Despite increased access to health care, maternal health risks are rising.
Guyana has had a national action plan to address maternal health risks for many years now. The focus has been on increasing access to trained professionals throughout the country. This plan has included building schools and hospitals, and training health care professionals abroad. Unfortunately, despite these efforts, maternal health risks have increased and rather then achieving a reduction in maternal mortality rates, they have actually been increasing since 1995 (Government of Guyana, 2010 Guyana CEDAW, 12 August 2010, 9 September 2012) 49, 50). There are relatively few pregnancies in this country, so single-year trends are not reliable, but since 1990 the adjusted maternal mortality rates (in five year increments) have increased from about 150 deaths per 100,000 births to about 250 in 2010 (WHO).
Guyana is a small country on the northern South American coast. It is actually considered to be part of the Caribbean. The country achieved independence in 1966 from the UK. While there have been some regional border disputes, external disputes have been minimal. Domestically, the political world is dominated by two parties which represent the two largest ethnicities. Power sharing has not been common and frequent violent disputes often arise around elections. Combined with an export-based economy of primary goods, the country is highly susceptible to market fluctuations. These political and economic conditions have resulted in a high debt burden which limits the country’s ability to invest in local infrastructure to provide even basic services such as road, sanitary water and electricity to many areas of the country ( ).
These conditions exacerbate the already difficult situation for women’s health care. While the country theoretically grants health care to all its citizens, access to quality and timely care is still highly variable. Technically, over 90% of all births are attended by a skilled healthcare practitioner ( ). However, it has been noted that there have been cases of severe bleeding after childbirth and hypertensive disorders resulting in maternal deaths becuse family members’ complaints about lack of prompt attention were ignored by nurses (United States Department of State, Country Report on Human Rights, accessed 6 February 2013, 14.0).
Under the Maternal Mortality Reduction Strategic Plan for the most recent period, state officials expected that the maternal mortality rate would be lowered to fewer than 100 deaths for every 100,000 live births. This estimate was based on an expansion of the Reproductive Health Care Programme, which has been implemented through the Ministry of Health’s Maternal and Child Health Department in partnership with the Guyana Responsible Parenthood Association and the Guyana HIV/AIDS Reduction Programme (GHARP). This program provided training in gynecology, with an aim to reduce risks and improve safe deliveries both in urban and rural areas, as well as counseling in family planning and contraceptive use (Government of Guyana, 2010 Guyana CEDAW, 12 August 2010, 9 September 2012 49, 50). We applaud them for their efforts but encourage the government and aid agencies to consider the additional factors contributing to poor maternal health outcomes which are not related to access alone.