Why is sub-Saharan Africa such a dangerous place to be born?

Save the Children - State of the World's Mothers 2013 - front coverOn 12th May 2013 Save the Children launched their 14th annual State of the World’s Mothers report.

The report details the best and worst places in the world to give birth.  Here are some facts about sub-Saharan Africa.

Sub-Saharan Africa is by far the riskiest region to be born.

  • The 14 countries with the highest first-day death rates are all in sub-Saharan Africa.
  • As a region, sub-Saharan Africa’s first-day mortality rate is 12 per 1,000 live births.
  • Babies born in sub-Saharan Africa are more than 7 times as likely to die on the day they are born compared to babies born in industrialized countries.
  • An estimated 397,000 babies die each year in sub-Saharan Africa on the day they are born.
  • The region accounts for 12 percent of the world’s population but 38 percent of the world’s first-day deaths.

Why is sub-Saharan Africa such a dangerous place to be born?

Many sub-Saharan African countries have unusually high rates of preterm birth. For example, in Malawi, 18 percent of babies are born too early – the highest prevalence in the world.

Poor Health
Poor health among African mothers contributes to high rates of first-day death for babies. Serious maternal malnutrition is common in the region, where 10-20 percent of women are underweight. Especially large numbers of underweight mothers are found in Ethiopia (24 percent).

Young Marriage
It is common for women in sub-Saharan Africa to marry and begin having babies at a young age, before their bodies have fully matured.

Low Contraceptive Use
Low contraceptive use, high fertility and poor newborn outcomes go hand-in-hand. Across the region, less than 16 percent of women use a modern method of contraception. It’s not surprising, then, that women in the region have on average five children each. Mothers in Malawi, Mali, Somalia and Zambia have six children on average.

Availability of Healthcare
Health care for mothers in sub-Saharan Africa is woefully insufficient. On average, only half the women in the region receive skilled care during birth. In Ethiopia, Niger and South Sudan, more than half of all women receive absolutely no skilled prenatal care. In Ethiopia, up to 90 percent of women give birth at home without skilled care. A severe shortage of health workers in Africa explains many of these dire statistics. The region as a whole has only 11 doctors, nurses and midwives per 10,000 people – less than half the critical threshold of 23 generally considered necessary to deliver essential health services. Out of 48 countries in sub-Saharan Africa with available data, only eight meet the minimum threshold for number of health workers.

This is the reason why we focus our work in sub-Saharan Africa.  To read the full report please visit our Resources section.  To find out what we are doing to help in each of our projects please click here.

Knitted vests delivered to babies in Malawi

Knitting Donations from S.Howden August 2012One of our trustee’s, Grace, is based in Zomba district, Malawi.  On a recent visit to the UK she took a huge box full of knitted baby vests and blankets back with her along with some blood pressure monitoring machines.  The vests and blankets are kindly donated by a wonderful team of volunteer knitters who regularly send us beautifully crafted items.

Nurses with the baby vests

This picture shows the nurses who are in charge of the six health centres; Chipini, Matiya, Thondwe, Magomero, Mayaka and Pirimiti sharing out the blood pressure machines, baby vests and blankets.  Each labour ward and postnatal ward will have a supply of vests and blankets to hand out to the mothers most in need.  Grace will be taking more vests back with her in June.

Mum and baby - CroppedHere is a new mum in Pirimiti hospital who has just been given one of the beautiful knitted dresses.  Many mothers can’t afford to buy extra clothes for their baby.  At night time the temperatures can drop considerably so the vests and blankets help to keep babies warm at night.

If you would like to knit some baby vests or blankets for us please find the Baby Vest Pattern here.  If you have any questions please email fundraising@maternityworldwide.org or call 01273 234033.

For more information about our project in Malawi please click here.

Thank you to everyone who has knitted items for us, the mothers who receive them are very grateful.


