Paige Munger
Women’s Health in Chad
From: Secretary of Health, Chad
To: Minister of Finance, Chad
Introduction
Maternal mortality is one of Chad’s most pressing issues. Chad’s maternal
mortality ratio is 1,200 per 100,000 live births, the third highest in the worldi.
Adolescents and poor, uneducated women located in rural areas are the most affected.
The extremely high maternal mortality ratio stems from low socioeconomic status,
anemia, rural living, lack of education, high fertility and lack of access to family planning
and quality obstetric care. The deaths of women from pregnancy complications and the
subsequent poor health or death of their newborns are a waste of a vital economic and
social resource in Chad. There are a number of low-cost, highly effective measures that
can be taken in order to drastically reduce these obstacles to Chad’s development. The
delivery of iron supplements to pregnant women, the training of women to become
contraceptive providers within their communities, and the implementation of a three-part
system designed to address the three delays faced in delivery, would effectively reduce
Chad’s maternal mortality ratio.
Nature and Magnitude of the Problem
Chad’s maternal mortality ratio is the third highest in the world. An estimated
1,200 women die per every 100,000 live births in Chadii. A woman’s lifetime risk of
maternal death is 1 in 14iii. The leading causes of maternal mortality in Chad are postpartum hemorrhage, infection, eclampsia and obstructed laboriv.
Affected Populations
Maternal health issues primarily affect poor, uneducated adolescents living in
rural areas. This problem is compounded by three demographic facts. First, the
adolescent fertility rate in Chad is high. One hundred and eighty births are reported per
one thousand women aged 15-19 yearsv. Adolescents face a higher risk of maternal
mortality in general because they may not be fully developed. Second, an estimated 81%
of all births in Chad take place in rural areasvi. Third, 80% of the population is below the
poverty line in Chadvii, making maternal mortality one of the most extensive and severe
problems that Chad faces today.
Risk Factors
The primary risk factors for poor maternal health in Chad are poverty, anemia,
rural living, high fertility rates, lack of education and poor access to family planning and
quality obstetric care. Women who are anemic are at much higher risk of suffering from
postpartum hemorrhage, and over 1/3 of women in Chad are anemicviii. In addition, the
fertility rate in Chad is very high. The average woman in Chad will give birth 6.3 timesix,
and with every birth, a woman increases her risk of maternal mortality. This high fertility
rate is due in part to a desire for large families in Chad, and in part to a lack of family
planning. The contraceptive prevalence rate in Chad is only 2.8%x. Many poor,
uneducated women lack the financial resources, knowledge or empowerment to access
and use contraceptives.
In addition, poor uneducated women in rural areas are more likely to suffer from
three major delays that contribute to maternal mortality. First, these women are less likely
to have a skilled attendant at delivery. Only 16% of all women in Chad have a skilled
birth attendant at delivery, and in rural areas only 7.3% of women have onexi. The lack of
a skilled birth attendant can lead to a failure or delay in identifying a pregnancy
complication. Even when a complication has been identified, poor rural women are more
likely to suffer from a delay in transport to a proper emergency facility. This is due to
their lack of financial resources to pay for transport and the distance of emergency
facilities from rural areas. Once at an appropriate medical facility, poor quality of care or
difficulty paying for emergency care can lead to the third delay: receiving proper
emergency obstetric care. These three delays are often fatal.
Economic and Social Consequences
The unnecessary deaths of women from maternal health issues and subsequent
likely illness or death of their newborns are a waste of a vital social and economic
resource. Women are often the primary caretakers in a household, and every mother that
dies is not only a loss to the work force but will also negatively impact the well being of
her entire family. The child that is born to the deceased will be particularly likely to
suffer. He or she will be likely to be malnourished, to fall ill and to die young. Thus,
another economic resource will be wasted unnecessarily.
Priority Action Steps
There are a number of low-cost, highly effective measures that can be taken to
avoid the unnecessary losses to Chad’s economic and social development caused by its
high maternal mortality ratio. First, the distribution of iron supplements to women,
especially pregnant women as a routine part of pre-natal care, would work to decrease the
prevalence of post partum hemorrhaging for very little cost. Second, working to spread
knowledge of and access to low-cost contraceptives would work to decrease the fertility
rate among women in Chad. This would be achieved through training young married
women to be outreach workers within their communities. These workers would visit the
homes of other women in their communities to teach about contraception and offer
contraceptive services.
Addressing the three delays (delay in seeking appropriate obstetric care, delay in
transport to an appropriate facility and delay in receiving appropriate emergency obstetric
care at a referral facility) will drastically reduce the maternal mortality ratio in Chad. The
delay in seeking appropriate obstetric care can be addressed through training midwives to
identify pregnancy complications within their communities. The delay in transportation
to an appropriate facility can be addressed through an ambulance system designed to
reach rural areas. The ambulances would be free for poor women but would require a fee
from wealthy patients to finance the system. Finally, the third delay can be addressed
through the establishment of health clinics within close reach of rural areas that are
required to have a properly trained obstetrician and anesthesiologist available 24 hours a
day.
Bibliography
i
“Maternal Mortality Ratio.” The World Bank. http://data.worldbank.org/indicator/SH.STA.MMRT
ii
“Maternal Mortality Ratio.” The World Bank.
iii
Chad: Country Statistics. “UNICEF.” http://www.unicef.org/infobycountry/chad_statistics.html
“Maternal Mortality.” World Health Organization Department of Making Pregnancy Safer.
http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/
iv
“Reproductive Health at a Glance: Chad.” The World Bank. http://wwwwds.worldbank.org/external/default/main?pagePK=64193027&piPK=64187937&theSitePK=5
v
“Chad: Country Profile.” World Health Organization.
http://www.who.int/making_pregnancy_safer/countries/en/index.html
vi
“Chad.” CIA World Factbook. https://www.cia.gov/library/publications/the-world-factbook/geos/cd.html
vii
“Chad: Nutrition Country Profile.” Food and Agricultural Association.
http://www.fao.org/ag/AGN/nutrition/TCD_en.stm
viii
ix
“Reproductive Health at a Glance: Chad.” The World Bank.
x
Reproductive Health at a Glance: Chad.” The World Bank.
xi
“Chad: Country Profile.” World Health Organization.