Reducing maternal mortality in SADC is possible

Reducing maternal mortality in SADC is possible

Date: December 13, 2020
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By Sifisosami Dube,

Johannesburg, 11 December : As soon as she settles down to eat her breakfast, Gogo Snanzeni is interrupted by a boy who has been sent to tell her that her midwifery services are urgently needed. She immediately realises that she has to walk almost five kilometres to assist Lindi to deliver her baby. With her kit ready, she embarks on the long journey.

Many rural areas in the Southern African Development Community (SADC) region have a traditional midwife or Traditional Birth Attendant (TBA) in their midst. The poor investment in maternal health infrastructure in many rural areas has seen many women give birth without skilled birth attendants. Despite many years of experience for most traditional midwifes, there is need to innovate and build their capacity to ensure that no woman loses her life whilst giving birth.

Maternal mortality remains high across the region, despite political commitment to reduce it. According to the #VoiceandChoice, SADC Gender Protocol Barometer, fourteen countries in SADC remain below the target of 70 deaths per 100 000 women. Seven SADC countries have a maternal mortality ratio which is higher than 300 with Lesotho recording the highest at 544. Issues such as child marriages and lack of maternal health facilities has contributed to these high ratios.

Lockdown measures during COVID-19 have activists worried about an increase in pregnancies, highlighting the critical need for easier access to antenatal care. Limited transportation facilities and services in health institutions could worsen the unmet demand for skilled birth attendance. However, some innovation in the form of mobile maternal and neo-natal health facilities have made a positive difference for many women in rural areas. The capacity building initiatives of traditional midwives by some health focused organisations and local clinics will go a long way in contributing to the reduction of maternal mortality rates especially in the rural areas.

The economic challenges posed by the COVID-19 pandemic has further reduced access to maternal health by many women as they are struggling to pay for antenatal classes, Caesarean section operations and other maternal health services. While countries such as South Africa are making progress towards a National Health Insurance which may reduce the burden on maternal mortality costs, there is still need to build capacity of communities and traditional midwives on maternal health care.


Capacity building initiatives by some health centres include training midwives on prevention of HIV transmission during birth, early detection of high blood pressure and anaemia and body exercise for pregnant women. Adequate training of these maternal health care providers combined with professional care and facilities will definitely contribute towards reduction of maternal mortality health.


According to the World Health Organisation, at least 30% of births in Malawi occur in the rural areas. The Malawi Government prioritised training of Traditional Birth Attendants (TBA) as early as prior to the Sustainable Development Goal period. The training of TBAs has been seen as a contribution to the country’s strategy to achieve Universal Health Access. Although the training of TBAs may not have reached all regions of the country, there is at least a register of experience TBAs in most districts. The COVID-19 situation calls for harnessing these locally available resources to bridge the gap of high maternal mortality rates.


As medical science advances, there is need to combine the existing knowledge of TBAs with new clinical methods of maternal health care. Accordingly to the PubMed journal, Sixty percent of the 60,000 annual deliveries in the province of Manicaland, Zimbabwe occur in the home under the care of a traditional birth attendant (TBA) who is usually a family member. Most of these TBAs have been trained using mostly locally obtainable training materials used were only those that could be locally obtained. The continued contact with the TBAs by Ministry of Health training officers has served as a means for obtaining data on births, delivery-related morbidity and mortality. This record keeping is particularly important in times of COVID-19 when the pandemic has taken over other health issues.

Integrating maternal health care in COVID-19 response including TBAs is important. As a large part of Sexual Reproductive Health and Rights, maternal health care must be a prioritised in investment by Ministries of Health.  TBAs who have been trained often exhibit improved practices, refer more high-risk pregnant women to clinics, and perceive themselves to be attending fewer births. As a result of delivering fewer babies, the TBAs believe that they have lost credibility as health educators yet this is due to integration of modern delivery methods with the experiences they have over the years.

In Zambia’s Central Province, UNFPA has intervened by training TBAs including the lifesaving Emergency Obstetric and Newborn Care (EmONC) and repairing cervical tears. Rural areas across the country are estimated to have only 70 health care workers per 100,000 people, with some rural health facilities managed by only one health worker or unqualified support staff. In the country’s Central and Western Provinces, the ratio of nurses, midwives, medical and clinical officers to patients fall below the World Health Organization’s recommended threshold of 2.28 per 1,000 people.

Reducing maternal mortality in rural SADC is possible through capacity building initiatives that include training midwives on diagnosing multiple births and attending to cervical tears. Women experience cervical tears during labour and delivery for a range of reasons, including being a first time mother, having a large baby or one in an unusual position, or having prolonged labour. During the time it takes a tear to heal, women experience discomfort that affects other aspects of their overall social well-being. The stretched health systems in the region will definitely benefit from more skilled and equipped midwives.

Innovation in rural maternal health care is possible and should be supported by the governments. The communities must be allowed to discuss root causes of high levels of maternal mortality as well as tap onto existing local knowledge of preventing maternal mortality. The COVID-19 era presents opportunities to combine science with traditional methods in reducing maternal mortality. Universal Health Care by 2030 is a possibility if governments tap onto the pool of both professionally trained and TBA health personnel.

Sifisosami Dube is a gender expert. She wrote the Sexual and Reproductive Health chapter in the 2020 #VoiceandChoice SRHR Barometer, read chapter, watch video. This story is part of the GL News Service 16 Days of Activism News series.

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