Editorials

Infant and maternal mortality in The Bahamas

Over the last several days, allegations of infant and maternal death due to inadequate medical care at Princess Margaret Hospital (PMH) have surfaced and are now said to be under investigation by the Public Hospitals Authority.

Publicized anguish of bereaved mothers and loved ones brings attention to infant and maternal mortality rates in The Bahamas, the former having charted unacceptable increases over the last two decades.

A country’s infant mortality rate (IMR) — a measure of infant deaths under the age of one — is a key indicator in assessing its overall physical health, and is positively correlated with access to medical care, sanitation, education and nutrition.

From a low of 12.7 infant deaths per 1,000 live births in 2001, the country’s IMR shot to a high of 21.1 in 2009, and stood at 16 in 2016, according to the Ministry of Health’s most recently published statistics — well above the IMR of comparable countries in the region.

According to the United Nations Children’s Fund’s (UNICEF) 2016 Health Equity Report, 98 percent of those living in The Bahamas have access to clean drinking water, and 92 percent have access to improved sanitation facilities.

Access to the public healthcare system exists for all regardless of income, education from primary to secondary is free and The Bahamas had an estimated gross domestic product (GDP) per capita of $32,933 in 2019 — the highest among CARICOM countries.

Our double digit rates of infant deaths betray the country’s current standard of living, and point to what must be a reprioritizing of healthcare funding and conceptualization, so that economic and touristic achievements do not continue to markedly outstrip achievements in improving healthcare and the overall health of the nation.

IMRs, along with statistics on infant deaths at the country’s major hospitals, also raise key questions about leading factors in infant deaths in the country, and the extent to which emerging levels of poverty among Bahamians and immigrant populations factor into the number of babies who die before their first birthday each year.

In the 10-year period between 2006 and 2016, 1,006 infant deaths occurred at PMH; one at Doctors Hospital; 28 at Rand Memorial Hospital on Grand Bahama; and five on the Family Islands, according to the ministry’s Health Information and Research Unit.

The country’s maternal mortality rate (MMR) — the number of women who die while pregnant, within 42 days of childbirth or from complications of an abortion — is estimated at 70 per 100,000 live births in 2017.

Jamaica’s MMR for that year is estimated at 80 and Barbados’ at 27 — the lowest in the Caribbean Community.

UNICEF puts at 85 percent, the proportion of women aged 15 to 49 who have attended at least four antenatal care visits during their pregnancy, and the Pan American Health Organization (PAHO) cites late presentation to antenatal care among factors that influence infant mortality in The Bahamas.

In addition to analyzing and addressing deficiencies in the quality of care provided to pregnant women and infants in the public healthcare system, government can take progressive steps to addressing infant mortality by developing a true and adequately financed national breastfeeding program supported by labor legislation that promotes and protects breastfeeding for working mothers.

Research worldwide agrees that exclusive breastfeeding is among the strongest predictors of infant survival, with leading US-based studies reporting that babies who are breastfed have a 21 percent lower risk of death in their first year, and their reduction in risk of death increases to 38 percent if breastfed for three months or more.

Former Health Minister Dr. Duane Sands previously pointed to The Bahamas’ “low” rates of breastfeeding of 10.9 percent to 29.2 percent between 2005 and 2011 — rates far below PAHO’s recorded average rate of 40 to 60 percent for exclusive breastfeeding in the Caribbean.

Back in 2017, PAHO cited just $4.70 per newborn as what would be needed to increase the global rate of exclusive breastfeeding among children under six months to 50 percent by 2025, coinciding with the World Health Organization’s Sustainable Development Goals.

The Bahamas is too prosperous a nation not to put the kind of focused attention on nationwide healthcare and on infant and maternal mortality rates, that the country deserves. 

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