Maternal deaths in Africa: Cutting down the distance that kills
Written by William Foreman
Jody Lori has been a midwife for 20 years and has never had a patient die in the U.S. But in Africa, she has seen many women lose their lives to childbirth-related complications.
“You ask someone in Africa, ‘Have you ever heard of a woman who has died in childbirth?’ and everybody says, ‘Yes.’ Everybody,” Lori said. “Their sister. Their aunt. Their neighbor. Their cousin. Their own mother.”
What’s one of the biggest killers of expectant mothers in rural Africa? Distance. Women often live hours away from a hospital. So if something goes wrong, they’re in serious trouble.
“It’s not unusual for a woman to go into labor and have to walk 10 miles to get to a health clinic,” said Lori, an associate professor and associate dean for global affairs at the School of Nursing at the University of Michigan.
Lori is part of an effort working to solve this problem in the Southern African nation of Zambia. The project has received funding from Merck for Mothers*, the ELMA Foundation and the Bill & Melinda Gates Foundation, which taken together totals $11 million.
Key to the project is building maternity waiting homes—places close to primary health care facilities where women in the late stages of pregnancy can live until they’re ready for delivery. Twelve of the homes are being built in two districts where Lori is working. The first six are expected to be ready later this month.
The structures—constructed of bricks made by the community—will include 10 beds for women waiting to give birth. Four more beds will be available for those returning for postpartum visits. A common area will be available for educational classes for mothers.
Each maternity waiting home will be within visual walking distance to a primary health care facility that provides basic obstetric care. The homes will also be within two hours by transport from a facility where a woman can get a Cesarean section and comprehensive emergency obstetric care.
Lori explained how the system would work: If a woman knows her due date is within a couple of weeks, she will go to the maternity waiting home. She will bring food with her which will be supplemented with food grown at the maternity waiting home. A family member or traditional midwife from the village might accompany the expectant mother.
While she is waiting, the pregnant woman will receive instruction about how to breastfeed, family planning and how to care for herself and her baby. When she’s ready to give birth, she will move to the primary health care facility—a short walk away.
“If labor doesn’t progress and the woman needs a C-section, the skilled birth attendant at the facility can call an ambulance,” Lori said. “Emergencies do happen in childbirth, but there are warnings. Time is of the essence.”
In Zambia, 224 women died per 100,000 births in 2015, while in the U.S. the number is 14, according to The World Bank.
Lori is also excited about the project’s potential for research.
“One of the main questions is: Are we reaching the most vulnerable women?” she said. “Are the women who come to the maternity home the ones who live the farthest away, which we define as farther than 10 kilometers (six miles) from the health facility?”
Researchers will use global positioning systems to map where the women are coming from, the distances they are traveling and the outcomes of their births. They are also looking at the cost benefits—what’s the cost of the homes and the benefit to the community?
“The big goal is: How can this be sustainable over time?” Lori said. “We know that a similar project worked in rural Liberia, but every place has its own context. The Zambians are very interested in scaling this up for their own country.”
U-M is collaborating with Africare, one of the most experienced and largest African-American-led nonprofit international development organizations on the project. Other partners in the project include the Boston University School of Public Health and the Zambian Center for Applied Health Research and Development.
*This program includes funding from Merck, through Merck for Mothers, the company’s 10-year, $500 million initiative to help create a world where no woman dies giving life. Merck and Merck for Mothers are known respectively as MSD and MSD for Mothers outside the United States and Canada.