Imagine giving birth, or watching a loved one give birth, in a mud-floored hut without access to clean water or a basic latrine. This is the reality for millions of women in Malawi and other developing nations.
In Malawi, approximately 30% of people in rural areas lack access to clean water and more than half lack basic sanitation. Malawi is one of most perilous places for a woman to give birth, with nearly 40% of rural women giving birth at home. The birth rate is among the highest in Africa, at over 40 births per 1,000 people, and the maternal mortality ratio is also exceptionally high, with approximately 460 deaths for every 100,000 live births.
As Oliver Cumming of the London School of Hygiene and Tropical Medicine pointed out at the Global Maternal Health Conference (GMHC2013) in January, but the vast majority of home births in Malawi take place in a home that lacks improved water and/or sanitation facilities. Changing this will require taking on many challenges. For instance, upwards of 80% of Malawi’s inhabitants live in rural areas, so distance to health services is a major challenge. The geographic proximity to emergency obstetric care is a key factor in determining the risk of whether or not rural deliveries will be safe, but even in the presence of medical care, lack of access to a clean water source and sanitation facilities can lead to severe risk of infection for both women and babies. However, efforts are underway to improve conditions for birthing mothers in Malawi.
Her Excellency, Dr. Joyce Banda, the President of Malawi, has recently sanctioned the President’s Initiative on Maternal Health and Safe Motherhood to address barriers faced by women in rural areas to giving birth at a health facility. This is achieved in part through the construction of Maternal Waiting Shelters, which are built adjacent to birthing centers or health clinics, and provide a place where women can stay with an attendant prior to giving birth.
The shelters will allow rural expectant mothers to make the long journey to medical clinics before the onset of labor, while providing them a space to wait until they are ready to give birth. The implementation of these new waiting shelters will reduce the risks that go with giving birth at home in remote villages with traditional birth attendants, often far from any medical, clean water or sanitation facilities.
In order to further improve maternal health in Malawi, Freshwater Malawi together with its U.S.-based sister organization, Freshwater Project International, has developed an idea that is focused, but comprehensive it its approach. Our proposal is a pilot project that includes a community-driven, social work approach to the provision of a fresh water source (borehole) and sanitation facility (latrine) at a Maternal Waiting Shelter built adjacent to a health center/birth facility in a rural area of southern Malawi.
The project will also include neonatal hygiene care/behavior change training and resources for healthcare professionals to implement with expectant women in the waiting shelters. A site-specific assessment study of the maternity ward at the health center and delivery of a 40-ft container of obstetric-specific medical supplies and equipment will be implemented by our partner organization, Project C.U.R.E.
Monitoring of key health, social, environmental, and performance indicators will be used to quantify and demonstrate the benefit to maternal and neonatal health. The primary objective is to reduce incidences of infection at birth. The expected impact of the project includes a reduction in maternal mortality in the southern region of Malawi. This project is innovative because it utilizes a comprehensive, cross-sectorial approach to saving lives at birth through the provision of safe, sanitary access to WASH resources and further strengthens the obstetric capacity of the health centers. If the pilot project is successful, plans will be made to scale up the initiative at other Maternal Waiting Shelters throughout the country.