The Malawi Maternity Project
Globally, 94% of all maternal deaths occur in low and lower middle-income countries, yet most of these deaths could have been prevented (WHO). In Malawi, approximately 70% of pregnant women face issues in accessing maternal health services, whilst many women have to walk up to 9km to reach a clinic, and can lead to birthing complications and even death for those in labour (Malawi DHS, pg 140). In addition, 19 newborns (per 1000 live births) will die before reaching their first month of life (UNICEF).
Patuma and Alidi’s Story
“My labour pains started at midnight and my husband was so scared since it was our first baby. He rushed to tell my mother. She told my husband, Joseph, to put me on a bicycle, which was already on standby, and head to the hospital.”
This is the beginning of the story of Patuma and Alidi from a remote village in the rural lake district of Mangochi, Malawi. It is a story of how conditions in some areas of the world make childbirth life-threatening both for mother and child. However, it is also a story of how help and kindness from the public can save lives in a resource limited setting.
“On our way to hospital, we met some people who were coming from the beer hole. We became scared and because of my condition, we decided to face them and explained our story – that we were rushing to the hospital for delivery. The men then decided to escort us to the Health Centre.”
“My condition became worse when it started to rain and it was cold. One of the men who joined us had a raincoat which he gave me and we had to seek shelter in the nearby village until the rain became less heavy. When the rain stopped, we continued our journey to the health Centre. When we reached the Health Centre, I was almost ready for the delivery, the nurses were also busy helping the other women in the labour ward so there was nobody to attend to me. Just after ten minutes, labour started and I was assisted by Hospital Maids and I delivered a baby boy. Fortunately, we both survived.”
Some women aren’t as fortunate. In Malawi there have been cases of women dying in labour on public buses in an attempt to reach the nearest healthcare facility.
Help mothers in difficult circumstances access healthcare without barriers >Why is the Malawi Maternity Project Needed?
In the southern regions of Malawi, expectant mothers face difficulties in accessing maternity clinics for antenatal appointments, postnatal checkups and deliveries/births. Public transport is often too expensive and runs within a limited time frame - particularly inconvenient and often life-threatening in emergency situations (Government of Malawi). Those with less money to spare may walk up to 9km distances to attend appointments, often in conditions when they are most at risk to miscarry, including whilst in labour. (Health Foundation) Some expectant mothers resort to visiting traditional birthing assistants, and avoid healthcare clinics altogether due to the difficulty it takes to reach the clinics. Many expectant mothers have therefore experienced birthing complications or in worst case scenarios, died due to the distance and time it takes to reach a clinic.
Why do women die?
Maternal health deaths are mainly due to complications during and after pregnancy; many which can be avoided if sufficient antenatal and postnatal care is provided. Complications include:
- Severe bleeding after childbirth
- Infection after childbirth
- High blood pressure during pregnancy
- Complications from delivery
- Unsafe abortions
In order to reduce these complications, the access to maternal health services must be increased. DWW therefore aims to support and invest in local clinics and communities in order to develop a sustainable method of increasing the uptake of maternal health services.
“Increasing access to maternal health clinics will result in an increased uptake of postnatal and antenatal care services. This will help to identify any complications to ensure safer deliveries and reduce the number of maternal health deaths.” -Malawi, Project Support Officer
The Malawi Maternity Project in Action
Whilst maternal care has been one of the core areas of our work in Malawi since 2016, DWW has since been focusing on building and scaling up the provision of maternal care services by addressing some of the key barriers in accessing maternity care in rural areas of Malawi, including the development of transport links through the introduction of ambu-bikes, new maternity clinics in strategic locations, access to free maternity packs to enable mothers to give birth in clinics, and increased training of maternity healthcare workers. Through this, we aim to increase the number of vital antenatal care (ANC), postnatal care visits (PNC) and delivery appointments in healthcare facilities which can reduce the number of mother and baby deaths - 75% of which are preventable with the early identification of any birthing complications (WHO).
The full list of project activities includes:
- Building maternity clinics in strategic locations: new clinics will be built in rural areas of Balaka and Chiradzulu that do not currently have health coverage
- Rehabilitation of maternity clinics: all clinics will be supplied with equipment required for antenatal and postnatal appointments e.g. ultrasound machines and strengthening existing systems
- Training healthcare workers in basic and advanced maternity care to support the reduction of birthing complications: we will work with local & international trainers to upskill and train healthcare staff on topics they have not had training access to, or are not confident in delivering to an audience
- Widening the access to maternity clinics by creating Ambubike transport routes: Ambu-bikes will be constructed and developing a transport link between villages and healthcare facilities
- Providing mother-baby packages to those unable to afford them: all essential items required for the birthing process and for mother and baby will be supplied
In detail: Maternity Clinic Build
DWW will be funding the rebuilding of two clinics in strategically placed areas: Balaka and Chiradzulu. In Chiradzulu, the current healthcare clinic is operating poorly and is in a state of disrepair, requiring a complete rebuild and rehabilitation. In Balaka, Chisinga, the current clinic is dysfunctional and incomplete with a lack of maternity services. Both clinics are strategically placed in serving the needs of the population, particularly as both are rural regions with limited access to healthcare. DWW will also oversee the training and capacity building in these new sites to ensure quality medical care and standards continue to be delivered and maintained.
In detail: Ambu-bikes
The distance required to reach healthcare clinics has been identified as the biggest barrier in accessing maternal health services (DHS). DWW is therefore investing in Ambu-bikes as a way of combating this issue. The Ambu-bike project aims to utilise volunteer community members as well as locally made bikes to build an Ambulance-like transport network throughout the rural areas of Mangochi. DWW will pay for Ambu-bike materials, customise them to provide a space to lie down and be protected from the weather, and oversee the training of Ambu-bike cyclists in a bid to increase local access to maternity clinics, with the aim of reducing maternal mortality and complications, and increasing the uptake of mother and baby health checks.
In detail: Mother-Baby Packs
DWW will offer Mother-Baby packs to those who are unable to afford them - a key barrier faced by many vulnerable women who often choose to give birth in unsafe conditions at home as a result of poverty and shame felt by mothers who cannot afford basic items for birth such as a wrap to cover their newborn baby, or sanitary pads for the postnatal bleeding. These packs, worth between £20-£30, are essential in ensuring mothers give birth in clinics safely especially as these packs must be brought to the clinic by the expectant mother in order to give birth at the clinic.
The Mother-baby packs contain essential items required for the first 28 days of a newborn’s life including the mother. To incentivise this free provision, mothers will have to complete the Ministry of Health recommended number of four Antenatal Care (ANC) visits and ensure delivery takes place at a health facility. This is with the aim of reducing newborn and maternal mortality by identifying complications early on and ensuring delivery is taking place in a safe and sanitary environment. The Mother-Baby packs contain the following:
- Wrapping Cloths
- Baby Blanket
- Basin for the Mother
- Basin for the Baby
- Washing Soap
- Bathing Soap
- Plastic Sheet
- Candles
- Safety Matches
- Razor Blade
- Cotton Thread Ball
- Sanitary Pads
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