Fighting the epidemic of maternal and newborn mortality with ‘Big Belly Homes’
Since 1987, the number of pregnancy-related deaths per 100,000 women in the U.S. has more than doubled — from 7 to 17. It now has the highest maternal mortality rate in the developed world. Yet, it is still far lower than in Liberia, where I worked as a trained midwife for several years before joining the country’s Ministry of Health.
In Liberia and across sub-Saharan Africa, pregnancy can be as dangerous as many infectious diseases or cancers. For every 100,000 children born in Liberia, there are 1072 maternal deaths. And for every 1,000 live births, there are 26 neonatal deaths.
In Liberia, postpartum hemorrhage and sepsis remain key killers among mothers, while asphyxia and sepsis are the leading causes of deaths among newborns. Globally, 300,000 women die every year — some 839 every day — from pregnancy related complications like postpartum hemorrhaging. That’s about the same number of women that die every year from cervical cancer.
Yet, the issue of maternal mortality does not spark the kind of consistent, impassioned attention devoted to other pregnancy-related concerns, even when international celebrities like Serena Williams and Beyoncé speak of their harrowing experiences with dangerous, though all too common, pregnancy-related complications. But maternal mortality has the potential to generate a rare island of consensus in the sometimes stormy waters of reproductive health issues.
It’s hard to imagine a more important matter for families, communities and countries than preventing deaths in pregnancy, which makes its neglect harder to fathom. Along with protecting the health of mothers, we are talking about preventing situations in which many children arrive in this world at the same time the person who gave birth to them dies.
Also, the same lack of care during and shortly before and after birth that is a major contributor to maternal mortality is a key reason one million infants die every year in their first day of life—and another million in the next six days.
For pregnant women in Liberia and elsewhere in sub-Saharan Africa — a region that is home to half of the world’s maternal deaths — a key risk factor is the lack of a safe place to give birth. Where I work, many women live in remote rural villages where they have limited or no access to transportation.
Getting to a health facility could require a walk of anywhere from two to ten hours — difficult on a good day, terribly painful or just impossible when they are in labor, and in need of skilled attention.
Their choice is to either stay put or risk a walk to a health facility, which I’ve seen end with the mom having the baby on the side of a road, or worse. Skilled midwives can make a difference, but they can have the same difficulty in reverse: of making their way to rural villages to assist with a birth. I know at least one fellow midwife who was bitten by a snake while rushing in the middle of the night to assist a woman in labor.
Liberia and several other African countries, including Zambia and Ethiopia, have been working to address this problem by establishing a system of what are often called maternity waiting homes — though in Liberia some playfully refer to them as ‘Big Belly Homes.’
These are facilities where women nearing the end of their pregnancy can stay until they are ready to give birth. And to ensure that women get the care they need when labor begins, the waiting homes are strategically located near a well-equipped and resourced rural health facility.
Since 2010, we have established 114 maternity waiting homes across 14 of Liberia’s 15 counties. The challenge is there are still not nearly enough homes to serve all of the communities in Liberia and the ones that are available often lack the beds and materials needed to meet the demand.
To be successful, the waiting homes also need to be linked to healthcare facilities that are equipped to provide safe maternity care for pregnant women and their newborns, including handling complications. The reality is that maternity waiting homes are only part of the solution. The global plague of maternal and newborn deaths is ultimately a symptom of a chronic neglect of basic health care.
But in Africa, for governments, donors or aid groups looking for ways to fight the epidemic of maternal and newborn mortality, the homes are a low-tech, extremely cost-effective intervention. They offer women close to birth the simple opportunity to spend those last few days of pregnancy planning for the future of their child, instead of worrying about dying in labor or delivery and never getting the chance to meet their newborn.
While the situation in the United States is very different, the key conclusion from the CDC assessment of maternal mortality that ‘most pregnancy related deaths can be prevented’ holds true for Africa as well.
If we truly value life — of both mothers and the children they are carrying — we should be dramatically escalating an international effort to ensure maternal mortality is a rare event, rather than the tragically common occurrence it is today.
Bentoe Zoogley Tehoungue is director of the Family Health Division at Liberia’s Ministry of Health.