Roadside delivery as maternal mortality decreases worldwide

Date: May 19, 2010
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Mercy Phiri gave birth to her fourth child on the muddy and harsh roadside with assistance from strangers in a village nearby. She left her home in Undi, a remote village in Dowa District in Malawi when realising labour had begun. On foot, she headed towards Dzoole Health Centre 23 kilometres away – a walking distance of three hours.

The rainy season was at its peak and Phiri arrived soaking wet at an overcrowded health centre alone, just to realise that the only doctor at the health facility was on leave. In spite of her vulnerable condition, she carried on walking towards Mponela Hospital, 15 kilometres away, as the motorcycle ambulance had broken down – she never reached the health facility.

This is only one personal testimony drawing the unjust picture of the reality facing pregnant women in Malawi. Today in Malawi, 16 women will lose their lives due to complications related to pregnancy or childbirth. According to the 2006 Malawi Multiple Indicator Cluster Survey (MICS), out of 100,000 live births 807 women will not survive, which makes Malawi among the countries with the highest maternal mortality rate (MMR) in Africa.

One contributing driver to the unnecessary loss of lives is the fact that only 54% of Malawian mothers deliver with skilled attendance at a health facility. Most women in Undi confess that they at some point have delivered in the village with assistance from a traditional birth attendant (TBA) or the herbalist; at the same time there is consensus among them that the best solution to a safe delivery is the Health Centre in Dzoole.

Even with good intentions to deliver with skilled attendance at a health facility, the women in Undi and across Malawi face critical barriers and causes of delays, as in the case of Mercy Phiri. One of them is bad infrastructure; secondly, the long travel distance places a serious threat to the health of the pregnant women, in particular if they only start the journey once in labour.

Additionally the general poverty proves to be another critical barrier to safe delivery at a health facility, Mercy Phiri shares: “most of us do not have the two dollars to go by minibus, and when we have cash at hand we prioritise pressing needs as school uniforms, household utilities, soap and food.”

Dr. Owen Malema, District Health Officer at Dowa District Hospital stresses that the high maternal mortality rate in Malawi really is a clear measure of poverty. “If women were empowered the MMR would decrease,” he says. “Our society needs to prioritise the health of women before we will see positive improvements”

Alufao Chirwa, a Nurse Midwife Technician at Dzoole Health Centre sheds light on the causes contributing to the dangerous delays at this health facility, “the place is overcrowded every day and we only have one delivery bed serving a population of 39058 – therefore women end up giving birth on the floor.”

“On top of that we are extremely understaffed – according to Government requirements, we are supposed to be 15 nurses at this health facility but I am the only one and there is only one doctor who is on leave today.”

Lack of equipment and consumables appear to be constraining the provision of proper health services to the pregnant women as well. “We lack delivery pads, forceps, and cloth for keeping equipment clean and hygienic. Delivery beds are of course an urgent need and in case of complication we do not currently have a vacuum extractor,” the courageous nurse explains.

The “health facility solution” in its current state might in fact involve greater risks for pregnant women than simply delivering at home in the village. It is indeed an alarming and unbearable reality of provision of healthcare services, which calls for urgent actions. Malemba recognises that urgent actions are needed but he also highlights the positive progress which has been detected in terms of increased deliveries at the health facilities in Dowa.

“Our main challenges are the bad infrastructure and the long distances expectant women have to travel to reach a health facility, which can assist in the dangerous delays of labour,” he pointed out. “Those challenges must be addressed in a collective manner with focus on community mobilisation as Government alone cannot collect each and every single pregnant woman.”

For its part, Government exhibits commitment to Millennium Development Goal 5 in Dowa District by providing specialised services for pregnant women living in the so-called “hard to reach areas,” that is a village more than eight kilometres from a health facility. They collect women once a week to come and stay in waiting shelters at the District Hospital. This pilot intervention will be scaled up across the district if it proves successful.

Another proposed solution is to build more health facilities in Dowa to decrease the number of “hard to reach areas.” Those plans are in the pipeline with Government in Lilongwe, Malawi’s capital.

The unacceptable reality is that maternal mortality remains the leading cause of deaths among women and girls in the productive age at a global level, in spite of a recent report in the Lancet Journal indicating that the MMR worldwide has decreased. Let us remember that pregnant women across the world and in Malawi also have a right to healthcare services and a right to life. Let us call upon the duty bearers to fulfil their obligations and to put an end to deliveries at the muddy and harsh roadside.

Helene Christensen is a freelance journalist based in Malawi. This article is part of the Gender Links Opinion and Commentary Service which offers fresh news on every day news.


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