating the progress of implementing recommendations and progress towards the SDG (Evaluation and monitoring) VI. Strengthen lines of communications at all levels of care [Support the frontline healthcare workers- Provincial down to the lowest levels of care (HODs & MECs to visit institutions and engage with clinicians and patients on their daily challenges)], VII. Ensure functional communication channels exist for consultation with and referral to higher levels of care -Easy access (inter- and intra-facility) by the community. VIII. Establish on-site midwife birthing units (OMBUs) at all large district, regional, and tertiary hospitals (conducting large numbers of births for women with no identifiable risk factors). Clinical and Training Focus on the top five leading causes, (5 Hs): (NB: These apply to all with more emphasis on leading causes) I. Institutionalise pandemic lessons about maintaining MNH and sexual and reproductive health services during humanitarian situations. Integration of COVID-19 services into maternity and neonatal health services II. Contraception services need to expand to include postpartum long acting reversible contraceptives (LARCs) (especially intra-uterine device insertion) and ensuring contraceptive availability at all facilities caring for women and at high-risk medical clinics III. Antenatal care must be restructured to ensure every problem case is reviewed on-site prior to referral by the most experienced midwife, and all pregnancies reviewed by the most experienced and knowledgeable midwife at least once between 28-34 weeks gestation. IV. Clinical examination skills during antenatal, intrapartum, and postpartum care (medical obstetric clinics) V. Before discharge from a ward and facility, specific criteria must be met and documented. Community involvement Noneof theavailable interventionswill achieveameaningful reduction in maternal deaths without partnering and involvement of the target communities. Involving and partnering with communities will ensure dissemination and acceptance of health promotion messages, raise awareness regarding the importance of antenatal care, institutional deliveries, danger signs and timeous seeking of medical assistance during an emergency. Engaging community leaders (traditional, religious, etc) and male members of the communities will also facilitate reduction of cultural and gender healthcare access related barriers. The above strategies should be further reinforced by improving access to emergency transport systems at community level, advocating for healthcare infrastructure, including both personnel, equipment and physical infrastructure. This AFJOG edition highlights the in-depth analysis of some of the leading causes and emerging issues of concern of maternal mortality. These include obstetric haemorrhage, pregnancy related sepsis with a special focus on bowel injury at caesarean delivery, medical and surgical conditions (with a special emphasis on cardiac diseases), and the previously rare acute collapse, including embolism now on the rise. Conclusion While maternal deaths have been on the decline globally, low and middle income countries, including South Africa, has an enormous task ahead in order to achieve the 2030 SDGs by targeting maternal deaths due to preventable pregnancy-related complications and establishing strong community partnerships. EDITORIAL African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 02