Fact: The national rate for stillbirths is a disgrace
Holding my newborn babies and watching them take their first breaths, the oxygen transforming them from ash-grey to golden-pink, are among my most treasured memories.
I cannot imagine the pain of giving birth to a dead baby ‘ as many mothers at Frere Hospital did last year.
Unfortunately, their pain has become a political football in the hands of politicians ever since the high rate of stillbirths at the hospital was reported in the Daily Dispatch a few weeks back.
Writing in his weekly online ‘letter from the president’, President Thabo Mbeki says that the newspaper’s story is ‘false’. He accuses the Dispatch and the Democratic Alliance of being ‘post-modernists’ whose version of reality does not correspond to ‘the facts’.
Instead, says Mbeki, in a roundabout way while quoting Charles Dickens and discussing the ‘facts’ about mini-skirts, ‘members of the ANC, such as the Minister of Health, remain committed to the discovery of Facts ‘ truths that corresponds (sic) with reality’.
I’m not sure where ANC member and Deputy Health Minister Nozizwe Madlala-Routledge, who describe the situation at Frere as a ‘national emergency’, fits into this.
However, most politicians are renowned for torturing ‘facts’ until they ‘confess’ to whatever suits their political agenda. So what are the ‘facts’?
Mbeki relies for his Frere ‘facts’ on a set of statistics compiled by an as-yet-unpublished report by the Medical Research Council called ‘The Saving Babies Report’.
The figures he quotes are for ‘perinatal mortality’, which is the number of babies born dead in the last trimester of pregnancy (stillbirths) and who die within the first seven days of life per 1000 deliveries and ‘neonatal mortality’, which is the number of babies per 1000 who die within the first 28 days of life.
The Dispatch articles report only on stillbirths and do not talk about rates but absolute numbers. The paper relies for its ‘facts’ on a primary source – the actual Abortions and Stillbirths book at Frere Hospital.
‘We got access to the book where stillbirths and abortions are recorded in the ward and stripped out the abortions, which were clearly marked. That left 199 stillbirths,’ says Daily Dispatch editor Phylicia Oppelt.
Mbeki’s figures on Frere show that its perinatal mortality rate last year was 34.5 dead babies per 1 000 births. He doesn’t distinguish between stillbirths and babies who died within a week.
According to this perinatal mortality rate, if the hospital delivered 6 000 babies last year, 207 of these would have been born dead or died within the first week. It is thus entirely conceivable that there were 199 stillbirths, as the Daily Dispatch reported.
But then Mbeki tries to normalise the sad situation at Frere, by saying: ‘The facts communicate the conclusion that neonatal mortality at Frere Hospital is not significantly different from the national incidence of such mortality’.
The Dispatch wasn’t reporting on ‘neonatal deaths’ but on stillbirths ‘ a figure that is lower than the neonatal death rate.
A high stillbirth rate is often an indication of poor healthcare when problems in pregnancy are not picked up at antenatal check-ups or mothers-to-be are not attended to fast enough in labour when their babies are in foetal distress. The stillbirth risk also increases significantly when a mother is HIV positive.
However, it is true that the perinatal mortality rate that Mbeki quotes for Frere as ‘fact’ of 34.5 dead babies per 1000 births is close to the 2005/6 national average of 34.
But it is not clear whether this statistic is ‘fact’ as it jars with the perinatal mortality rate reported from Amatole, the district that Frere Hospital falls under.
According to the District Health Barometer, using figures compiled from the district health facilities themselves, Amatole’s perinatal mortality rate for 2005/6 was 41.3 per 1000 births. Its stillbirth rate was 31.7
Frere Hospital is one of two regional hospitals in the district. Complicated labours would be referred to it from district hospitals and clinics, making it likely that its perinatal mortality rate would be higher than the district average.
Amatole had the 12th worst perinatal mortality rate out of the country’s 53 districts and the 11th worst stillbirth rate, so it was far from ‘normal’.
In addition, the district’s stillbirth rate has increased substantially from 2003/4 when it was 26.1 while the perinatal rate has increased marginally from 40 to 41.3.
But even if the figure quoted by Mbeki as fact is accurate for Frere, is a national average of 34 perinatal deaths per 1000 acceptable?
A study of the stillbirth rates of 190 countries published last year in the Lancet found the average stillbirth rate for developing countries to be 25.5 deaths per 1000 births and 5.3 in developed countries for the year 2000.
‘The deaths of most of these babies are avoidable, as evidenced by the low stillbirth rates of four per 1000 total births seen in rich countries relative to stillbirth rates of 40 per 1000 or higher seen in countries with the weakest health systems,’ concludes the Lancet.
The health system in the Eastern Cape health has long been a worry, with its six districts consistently among the worst performing in the country, according to the Barometer.
The Dispatch articles prompted the Department of Health to offer suggestions to improve operations at Frere and that is a good outcome.
How much better it would have been if our country’s leaders could have acknowledged the pain of the parents who have lost their children and committed themselves to radically reducing the disgracefully high national ‘norms’ of stillbirths, perinatal and neonatal deaths. ‘ Health-e News Service.
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