YANGON , 20 January 2009 (IRIN) - Mya Khin never once saw a doctor when she was pregnant. All four of her children were delivered at home by an untrained, illiterate birth attendant.

But at 47, giving birth to her fifth child, complications arose and she began to haemorrhage. Neither the attendant nor her family knew what to do, and the nearest hospital was 45 minutes away.

"We didn't even have the taxi fare to bring our mother to the hospital," said her daughter, who frantically tried to find a doctor in her village outside Yangon, the former Burmese capital.

"When we got home, my mother was already dead in a pool of blood," the distraught 16-year-old said.

MDG off target

According to the UN Population Fund (UNFPA), in Myanmar an estimated 3,800 women die in pregnancy and childbirth each year, mainly from post-partum haemorrhaging, infection, unsafe abortion, eclampsia and obstructed labour.

"Maternal mortality remains high," Pansy Tun Thein, UNFPA's country representative, told IRIN.

"It's not an easy job," San San Myint, a national consultant with the UN World Health Organization (WHO), told IRIN. "It requires very hard work in the six years ahead," referring to the 2015 Millennium Development Goal that is increasingly looking unachievable.

According to the Nationwide Cause Specific Maternal Mortality Survey (2004-2005), Myanmar's MMR stands at 316 per 100,000 live births.

A government target of 56 per 100,000 based on earlier 2001 data would also not be achievable. "Even that will prove a challenge," Pansy Tun Thein said.

Significant barriers

In Myanmar, most births take place at home, with about 57 percent of deliveries overseen by a skilled attendant or midwife, according to the State of the World Population 2008.

UNFPA said 87 percent of maternal deaths occurred in rural areas, with issues of access, road conditions and under-service facilities all contributing factors.

Of those women, the Survey reported that 88 percent died at home, 2 percent died on the way to a healthcare facility, and 10 percent died at the health facility itself.

Many women often arrive at hospital in such poor health that even blood transfusions cannot save them, while in other cases, health facilities simply cannot provide adequate care in time, say health experts.

Heightening the risk is the lack of skilled birth attendants in the country.

"Ideally, each village should have one midwife. But currently it seems that one midwife has to cover from five to 16 villages," Thwe Thwe Win, a national programme officer with UNFPA, said.

In addition to lack of manpower, training, facilities and equipment, low awareness at the community level about possible risk factors was also a contributing factor.

Recommendations

But while there are many situations leading to maternal death that are not predictable, there are a number of measures that can be done to mitigate them, including obstetric emergency response.

In addition, all women should have access to high-quality antenatal care for the detection of anaemia and high-risk pregnancies so as to ensure well-planned deliveries.

To improve quality pre-natal and post-natal and obstetric emergency care, UNFPA and the UN Children's Fund (UNICEF), with the government, are working to improve the capacity of basic medical staff, as well as auxiliary midwives through training and technical support.

"We also provide maternity waiting homes near health facilities for those who live away from the health facilities," said Thwe Thwe Win.

To date, the two agencies have opened about 250 maternity waiting homes in 230 townships.

According to UNICEF's State of the World's Children report [see: http://www.unicef.org/publications/index_47127.html] released on 15 January, women in the world's least developed countries are 300 times more likely to die in childbirth or from pregnancy-related complications than women in developed countries.

Each year, more than half a million women worldwide die as a result of pregnancy or childbirth complications, the agency reported.

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