A senior health official has identified delay in receiving care at medical facilities and lack of knowledge among pregnant women about warning signs during pregnancy, as the two main factors contributing to Jamaica’s maternal mortality rate climbing to a worrying high.

However, the Ministry of Health and Wellness says it has implemented response measures to deal with the problem.

Dr Julia Rowe Porter, director of family health at the Ministry of Health and Wellness, highlighted the issue while pointing to the ministry’s Population Health Status Report for the period 2000-2022 which showed the maternal mortality rate at a high of 211.3 per 10,000 live births in 2021 due to the COVID-19 pandemic.

The figure dropped to 156.7 in 2022, but this was still more than double the sustainable development goal standard.

“Globally, the target is for the maternal mortality ratio to be 70 per 100,000 live births, and Jamaica’s figures are not looking good… over the last two decades, the trend has been an upward one. It fluctuates, but then when you step back and look at it there are concerns that it is generally trending up,” Dr Rowe Porter told the Jamaica Observer.

“Based on the analysis of our trends and our figures, our situation is showing that we have a problem with delay one, which is the patient did not recognise the problem, so that’s an awareness problem for the population; and delay four, which is a health facility problem, where once they access the facility then there is a problem at the facility level in terms of how the health system responds to their situation,” said Rowe Porter.

The director explained that there are many factors at the health-care level that have contributed to the high rates, such as a shortage of skilled medical staff to handle complex pregnancy emergencies, lack of resources and equipment, as well as improper diagnosis by medical officials.

She added that in complex cases, patients are also referred to other hospitals, and transportation time creates a delay in treatment, which increases the chances of mortality.

ROWE PORTER… we would have been crafting regional plans with the teams on the ground to be able to be more strategic at the service delivery level (Photo: Naphtali Junior)

Post-partum haemorrhaging and a lack of blood at medical facilities have also contributed to high maternal mortality rates said Rowe Porter.

“We know that during COVID there would have been an acute worsening of the staff situation, especially with respect to our nurses, our midwives and these are skilled birth attendants that manage our primary care clinics or antenatal clinics which do the checks for pregnant women,” she told the Sunday Observer.

“With a critical shortage of our nurses, that puts a strain. I know that there are missions that are planned to recruit staff from other countries, but it is something that the ministry is looking into with respect to filling this gap,” said Rowe Porter.

The report further stated that Jamaica’s neonatal mortality rate (death among newborns) moved from 9.2 per 100,000 in 2000 to 14.6 in 2021. During the same period, infant mortality rates moved from 13.2 to 17.7 while the under-five mortality rate moved from 16.4 to 19.0.

Addressing these increases Rowe Porter said, “The infant and the under-five mortality rate include the neonatal mortality rate so those two rates are affected by the neonatal mortality rate. It’s not necessarily that our older children are dying, it’s the neonates.”

When asked about the cause of the increases, she attributed this to respiratory and cardiovascular conditions during the period of labour, delivery and birth, as well as medical conditions of the mother that affect the child.

“It’s important to note, for example, that one of the conditions that contribute to that category is respiratory distress syndrome so that would happen in premature deliveries [and] that would speak to our capacity as a country to manage critically ill babies that are born. If they are premature, they are [at a] very high risk, and it would require a significant specialist and equipment to be able to avert the deaths,” she explained.

Sepsis — an infection that spreads in the blood and throughout the body — and meningitis were also identified as factors leading to increased mortality rates for neonatal babies.

Rowe Porter admitted that the decline in Jamaica’s birth rate, mixed with increases in maternal and infant mortality rates, is cause for concern and the ministry is working to address the issue.

“We would have reached our target for the fertility rate, which replacement fertility was 2.1, and we are now at 1.9, but the number of births is going down,” she said.

“The number of maternal deaths has really been a bit steady except for the COVID period, but because it’s a ratio, when you compare the number of maternal deaths to live births, the ratio shows that there is an upward trend. It is a concern, and it will reflect in the maternal mortality ratio trending up over the years; hence, the reason why we’re accelerating our response at this time,” she explained.

That response includes a series of maternal health fora currently being staged by the ministry across the island with each regional health authority to assess the trends.

“We would have been crafting regional plans with the teams on the ground to be able to be more strategic at the service delivery level to address whatever nuances we’ve identified for each regional health authority,” added Rowe Porter.

She said to increase the mother’s awareness of signs of pregnancy complications, the ministry is in the process of planning an antenatal care and well-being campaign, which will run for 15 months.

Rowe Porter pointed out that the ministry recently completed the Programme for the Reduction of Maternal and Child Mortality (PROMAC) which sought to strengthen the health system as well as coordinate programmes to improve infrastructure, and equipment, build the capacity of health workers, and undertake a coordinated programme of public education targeting the areas of maternal and child health.

“We would want to look at the outcomes of this project to see, where needs be, we can assess the infrastructure, and the staffing structure as well, and all the other inputs as well in terms of training through this project to determine the way forward,” said Rowe Porter.