Maternal Mortality in Botswana: A Red Flag of the Millennium Development Goals

She was only 15 years old when he promised her the world.

“I’ll take care of you,” he said, “I mean it.”

He was 3 times her age, and thus he held all the power.  He refused to wear condoms, even though social stigma left her too frightened and ashamed to the clinic to get contraceptives.  Her only feeble safeguard against pregnancy were the “morning-after” pills that he bought for her.

One day, he did not bring the emergency contraception she so dearly needed.  She knew, even before she took the pregnancy test, that she was pregnant.  She panicked at the thought of bringing a child into the world when she was still one herself.

“I can’t tell my parents,” she hyperventilated.  He held her.

“I’ll take care of everything,” he promised.

The next day, he took her to a decrepit house on the outskirts of their village to meet with a man who had claimed to be an expert in pregnancy termination.  He mixed her a bitter-smelling concoction that, he claimed, would resolve all of her issues.  She drank it, gagging, and returned home.

That night, this girl – my friend – bled to death in her bed.   Though l lost somebody I loved dearly, our community and our country both lost something valuable too: a bright, vivacious girl who could have become Botswana’s president, in time.

Women are important and crucial to the social and economic development of society in Botswana, both as members of the workforce and the backbone of many households.  The issue of maternal mortality threatens this progress drastically, and quantifies a suffering that should not exist anywhere on earth.

During the Millennium Development Goals (MDGs) era, Botswana was flagged as a country afflicted by high rates of maternal mortality incidence.  Despite the commitment of MDGs 5 to counteract this issue, maternal mortality remains unacceptably high in Botswana, even in consideration of the decline of reported incidents in the recent years. This goal has since been replaced by the Sustainable Development Goal (SDG) 3.1, which pertains specifically to reducing maternal mortality in the wider context of improve health and wellbeing.

Maternal mortality is defined as the death of a woman while pregnant, or within 42 days of termination of pregnancy – regardless of the site or duration of the pregnancy – from any cause related to, or aggravated by, the pregnancy or its management.  However, this does not encompass accidental or incidental causes.

Maternal mortality: Contributing Factors

It is important to note that abortion is illegal in Botswana, but it is still a contributing factor to the high rates of maternal mortality cases.  Unsafe or illegal abortion is one of the indirect leading causes of maternal deaths in Botswana, as recorded by the Ministry of Health (MOH) in a number of health facilities across the country, including the Princess Marinah Hospital and Nyangabwe Hospital.  There are many dangers associated with unsafe or illegal termination of pregnancy, because the methods used are oftentimes crude, unsanitary, or brutally violent.  In Botswana, the predominant methods of illegal abortion are the consumption of methylated spirits, or the harrowing “coat hanger” method, in which the girl or woman’s womb is scraped by the sharp hook of a coat hanger.  These can lead to poisoning, internal bleeding, hemorrhage, womb perforation, and death.

Pregnant adolescents also contribute greatly to maternal mortality statistics, as expectant mothers who have not fully developed anatomically are often less physically able to carry a child to full term.   Pregnant teenagers tend to seek illegal abortions out of a desire to stay in school and conceal their pregnancy, which places their individual health at greater risk.

Statistics: Causes of Maternal Deaths

Combating Maternal Death on the Frontline

Maternal death is a complex concept, as pregnancy and family planning – both important health topics – are inextricably linked to sexual activity, an oftentimes taboo subject in not only Botswana, but in many cultures.

Combating these preventable deaths means having confronting, even uncomfortable, conversations around sexual health.

It is important to accept that adolescents engage in sexual activities.  Thus, advocating for abstinence as opposed to safe sex (with access to contraceptives) continues to put these girls at high risks.  In a survey conducted by my organization, The Voice of Africa Trust, we found that most girls reported to using emergency contraception instead of birth control, as the latter receives stigma when requested at medical clinics, whereas the “morning-after pill” can be bought discreetly over the counter.

The Voice of Africa Trust recently partnered with Miss Public Service on a project called “Let’s Talk About it” (or, #LETAI), a strategic advocacy initiative aimed towards ending preventable maternal mortality in Botswana.  The project seeks to combat the leading causes of maternal mortality through innovative, community-driven programming, such as a national educational and awareness campaign, media outreach programs, pregnancy care advice via SMS, and condom drives to disperse and educate on sexual health barrier methods.

Its aim is to break the taboos and speak to young girls about issues that they cannot or will not discuss in their homes or schools.  This objective is to empower women and girls through education about their sexual and reproductive health rights, with a focus on bodily autonomy.  This program involves community-focused dialogues, policy formulations, and partnerships with relevant stakeholders to work towards the attainment of SDG 3.1.

Whilst I miss my friend dearly, her experience brought to light the brutality and misery of preventable maternal death.  It is my hope that the lessons learned from her story can save the lives of countless others, until maternal mortality is no longer an issue in Botswana, Africa, or anywhere else on earth.