"No woman should die during pregnancy or childbirth"

By Liz Bird

	Diana's mother died in childbirth. APZU is working to make sure Diana will not face the same struggle as her mother.

“If you want to understand what Abwenzi Pa Za Umoyo has done,” said Veronica Kanyenda, a nurse at Neno District Hospital in Malawi, “you should know the story of the baby Diana.” She pointed out a small child sitting on a young woman’s lap in the shade of the health center’s metal roof. 

Veronica, affectionately called masiteni (mother) by junior staff, first met Diana the day after her birth in January, 2007.  Diana’s mother, Madalitso, was just 15 years old. Afraid to tell anyone of her pregnancy, she hid it, and delivered Diana behind her home. She suffered a post-partum hemorrhage—heavy bleeding that usually requires emergency medical care.   Although her family and neighbors administered traditional medicines, Madalitso died at home, leaving Diana an orphan. 

Wondering how she would feed and support the tiny baby, Diana’s young aunt brought her to Neno District Hospital, where staff from the Ministry of Health (MOH) and PIH’s sister project in Malawi Abwenzi Pa Za Umoyo (APZU), provided the newborn with medical care, and gave her family infant formula, clothes, and the on-going social support of a community health worker. 

“Without APZU, Diana would have been another statistic,” said Veronica. “She would have been an orphan in a family that lacked the means to support her. She would have died.

	Two-year-old Diana at her home.

Today, Diana is a lively, 2-and-a-half year old child who plays her cousins and chatters with her neighbors. Yet the tragic fate of Diana’s mother occurs daily in Malawi--one woman out of every 18 is at risk of dying from pregnancy or childbirth in her lifetime.  Malawi’s maternal mortality rate—a measure of deaths from pregnancy related causes—is among the highest for all developing countries.

The average woman in Malawi has five children, and almost half of these children are delivered at home. Home deliveries in rural Malawi are risky. When pregnancy complications requiring emergency obstetric care such as cesarean sections occur, health facilities with such services can be hours or even a day’s journey away.

To prevent maternal deaths, APZU is working to support a community-based model which supports women in their reproductive health choices, this in conjunction with a strong clinic and hospital-based women’s health program.  The programs are working to focus on antenatal care (as is standard in most public health programs) and on emergency obstetric care; as well as transport to a facility for women in labor, skilled attendants to perform deliveries, and blood and surgical services for when complications occur.

When Veronica first met Diana, she felt empowered by the presence of APZU’s Program on Social and Economic Rights (POSER), which enabled her to provide social support as well as clinical care.  POSER embodies PIH’s efforts to address the social determinants of health and provide the poorest patients with support such as food, transportation, jobs and agricultural inputs. Since Diana’s birth two and a half years ago, the POSER team routinely has provided her family with baby formula, food, fertilizer, soap, and charcoal to cook with.  “APZU, saved this child’s life,” Veronica asserted.

However, Veronica, herself a mother of seven, was also quick to emphasize the work left to be done—that no woman in Neno District or anywhere else should die during pregnancy or childbirth. 

	Community Health Workers at their monthly training.

In order to address maternal health, APZU in partnership with the MOH has taken steps to expand the community health worker program, which initially focused on HIV and TB care, to include other patients such as pregnant women.  APZU has also utilized traditional birth attendants to advocate for delivering babies at the health center rather than at home.  Both community health workers and traditional birth attendants are also educating women about the importance of family planning. In part because of these initiatives, Neno has become one of three districts in Malawi designated as a Safe Motherhood Focus District by Joyce Banda, the Vice President of Malawi and UN Ambassador for Safe Motherhood.

With these growing efforts, there is hope that Diana will never face her mother’s struggle herself. And day may come when Veronica will no longer have to tell the story of a small child orphaned because her mother died during childbirth.

Liz Bird worked for APZU in Neno, Malawi.

[published March 2010]