Midwives a Potential Fulfillment of Ghana’s CARMMA?

| October 20, 2011 | 0 Comments

By Beth Kinsella
Maternal & Child Health Columnist

The launching of the Campaign on Accelerated Reduction of Maternal Mortaility in Africa  (CARMMA) in the Eastern Region of Ghana by First Lady Ernestina Naadu Mills on September 30, 2011 marks a decisive step toward improving maternal health in the country.  The lifetime risk of maternal mortality in Ghana is as high as 1 in 66.[1]  Although maternal mortality has decreased since 1990, the Millennium Development Goal of 75% reduction in maternal mortality by 2015 is far from being realized in Ghana.[2]

recent report by the State of the World suggests that increasing the number of midwives in countries such as Ghana has the potential to greatly reduce maternal and infant mortality.[1]  The 1st Annual Midwifery report published this June, which identifies 58 countries comprising 91% of global maternal mortality, concluded that doubling the number of midwives in these countries could decrease global maternal deaths by 20%, stillbirths by 18%, and newborn deaths by 23%.[1]

Midwives in Ghana are trained in 2007 using anatomical models. Doubling the number of midwives in Ghana could drastically improve maternal and infant health. Photo courtesy of unfpa Ghana on Flickr.

CARMMA, which was established in 2009 by the African Union, is designed to help African nations achieve Millennium Development Goals (MDGs) four and five of reducing child and maternal mortality.  Ghana’s progress toward these MDGs was deemed “off-track” by the Partnership for Maternal, Newborn, & Child Health 2011 Report.[3]  If Ghana were to include a plan for enhancing midwifery services through CARMMA, the nation would surely further its goals for reducing maternal mortality. 

Ghana’s current deficiency in midwifery personnel disproportionately affects the rural population, in which nearly 60% of live births have no doctor, nurse, or midwife in attendance.  In contrast, the urban population has approximately 80% of births attended by health professionals.  Furthermore, only 16 midwifery education institutions exist in Ghana.[1]

It has been shown that increasing the number of midwifery schools can lead to greater skilled birth attendant coverage, especially in rural areas.[4]  However, physical access factors such as distance from the hospital or transportation costs, have been shown to limit the outreach of midwifery programs in rural Ghana.[5]  Therefore, to be most effective, midwifery education must extend beyond the classroom into organized deployment contracts.[4]

Implementing a more widespread midwifery program in Ghana would certainly promote CARMMA’s goal of advancing “universally accessible quality health services including those related to reproductive and sexual health which are critical for reducing maternal mortality.”[6]  Indeed, CARMMA’s launch in the Eastern Region of Ghana was welcomed by Dr. Erasmus Agongo, who serves as the Director of Health Services in the Eastern Region.[7]  With First Lady Mills, Agongo encouraged district policy makers of the region to increasingly allocate funds to reduce maternal mortality.

Furthermore, as reported by UNFPA Ghana, Agongo praised the bottom-up nature of the new programming under CARMMA and acknowledged that the benefits of maternal health improvements extend far beyond the health sector.[7]  As Secretary-General of the UN Ban Ki-moon stated in the Midwifery Report, “We must safeguard each woman and child so they may live to their full potential.  The results will reverberate far beyond the lives of those directly affected”.[8]


[1] United Nations Population Fund.  The State of the World’s Midwifery.  Barcelona: 2011.   <http://www.unfpa.org/sowmy/resources/en/main.htm>. 11 October 2011.

[2] United Nations.  The Millennium Development Goals: Report 2010.  New York, 2010.  <http://unstats.un.org/unsd/mdg/Resources/Static/Products/Progress2010/MDG_Report_2010_En.pdf>.  11 October 2011.

[3] PMNCH.  “Analysing commitments to advance the global strategy for women’s and children’s health.” PMNCH 2011 Report.  2011. <http://www.who.int/pmnch/topics/part_publications/PMNCH_Report_2011_-_29_09_2011_full.pdf>.  11 October 2011.

[4] Freedman, L.P, W.J. Graham, E. Brazier, J.M. Smith, T. Ensor and V. Fauveau, et al. “Practical lessons from global safe motherhood initiatives: time for a new focus on implementation.” Lancet, 370 (2007):1383–1391.

[5] Mills, Samuel, J. Williams, M. Adjuik, and A. Hodgson. “Use of health professionals for delivery following the availability of free obstetric care in Northern Ghana.” Maternal and Child Health Journal 12 (2008).

[6] African Union Commision, Department of Social Affairs.  Factsheet on CARMMA.  2009.  <www.africa-union.org>.  11 October 2011.

[7] UNFPA Ghana.  “CARMMA takes another dimension in Ghana.” 2 October 2011. <http://countryoffice.unfpa.org/ghana/2011/03/08/3101/united_nations_population_fund_ghana_unfpa_because_everyone_counts/>.  12 October 2011.

[8] Ki-moon, Ban.  “Foreward.”  The State of the World’s Midwifery.  Barcelona: 2011.   < http://www.unfpa.org/sowmy/resources/en/main.htm>. 11 October 2011: ii.

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