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).
Felicity's Story
During Felicity's first pregnancy, the closest available antenatal clinic was only accessible by foot, a number of kilometres away. One night, there was a sudden onset of labour, yet the cost of hiring a motor vehicle to travel to the hospital was unaffordable. The only option was to walk. When Felicity was a few kilometres away from the hospital, it started raining and Felicity’s condition worsened whilst her labour pains grew stronger, so she decided to stop and rest. A few hours later, Felicity gave birth to a premature baby and rushed to the hospital with her husband to receive postnatal care. Unfortunately, upon arriving at the hospital, the baby was found to be excessively cold due to the heavy rains and despite the doctors' best efforts, they were unable to resuscitate her child.
“Years later, exciting news spread through the village about the introduction of a maternity clinic at Somba. During my second pregnancy, I started attending the antenatal clinic there and one evening, when labour started, the nurses rushed me into the labour ward and I progressed through to delivery, giving birth to a live full-term infant without any complications. As I am reporting this, I am pregnant once again, and attending antenatal appointments here at Somba.”
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:
- 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: 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: Addressing delays in Maternal Care
We are addressing each of the three categories of delays in the widely accepted 'Three Delay Model'* that increases maternal mortality across the world. Specific to Malawi, we are working with a partner organisation to tackle local issues such as poverty, lack of education and cultural practices while at the same time introducing emergency equipment and resources to bring maternal health facilities up to standard.
*The Three Delay Model:
- Delay in decision to seek care due to lack of understanding of medical needs, cultural barriers and financial struggles etc.
- Delay in reaching care due to distance, availability and cost, poor roads and infrastructure etc.
- Delay in receiving adequate health care due to lack of supplies, trained staff and well-functioning facilities etc.
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