Mothers Suffer Delays in Emergency Obstetric Care
“A woman who is pregnant has one foot in the grave.” (Proverb, Chad)
“Clothes should not be made for an unborn child.” (Bangala Proverb)
When a woman gives birth in Uganda, she is congratulated “kulika omwana,” meaning “well survived.”
While the 47% reduction in global maternal mortality over the last two decades is an impressive gain, the fact remains that childbirth continues to be one of the most life-threatening events for a woman and her baby in the developing world.
So, where does the healthcare system, or lack thereof, fail the world’s mothers?
There are three main delays when seeking emergency obstetric care: recognition, transport to a healthcare facility, and receipt of care at the facility.
Recognition and Decision to Seek Care
In Sub-Saharan Africa, more than half of all births take place at home in the absence of skilled care. While traditional birth attendants may attend these births, the lack of skilled midwives or those with comparable skills may delay recognition of life-threatening complications like postpartum hemorrhage. In the case of postpartum hemorrhage, visual estimation of blood loss is notoriously inaccurate and recognition hinges on differentiating between normal and excessive blood loss. The story of a woman suffering excessive bleeding for hours before her family takes her to a hospital or clinic is all too familiar.
While recognition poses its own challenges, the decision to seek treatment may not be a foregone conclusion. Cost concerns and the tendency to undervalue a woman’s life affect timely transport to health-care facilities.
Furthermore, cost of transport to the facility alone may present an insurmountable obstacle for families that cannot afford the fee. Once the decision is made, traveling from remote areas is wrought with hardship. The limited availability of ambulances or other vehicles in developing nations poses serious concern for a mother’s timely referral to the healthcare facility. Rural roads are sometimes unreliable, and the nearest clinic might be too far. The time it takes to transport a woman with severe complications can cost her life.
Receipt of Emergency Care
Once a woman arrives at a clinic, the ordeal is not over. The clinic may be understaffed and undersupplied, with no doctor or midwife present to care for her and no supplies to use. The lack of reliable electricity is especially problematic at night when lighting is necessary to perform a procedure. Additionally, if a woman cannot pay for services, she may not be admitted to the hospital.
By focusing on righting these wrongs, by empowering women and changing the way families perceive girls, by working to improve infrastructure and increase access to healthcare, by developing low-cost solutions to treat these complications, progress is within reach.
PWRDF. 2012. Bicycle Ambulance. [Photograph]. Available from https://flic.kr/p/dT22sQ*
Irene Scott for AusAid. 2013. A small child walks across the lawn at the Christian Care Centre. [Photograph]. Available from https://flic.kr/p/hfix6p*
Amnesty International Publications. 2009. Out of reach the cost of maternal health in Sierra Leone. Available at: http://www.amnestyusa.org/pdf/SierraL_maternaltrpt.pdf
*In no way does the licensor of this image endorse SCIWHF, the content of this post, or the use of this image on this website.