Making motherhood safe in the West Bank, occupied Palestinian territory

Abstract

Objective: To determine causes of death among women of reproductive age; to determine MMR; to review death notification and registration procedures, and to examine the fate and status of under-5 motherless orphans in the West Bank.

Methods: All reported deaths (n= 431) of women 15-49 years old during 2000-2001 in the West Bank area of OPT were investigated. Data were collected from official agencies and through interviewing the deceased women s relatives using the verbal autopsy approach in all 10 West Bank districts over a period between January 2000 until June 2002. Data on circumstantial events related to death and causes of death were analysed. An avoidability analysis of maternal deaths was performed, and deaths were classified as unavoidable, preventable and treatable. Motherless under-5 orphans were investigated after an average of three years following their mothers deaths by interviewing custodians/ caretakers. Orphans weight and height were measured; wasting and stunting rates were calculated and analyzed. The quality of death notification sheets and timeliness of death notification and registration was assessed and analysed.

Results: The overall reproductive-age mortality rate ranged between 45 and 48 per 100,000 women. Malignant and circulatory system diseases were the most common causes of women s reproductive age deaths while 8% were pregnancy related. MMR in the West Bank was calculated at around 29-36 deaths per 100,000 live births. Cardiovascular diseases and haemorrhage were the most common causes of maternal death and 69% of these were classified as avoidable. The reproductive death rate among single never-married women was 39 per 100,000 single women, and at time of death, 41% were under 25 years. Violent deaths and suicide among single women was almost twice as high as among married women. With the exception of three neonatal deaths, all motherless orphans traced were alive after about 3 years following their mothers death. Anthropometric measurement of the orphans revealed that 8.8% and 17.6% of under-5 orphans were wasted and stunted, respectively, and all malnourished orphans were girls. Death notification sheets were incomplete in 78% of cases, and notification and registration of 36% of deaths were significantly delayed.

Conclusion: The majority of maternal deaths were avoidable. Substandard care and misclassification of maternal deaths remain significant problems with negative repercussions on efforts to reduce maternal mortality. More qualitative research into critical issues of single women s status in Palestinian society focussing on health care-seeking patterns and barriers to appropriate reproductive and other health care should be considered. The higher proportion of violent deaths and suicide among the deceased single women is a serious indication of their vulnerability. Close monitoring and support to the motherless orphans health and nutritional status with a special emphasis on orphan girls should be ensured. Death notification and registration procedures need to be critically reviewed.