By Robert L. Mallett, Africare President and CEO
Every day in sub-Saharan Africa about 550 women die due to complications of pregnancy and childbirth. Liberia has one of the highest maternal mortality ratios, with 1 death out of every 13 deliveries. The mortality rate of newborns, within the first 28 days of life, is also high – 37 for every 1,000 live births.
These deaths are all the more tragic because they result largely from preventable complications that arise during the critical period of labor, delivery, and the immediate 24 hours after giving birth. These complications go untreated because women have poor access to health services. Pregnant women often have to cross rough terrain to get to a health facility, with little to no transportation options or support. It is dangerous, exhausting, and detrimental to an expectant mother. Every day in sub-Saharan Africa about 550 women die due to complications of pregnancy and childbirth.
To address one of the enormous challenges these women face, Africare and the University of Michigan developed a bold new approach to overcome the distance barrier for women living in some of the most remote regions of Liberia. From 2010-15, Africare and the University of Michigan with the support of the Ministry of Health (MoH) and with funding from USAID (United States Aid for International Development), developed a partnership to design, construct, and evaluate the first Maternity Waiting Homes (MWHs) in Liberia.
These are residential dwellings near health facilities where women in the late stages of pregnancy can stay to await delivery and receive care after giving birth. The Homes have been used in a variety of settings as a “geographic bridge” to overcome distance and transportation barriers that can prevent women from receiving obstetric care in a timely manner. Research conducted by the University of Michigan indicates that MWHs are saving lives.
The five original Africare MWHs in Liberia were used by more than 2,200 women during the first five years of operation, leading to a reduction in both maternal and neonatal mortality.
Following the successes in Liberia, Africare received funding from other donors to construct MWHs in rural Zambia, where half of Zambian families do not live near a health facility.
Africare and the University of Michigan worked together to continue to improve the model and apply lessons learned from Liberia. We know that to make a substantial contribution to maternal and neonatal health, the homes need to be culturally appropriate, offer high-quality care, and create an environment where women can be well taken care of during the final days of their pregnancy, sometimes far removed from their families and the support of their communities.
The homes must also prove sustainable in the long term by empowering local communities to both manage them effectively and generate income to support operations. Today – three years after completing the original MWH work – Africare and University of Michigan have returned to Liberia to conduct a country-wide assessment of the impact of MWHs on maternal/child health. We are gathering critical data to examine utilization, impact, and develop a core model of how MWHs should be designed in the future.
In partnership with the Ministry of Health and funding from the Bill and Melinda Gates Foundation, Africare and University of Michigan are conducting a country-wide landscape analysis of the scale-up of 100+ MWHs spanning all Liberia’s 15 counties. The team has visited and assessed 132 MWHs throughout Liberia. The outcomes of the Liberia study will help to improve and perfect the MWH model and ensure that MWHs are providing the care needed to help save the lives of women and infants in Africa.
“Last year there was a woman who came to visit the Phebe outpatient department for antenatal care. She entered the room and said ‘anytime I get pregnant, I always have a dead baby; it makes me sad and sorrowful.’ I examined her and determined she had an inadequate pelvis, which had most likely caused her stillbirths. I counseled her to come and stay with me at the MWH. I consulted with the doctor and upon going into labor, he did a C-Section and delivered a healthy baby. She is very grateful and visits me at the MWH often.” – Viola Makor, RN, Midwife and Reproductive Health Supervisor Phebe MWH, Bong County.