Update from Lensa, a trainee midwife in Ethiopia

Lensa at University

Lensa was a Diploma Nurse in the West Wollega area of Ethiopia.  We are sponsoring her 4 year course to become a qualified midwife.  Lensa started the course in October 2012 and we asked her to let us know how she is getting on.  Here is what she had to say;

I have classes Monday to Friday and sometimes tutorials on Saturday.  There are 53 students in my class and there are some very clever students.  I had exams in sociology and health technology and scored A in both.  I got an A+ in my anatomy exam last week and have my physiology next week.  The Myles textbook which Maternity Worldwide sent me has really helped.  I also have English classes as part of the course, I got a B+ for my exam but I am trying to improve.  I live in a nice dormitory with 8 other students.

It costs as little as £80 a month, on average, to sponsor the training of a midwife in Ethiopia.  In West Wollega, throughout the career of a midwife they could help to deliver approximately 7,500 babies.  At the moment around 94% of women give birth without any skilled health workers present.  We could change this by training more midwives.  If you would like to help then why not host a Muffins for Midwives event.

How two sheep can transform a family

In November 2012, Laura Brown, one of the Maternity Worldwide trustees visited our project in Ethiopia.  Laura was keen to see how the income generation schemes, started by Maternity Worldwide in 2006, had made a difference so she set about finding one of the first women to receive a loan from Maternity Worldwide.

Meet Ebese.

Ebese received 325 Birr (£11) seed funding to buy two female sheep to breed with her existing ram, amazingly both sheep she received were already pregnant!  She sold one of the sheep for 410 Birr along with the lambs and raised an additional 1200 Birr.  With this money she bought a donkey to help her carry goods to market in Gimbie (10km away).  The original remaining female sheep (pictured) has continued to breed and produced 30 more sheep over the years.  Ebese has sold the 30 sheep at market.

The additional income from the sale of lambs has helped Ebese to:

• finish building her house

• educate her son by paying for him to go to school

• lend funds to others to set up their own small businesses

• become a respected member of the community

• become a role model for other women through her empowerment and knowledge

This relatively small amount of money has helped Ebese to transform her life and opportunities for her family.  By enabling Ebese to earn her own money Maternity Worldwide have allowed Ebese to become independent and make her own decisions about what she spends her money on.

We believe in providing sustainable ways of making a difference which will continue long after we have gone.  By empowering women to become financially independent, Maternity Worldwide are helping women to pay for transport to health centres when they are pregnant – this is helping to address one of the three issues contributing to maternal mortality.  To find out more about the three delay model please click here.

Long-term volunteers return from Ethiopia

Long-term volunteers Karen and Jeremy have just returned from a year of volunteering at our project in Ethiopia. Read Karen’s fascinating account of the time they spent there.

In October 2011 we were zipping up suitcases, overfull with baby clothes, potentially useful medical equipment and essential supplies of toothpaste, contact lens solution and shampoo. After much preparation, we were finally heading to Heathrow to board an Ethiopian Airline plane and were on our way to a year in Gimbie, Ethiopia.  Anticipation was tinged with trepidation as stories of draconian customs officials had us wondering whether the ultrasound scanner, so generously donated by friends, would make it through customs without a hefty tax bill. Would they let us take our computers through? What about the portable printer or the assortment of salami and cheese? In the event, all was well, possibly helped by an influx of Chinese engineers who helpfully created chaos at customs.

As we left the plane, however, we embarked into a different chaos – that of Addis.  Over the next few days we rushed from Government office to Government office, organising work permits, residency passes, the equivalent of an Ethiopian CRB check, and a remaining treasured possession; a driving licence.  Clutching our work permit book, duly stamped in 8 or 9 places, and more importantly, Jeremy’s medical registration, we headed off on the long and dusty road to Gimbie, and to the hospital that was to become our home for the next year.  Generously the hospital authorities allowed us a vacant house, the only one with a first floor, up a perilous staircase and with two bedrooms.  We also inherited a hen house, soon to be occupied by Masie and Daisy, intermittent suppliers of fresh eggs, and a monkey proof caged garden, which we planted with peas, potatoes, carrots and lettuce. Yes, we had definitely arrived.

