Commentary on “maternal mortality and morbidity in the developing world: Personal reflections and a profession's commitment”

Abstract

This is a rebuttal on a response to a paper to which the respondent made suggestions on how American obstetrician-gynecologists could help the situation of high maternal mortality in Africa. The author agrees that such high maternal morbidity and morbidity is tragic because most of it could be prevented with known low technology interventions. The author emphasizes that he believes the only strategies and a network of accessible first-level referral centers. He regrets that there are no highly effective interventions that can be applied in the village that will markedly reduce maternal mortality. In contrast several highly effective appropriate technology strategies are amenable to application in villages for increasing child survival such as oral rehydration and immunization. He believes that even if massive funds were spent training traditional birth attendants serious causes of maternal mortality would not be addressed. Instead governments must assign high priority to install staff and equip referral centers and transport systems. These centers must be able to give intravenous antibiotics blood transfusions and do cesarean sections. The writer further disagrees with the correspondents view that it would be helpful if American obstetricians spent time in their training on international medicine sent print materials to Africa went to Africa as visiting professors or donated American equipment to African teaching programs. Each of these suggestions has practical drawbacks; most are impractical because African practitioners do not need more training in our highly technological tertiary care approach. He believes that there is very little that American gynecologists can do to help African women.