Motherhood: Tale of joy, anxiety

 Felicia Yohane is looking forward to the day she will deliver her fifth baby. But wrapped around the anticipation is the fear that her baby may not live long. Or, it may never be born at all. Bright Mhango finds out why.

Felicia Yohane, 38, has given birth to four babies in her life. Two of the babies did not live to celebrate their first birthday.

Now that she is seven months pregnant, she is very aware of what can happen to her expected baby.

Yohane lives in one of the 197 villages that look to Lumbadzi Health Centre, some 20 kilometres from the capital, Lilongwe for assistance. She has to walk about two hours to get to the health centre.

And she is not alone. The health centre sees 160 maternity deliveries per month, 10 waiting cases per day and hordes of pregnant women coming for neo-natal care.

But the health centre, which is Yohane’s pillar, has only 13 beds in the small maternity wing that has no waiting area. The 13 beds, therefore, service women who have delivered and those about to.

Yohane finds herself between a rock and a hard place because the next nearest health centre is 15 kilometres away from Lumbadzi.

Giving birth

The situation at Lumbadzi is just the summit that is visible; the real mountain spans across Malawi. Almost all health centres in the country face what Lumbadzi Health Centre faces.

Out of every 100 000 women that give birth in Malawi, about 700 of them die in the process. This is high by all means; in Estonia, out of 100 00 women, only two women are expected to succumb.

Yohane’s deceased little ones are also part of the bigger nationwide problem; 80 babies die out of every 1000 before they complete their fifth year. She lost her babies at four and nine months, and the worry for her next baby is written all over her baby face.

Since Joyce Banda became Malawi President in April, she instantly leapt to highlight the plight of mothers and infants. If the late Bingu wa Mutharika sang food security and Green Belt, Banda’s song is from the safe motherhood studio.

Banda set up her Presidential Initiative on Maternal Health and Safe Motherhood. Though difficult to separate it from the politics that accompanies its activities, the initiative is breathing new life into the fight against preventable deaths of women and children around the pregnancy and birth period.

Misozi Jimusole is the initiative’s media and advocacy officer. I asked him why women need to be given priority.

“Women make up 52 percent of our population; they contribute the most to the country’s output. It’s only fair that they should be safeguarded. In safeguarding women, we will also be advancing towards Millennium Development Goal number five,” said Jimusole.

Yohane braves the October heat to travel to the hospital. She knows what dangers come with shying away from hospital; the rest are not that informed.

Cultural beliefs

Jimusole said some women, discouraged by distance, cultural beliefs and illiteracy, turn to traditional birth attendants who have little knowledge of pregnancy complications and motherhood best practices.

She said this exposes mothers to all manner of risks, including death.

While 71 in every 100 women go to the hospital, 29 seek the attention of traditional birth attendants, who obviously cannot perform a Caesarean section and will be quick to point to witchcraft for a simple complication.

Children born in the hands of traditional birth attendants are also likely to miss out on vital immunisation given to the baby in the early days of its birth. If the mother loses too much blood during the birth process, there is little the attendants can do but watch the new mother die.

But with only 13 beds at the health centre to accommodate 160 women all in a month, it might not be culture or illiteracy that is forcing women to deliver at home.

This is the focal point of Banda’s initiative.

Quality maternal care

“The initiative wants to construct maternity waiting shelters to ensure close monitoring of pregnant mothers and encouragement to seek quality maternal care at public health facilities to avoid complications arising from giving birth at homes,” said Jimusole

And it is not just cosmetic talk.

The initiative is also seeking to replicate its Mulanje feats in Dowa, Balaka, Karonga, Mchinji, Lilongwe and Ntcheu. Lumbadzi will also get a shelter.

In the drive to attain an almost zero maternal mortality rate, infrastructure and human resources are part of the package. The issue is, if all women decided to deliver in hospitals, are there enough trained minders?

For Lumbadzi Health Centre, there are 13 qualified nurses to mind not just the maternity wing but the whole facility such that the 160 or so pregnant women have to see the same people that people with malaria have to see.

President Banda’s other goal in the initiative is to beef up the number of these minders. In a slow but significant move, she has already identified 200 young women, 10 from several districts, to start midwifery training.

“The project aims at increasing the numbers of skilled and trained midwives. Maternal and neonatal rates are still high not only due to lack of sufficient health personnel but also untrained traditional birth attendants.

“We also want to build capacity of community midwives to promote health seeking behaviour and attitudes of the communities towards family planning, reduced pregnancy, delivery complications and encourage girl-child education,” said Jimusole.

Winning over communities

Again, having trained personnel and building infrastructure is no guarantee that the village folks will flock to get expert care. In Malawi, missionaries came with life-saving drugs but the population took years to accept modern medicine.

Some still have not.

Jimusole said the third goal of the initiative is just that; trying to win over communities.

“In order to achieve the effective access to maternal and neonatal health care, community mobilisation and training to chiefs and their subjects is of paramount importance. There is lack of knowledge on how to handle maternal and neonatal health care, so chiefs, as opinion leaders, are good targets in accelerating behaviour change.

“The chiefs promote cultural habits that influence health-seeking behavior and attitudes of the communities towards family planning, pregnancy and delivery, preserve women dignity by stopping defilement and other forms of violence that make women insecure and unstable in their lives,” he said.

One of the chiefs who is well won over to the side of progress is Inkosi Kwataine of Ntcheu.

He says his area of jurisdiction is on its way towards decreasing mother and infant deaths by employing a simple trick which he is now campaigning for.

“Local documentation of pregnancies will erase many problems. Chiefs will be able to track the progress of the pregnancy and ask if the mother-to-be has gotten a vaccine, whether she plans to go for delivery and to push her to go to the hospital when her time is close,” said Kwataine.

Hebeli Honde was also at Lumbadzi Health Centre when Nation on Sunday visited the facility.

Honde comes from kwa Chiponde Village in the area and is only 18. She has never given birth before; she will do so in three months.

“I cannot go trust azamba (traditional birth attendants). It’s my first time to give birth and I want all the attention I need. I will come and wait here when I am in my advanced stage,” she said.