WOMEN are being encouraged to practise proper pre-conception care in an effort to reduce the country’s maternal mortality rate, especially deaths caused by factors that are largely preventable.

The leading risk factors of maternal deaths in Jamaica, according to reproductive health epidemiologist at The University of the West Indies, Mona, Professor Affette McCaw-Binns, are advanced maternal age, having children over the age of 35; high parity – having five or more children; and obesity.

She said, too, that the main causes of maternal deaths are pregnancy-related hypertension, obstetric haemorrhage, unsafe abortion and heart disease or stroke — the majority of which point to lifestyle-related diseases.

While speaking to reporters and editors at the Jamaica Observer Monday Exchange this week, McCaw-Binns further revealed that one in every two pregnant women entering antenatal clinics locally is obese.

As a result, as part of a local project funded by the European Union, which forms one component of the Programme for the Reduction of Maternal and Child Mortality (PROMAC), McCaw-Binns is encouraging women to have their health evaluated before becoming pregnant.

The project, Partnership for the Promotion of Patients’ Rights in Maternal, Neonatal and Infant Health in Jamaica, aims to build the capacity of civil society to advocate better maternal and child health outcomes, enhance public participation in health care policy planning and monitoring, while advancing the human rights approach in the delivery of care to mothers and children.

“When you are contemplating having a child, you need to go and see your health provider and get evaluated. If you are overweight, maybe you need to work on improving your cardiovascular fitness. You may not be able to lose the weight but if you are exercising and you get your heart functioning properly by getting some exercise, you will be able to tolerate some of the challenges,” said McCaw-Binns.

She added: “Get your heart checked out because you may have some nascent problems. Half of the cardiovascular deaths we have seen are women that had rheumatic fever as children and they have rheumatic heart disease and valvular problems that were never a problem until they became pregnant. Get your health evaluated.”

The reproductive health epidemiologist said one troublesome condition often overlooked is diabetes, which is in tandem with obesity.

“There was a year we were having a lot of deaths from diabetes in this population, and one of the guidelines that went out was that every obese patient needs to be screened for diabetes. I remember one death, the girl was 19. These people think they are fit and fine even though they weigh 220 pounds. So you need to look after yourself and get yourself healthy and get yourself checked out before you have a baby,” she said. “People may say this is just a phase of life, and for 80 per cent of women it is something they sail through without a problem, but that 20 or 25 per cent that have problems or even that 50 per cent that have problems, bwoy do they give us trouble!”

In the meantime, Marion Waysome McIntyre, project coordinator for the National Family Planning Board’s (NFPB) PROMAC, said in relation to McCaw-Binns’ concerns, the NFPB deals with health-seeking behaviours.

“In terms of the hypertensive mother or the obese mother who has diabetes, we are approaching that area. Our work plan speaks to getting fit for pregnancy. We have a mass communications campaign [for which] we have actually drafted a terms of reference and it is now with the European Union for approval and should come on board later on this year,” she said.

Waysome McIntrye also pointed out that the campaign focuses on how to get women to be prepared for pregnancy with regards to nutrition, fitness and managing pre-existing conditions.

It also looks at the environment within which the mother will exist with the pregnancy and after the child is born, and getting women to seek prenatal care from the first trimester of pregnancy, instead of the end stage when complications are beyond control.

The latter, according to Waysome McIntrye, is being addressed more extensively through a campaign called “I Go to Clinic Because…”, that looks at ways to get women to embrace the concept of going in to the antenatal clinics and health facilities early and ensuring that they understand what the procedure is, as well as who are the individuals with whom they are supposed to interact.

In an effort to continue to address the preventative side of maternal deaths, Waysome McIntyre said training of midwives and community health aides to have better relationships with women in communities is ongoing.