Jeremy was soon busy in the hospital, working with Wasihun, the local obstetrician and Heidi, who was coming to the end of her volunteering time before returning to Denmark. In addition to offering ante-natal care to the immediate locals we were all hard at work helping women coming in as emergencies from far and wide; both from the Maternity Worldwide supported villages and from as far away as Asosa, a hospital 4 hours drive away, which sadly has no obstetrician at all. There was much to do and the first few weeks were full of surprises as we learned about the new and different situations we would encounter.  A real difficulty was looking after the small babies, often born in poor condition. Initially, I adopted the role of neonatal ‘expert’ as she had previous experience in this area of work. Having discovered that staff were not always knowledgeable about caring for neonates, we developed protocols and taught our local colleagues about the simple care that could help keep these small citizens warm, dry and fed.

Midwives from both the local college and one further afield, attend the hospital for their clinical placements. Having realised that there were Maternity Worldwide volunteers available to teach much needed skills, the ward rounds soon became accompanied by student midwives eager to gain new knowledge and skills. Classroom teaching was now extended to the clinical environment, with clinical cases from the ward round being used as a forum for discussions about obstetric complications and their management.

Additional learning opportunities arose from the provision of treatment for cervical cancer, which is a major health problem in sub-Saharan Africa, leading to early death and hardship for the family.  By training the local doctor to surgically remove the tumour, Jeremy was able to provide a hope of cure and certainly prolonged symptom and disease free survival for many women.

My work was largely community-based and so we were delighted when our much-needed ‘truck’, an ageing land cruiser, had arrived in Djibouti. So off we set again, and after completing many forms, we drove away from the opened shipping container.  After an exciting drive through the deserts of Afur and the eastern rift valley, we negotiated the unmade roads and were back home to Gimbie!  I became an intrepid negotiator of the back routes of West Wollega, visiting the Maternity Worldwide sponsored health centres and offering both training for local nurses, midwives and health officers, and antenatal screening clinics for local pregnant women.  As she bumped her way along the road, word soon spread and the clinics overflowed – the little faranji who drives very fast, as we were to learn she was called, was coming!

Women would travel for hours by foot to see her and were delighted, if not amazed to be able to see their baby on the ultrasound scan. In a world where women don’t have mirrors to see themselves, an image of their unborn baby must have been quite peculiar indeed. Having screened women for high risks, the car was always full on the way home with women who required hospital care. As many women remarked; it was an excellent team approach, with the wife finding the problems in the villages and bringing them back for the husband to treat in the hospital.

When volunteering in any African country, you are always perplexed by the ‘sustainability’ dilemma. Can whatever good you believe you are doing, continue after you have left? We spent many days and evenings discussing this very issue and were ever conscious of the need to train local people to continue the work. For much of the work we did, we believe that we have been able to leave some skills, attitudes and knowledge behind. At times, however, we had to accept that it is still valuable to improve the outcomes and alter the pathways for the individuals that we met and cared for.  For these people, there are sustainable differences, and that in itself makes our visit worthwhile. Lasting change though, is always more difficult to see, but perhaps more small babies will go home with their mothers as a result of simple interventions and perhaps both women and those who care for them in the community will see that labour is safely carried out in the most appropriate community and hospital setting.

All too soon, it was time to leave and now we are home having left behind many good friends, but with many fond memories and tales of adventure. We feel a real sense of privilege having worked in Ethiopia as volunteers for Maternity Worldwide. Without all the contributions to the charity, none of this would be possible.

To find out more about volunteering at one of our projects please call 01273 234033 or email info@maternityworldwide.org.

Our heartfelt thanks to Karen and Jeremy for the huge difference they have made whilst volunteering for Maternity Worldwide.