Deep in the outskirts of Lilongwe, Malawi, are three women who are nursing the wounds of having a life growing within them for nine months and then having to watch that same life slip through their fingers like it was nothing. 

For Nambewe, motherhood is something she had always looked forward to. She had always imagined herself holding her own baby in her arms until that fateful night when her mother got sick. Her mother got seriously sick on the same night that she got her labor pains. She wanted to go to the hospital, but she could not because the people around her would not let her. Someone had to stay and look after her sick mother. As fate would have it, her mother passed away, and again all the attention was given to the funeral and burial preparations. By the time her mother’s burial was over, and finally, someone paid attention to her, her baby had fallen out. Dead. And this was three days after her labor pains first started. 

Nangozo’s story is not so different from Nambewe’s. Nangozo’s labor pains also started around midnight, and she had to find a way to get to the hospital. For Nangozo, however, she was all alone, and the hospital was a long way off, but she was determined to have her baby delivered at a health center, and so she started walking slowly. On the way, her labor pains were being intensified, and so she had to stop multiple times and wished that there was someone who had a bicycle that would have helped her. Along the way, her legs got cold and numb, and she could no longer walk, and so she decided to sit down, and that is when she saw that the baby’s legs had started coming out. Due to the shock and urgency of the situation, she tried standing up but could not and so remained sitting all alone along the road until the baby finally came out, but it was already dead. 

For Nakhoma, her story is slightly different because she at least managed to get to the hospital, but her fate was also not different. She ended up losing her baby. Immediately her labor pains started, she found her way to the hospital, but on getting there, the midwife was not there, and a watchman had to go and get her. When the midwife came, she did not do anything but only told her it was not yet time for her to deliver and went back to sleep. In the meantime, Nakhoma gave birth with the help of a cleaner, but she was hurt during the delivery. The midwife had to be called back to sew her, but she did not do it until the next day noon when the birth had happened during the night. This delay led to Nakhoma having a Fistula. 

The cases of these three women show how much the system has failed the women of Malawi and made motherhood such a dangerous endeavor when it is supposed a beautiful journey for all women who wish to be mothers. In Africa, there are 211 deaths per 100,000 births, according to UNICEF, 2019. Malawi’s maternal death rate remains among the highest in the world; 675 deaths occur per 100,000 live births. 45% of women in Malawi are in the reproductive age bracket. (15 – 49 Years). 1 in 36 of the fifteen-year-old women is predicted to die from a maternal cause eventually. This is contributed to by the fact that contraceptive prevalence is at 42%, which is below average, and even at that, adolescents and communities in the rural areas have limited access to contraceptives. (Mgawadere et al., 2017). For most women in Sub-Saharan Africa, like Nambewe, Nongozo, and Nankhoma, the deaths of their babies or their own deaths could have been avoided if they had the power to decided for themselves to seek obstetric care. If they could access the health centers on time and if they were given the required attention at the health centers. All these factors feed heavily into the continuous loss of lives to maternal mortality. 

What Feeds the Monster?

According to the World Health Organization, 2013, an estimated 303,000 women die during pregnancy in the world and 99% of these deaths occur in low- and middle-income countries and specifically in sub-Saharan Africa and South Asia. The majority of these deaths are preventable because women do try to reach out to health services when an emergency occurs, but there are three delays that present a major problem. These delays are; delay in seeking care, delay in reaching care and delay in receiving the required care. In Malawi, 39.7% of women who do not have access to health care die at home, 21.2% of women access health care but still die at home and 52,1% of them die at the health centers. Even though these delays are the main causes of maternal mortality, there are factors that contribute to the delays happening in the first place. Contributing factors include a lack of awareness of obstetric complications, a weak health care structure, low institutional capacity, economic challenges of accessing health care, long waiting times and lack of skilled personnel. All these factors contribute to the three delays occurring which lead to women losing their lives during pregnancy. 

