* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
If we want to improve the lives of women in low-income countries we must broaden the lens beyond the relatively narrow problems we are seeking to address
Susana Oguntoye is the director of monitoring and evaluation Africare.
Tamanda is a young pregnant woman nearing full term in a small village in rural Zambia. Pregnancy is not an unusual event where Tamanda lives. Like most of sub-Saharan Africa, the number of births per woman is about twice the global average.
But Zambia, like the rest of sub-Saharan Africa, also has high rates of maternal mortality, in part because many women live far away from a health facility. In Zambia, for every 100,000 live births, 225 women die from hemorrhage or other complications related to childbirth. That compares to five maternal deaths per 100,000 in the Netherlands. Tragically, some women in Africa die on the side of the road in a desperate last-minute attempt to seek help.
Tamanda could dramatically improve her odds by traveling to a maternity waiting home (MWH) that would provide a safe place to stay before and after childbirth. These facilities are connected to health clinics equipped to handle common pregnancy-related complications for mothers and their newborns.
Yet, if that’s all she knows about such a home, that it’s a place relatively far from her village for delivering her baby, she will probably choose to give birth at home, just like most of the women in her village. For people committed to fighting maternal mortality, that decision can be difficult to understand.
The good news is that today across sub-Saharan Africa, more pregnant women like Tamanda are saying yes to maternity waiting homes. For example, Zambia’s Mother Shelter Alliance has partnered with the Zambian government to construct 24 homes. In Liberia, between 2010 and 2018—in the face of the Ebola epidemic—the number of MWHs went from five to 114. The homes are also in use in Zimbabwe, Ethiopia, Tanzania, Nigeria, Uganda, Ethiopia and Malawi, among others.
How the Alliance got from no to yes can offer important insights for decision-makers who will be attending this week’s Nairobi Summit, which marks the 25th anniversary of the International Conference on Population and Development. The evolution of MWHs into effective tools for reducing maternal mortality can help inform other efforts to empower women in low-income countries through sexual and reproductive health services.
The main lesson we can share is that to be successful, we had to consider women like Tamanda holistically, considering all of her needs, not just her pregnancy.
For most women in rural Zambia, pregnancy is not a medical issue. It’s a common, regular life occurrence. Daily, Tamanda’s primary concerns focused on tending to her maize crop, fetching water or cooking. Why should Tamanda press the pause button on all that to move into a MWH, leaving her husband and other children behind?
Our response has been to provide multiple reasons for Tamanda to press the pause button.
First, we make sure Tamanda understands she would be spending most of her time in a pleasant, comfortable home with other expectant mothers, not at the nearby clinic itself. We did this by working with staff and providing updated skills and continuing professional development.
We also worked to establish what are called local savings and internal lending communities. These groups—mostly comprised of women of child-bearing age—offer loans that women can use to purchase supplies for their newborn and to attend training courses while awaiting childbirth at MWH. The training sessions available at the MWH can help women learn business skills, like how to set up a tailor shop or mobile phone charging kiosk. Already, almost 7,000 people participating in these lending communities in Zambia are running their own small village enterprises.
Our journey has taught us that if we want to improve the lives of women in low-income countries, we must broaden the lens beyond the relatively narrow problems we are seeking to address. In the case of MWHs, that means governments and donors must be willing to invest in much more than the brick and mortar of the facilities themselves.
But the return is also much greater. What started as a shelter to help women safely deliver a child has also become a portal for connecting them to a wider world of opportunity and empowerment.