Baby death rate still stubbornly high

There has been no discernible improvement in the death rate for babies at, or around, the time of birth in the decade leading to 2013, according to a Statistics SA report released on 16 April 2015.

Perinatal deaths cover the period from 26 weeks of pregnancy to the first week of life. They stood at 24 per 1,000 births in 2003: 10 years later it was 25 per 1,000 births. The stubbornly high figures highlight the challenges facing the government if it is to reach the infant-mortality target it set itself in the National Development Plan. The plan says SA should aim to reduce infant mortality - which includes perinatal deaths as well as babies who die before their first birthday - to 20 per 1,000 births. It stands at 35 per 1,000, according to Statistics SA's deputy director-general for population and social statistics, Kefiloe Masiteng.

The government monitors indicators like these because they provide a measure of the strength of the health system and help gauge the effectiveness of its interventions. The Statistics SA report is its first on perinatal mortality, which until now has been monitored by the Department of Health via reports collected from health facilities. These "Saving Babies" reports broadly reflected the trend Statistics SA reported, said Dr Natasha Rhoda, a neonatologist and technical adviser to the department. Statistician-general Pali Lehohla said the sharp rise in perinatal mortality - from 17 per 1,000 births in 1997 to 24 per 1,000 births in 2003 - was largely due to improved death reporting, particularly by the areas covered by the former homelands. The increase was not due to HIV, he said.

University of Cape Town demographer Leigh Johnson agreed the increase in perinatal mortality during this period was not driven by SA's HIV epidemic, which had limited impact on babies who were only a few days old. Lehohla said these findings showed that both stillbirths and neonatal deaths could be reduced by providing better care in pregnancy and early infancy. Professor Sithembiso Velaphi, head of paediatrics at Chris Hani Baragwanath Hospital, said there were several reasons for the high South African stillbirth rate. He said one is that many mothers book in for a check-up only after 20 weeks of pregnancy so problems get picked up too late.

Also, a number of facilities get overwhelmed with numbers. There are too few nurses and midwives, and sometimes mothers need emergency C-sections but operating theatres are not available. Some provinces lacked adequate facilities in rural areas and a shortage of ambulances meant many women experienced delays in getting to specialists in towns.

Dr Simone Honikman, head of the Perinatal Mental Health Project at UCT, said previous perinatal loss increased the risk of maternal depression in subsequent pregnancies. She said mortality data is important but it does not give the full picture of morbidity.

Honikman said the figures are the tip of the iceberg of what is going on with the underlying factors and the consequences.

Business Day, 17 April 2015