The first delay, which occurs when pregnant women delay on making a decision to seek obstetric care is contributed to not seeking ante-natal care immediately one finds out that they are pregnant, seeking the help of traditional birth attendants who at times do not have the necessary skills but are not willing to send the women to the hospital and not seeking help immediately after the onset of labor pains. Most women in Malawi get their labor pains when they are still at home before seeking help. This is because the decision to seek help does not solely rest on them but on mothers-in-law, sisters-in-law and sometimes their mothers. Even if these women made the decision of going to the hospital, that decision is also largely affected by the distance that one is supposed to travel, the money needed, previous experience at the health center and the availability of someone to take care of them. For some women, they’d rather go to traditional birth attendants because they are nearer and cheaper and sometimes treat them better than midwives at the hospital. This is risky because when a woman develops complications, they are kept for a long period of time before being referred to hospitals and this endangers the woman’s life. All these reasons point to the fact that women being able to make the decision to seek obstetric care during pregnancy goes a long way in fighting maternal mortality. 

In most African countries, it is normal to visit a public hospital and then wait for hours and hours before finally getting attended to. This phenomenon should not be normal because a lot of lives are lost during the waiting process. The second delay is associated with women getting to the facilities that offer health care but still end up dying because of not receiving the needed care and attention. Weak health infrastructure is the main reason why most women do not get attended to at health centers and end up dying at home. In some situations, when a woman developed complications while at a Traditional Birth Attendant’s place, the attendant tried calling an ambulance but in most cases, the ambulance delayed. Lack of funds is also another reason why women who have sought help in hospitals before ending up dying at home. When the hospital is too far it means more expenses in terms of transport money and hospital fees need to be spent and most of the women cannot afford to pay so they discontinue the visits to the hospital. Improving the quality and availability of maternal health care is needed in order to prevent maternal deaths.

The third and final delay that causes maternal mortality is the delay in receiving care. As stated earlier, 52.1% of women die at the hospital. This is mainly because of a poorly equipped health care system. For some women who rightfully go to deliver at their nearest health centers, they experience complications in the sense that referrals might be delayed due to overconfidence of some caregivers or laxity in the overall system. Low institutional capacity also contributes to the delay. When there is a shortage of health professionals or equipment, drugs, and supplies coupled up with negligence by the midwives, maternal mortality increases. 

The three delays are very important as assessing them and finding solutions can be used as a way of saving the lives of women that are lost during pregnancy.

What should be done

The lives of women lost during pregnancy can be saved by providing health care services at an affordable price and timely. The quality of the services should also be improved, for example, the way the midwives treat the patients since negligence is also a contributing factor to maternal deaths. 

Through the use of already-existing women’s groups in the community, women can be educated on their sexual and reproductive rights and the importance of seeking obstetric care on time. These groups can also be used to come up with ways of helping other pregnant women have access to health care on time and the prospective impact would be great because of the trust that already exists within the group. The women should also be equipped with skills to engage in economic activities so as to empower them economically and their decision making power, especially about their bodies.

Help Change a life

Freedom From Fistula is a charity organization dedicated to helping women and girls who are injured and left incontinent following prolonged, obstructed childbirth – by providing free surgical repairs for patients already suffering with fistula, as well as maternity care to prevent fistulas from happening at all and save the lives of babies. 

Support the cause of the organization by donating and your support and donation will go a long way in transforming thousands of lives in Africa.

          #HealthcareMalawi, #MaternalHealth, #Childbirth, 

REFERENCE

Colbourn, T., Lewycka, S., Nambiar, B., Anwar, I., Phoya, A. and Mhango, C. (2013). Maternal mortality in Malawi, 1977–2012. BMJ Open, 3(12), p.e004150.

Changole, J., Combs Thorsen, V. and Kafulafula, U. (2018). A road to obstetric fistula in Malawi: capturing women&rsquo;s perspectives through a framework of three delays. International Journal of Women’s Health, Volume 10, pp.699-713.

Freedomfromfistula.org. (2019). FFF. [online] Available at: https://freedomfromfistula.org/about-us/who-we-are [Accessed 14 Dec. 2019].

Mgawadere, F., Unkels, R., Kazembe, A., and van den Broek, N. (2017). Factors associated with maternal mortality in Malawi: application of the three delays model. BMC Pregnancy and Childbirth, 17(1).

UNICEF DATA. (2019). Maternal mortality – UNICEF DATA. [online] Available at: https://data.unicef.org/topic/maternal-health/maternal-mortality/ [Accessed 14 Dec. 2019].
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