Keeping mothers alive in Africa
HIV accounts for 61,000 maternal deaths every year. Kenya, South Sudan, Uganda and Zambia all have a particularly high burden of HIV and maternal mortality, so a 12-month programme during 2011 set out to reduce maternal deaths in these countries.
The project, which also aimed to improve the health of HIV-positive mothers and their children, reached over 100,000 people, resulting in better-informed communities and an increase in safer deliveries. This is in countries where it is widely believed that death is all too often an inevitable part of giving birth.
In a generalised epidemic HIV-positive mothers are four to eight times more likely to die during childbirth. But the heightened awareness generated by this programme has seen an uptake in prevention of mother-to-child transmission services and more women opting to deliver at health care facilities. This has substantially increased their chances of delivering their baby safely and HIV-free. When prevention of mother-to-child transmission services are used the chance of a baby born to an HIV-positive mother becoming infected is less than 1%. Without these services there is a 20-45% chance.
Knowing what gives a mother and her baby the best chance for health and successfully communicating this are two different things, as the advice often contradicts traditional norms.
In all four countries community champions and peer educators have been key to engaging tribal, religious and community leaders who are the entry point to the rest of the community.
In Kenya, community radio aired talks with policymakers and community members and this helped get the message across to larger audiences in local languages.
When men recognise the value of maternal health services it can make it easier for women to access them, so in Zambia men were targeted through male-only community dialogues. Father of two, Amon Banda, said: “I went with my wife Mwenzi to the clinic. I always go. I want to know and care that my child will be born safely.”
Actually getting to a health facility is a big issue in rural areas. So in South Sudan rakshas (tuk-tuks) and moto-ambulances are being used to get women in labour there safely. Action for Rights Relief and Development (ARRD) is one of the community-based partners supported by the Alliance that implemented the programme in South Sudan. The organisation serves around 23,000 people, including Margaret Oleyo, 30, who has six children.
Margaret’s youngest, Juma, is three weeks old: “I’ve always had complications giving birth. Thanks to ARRD I could deliver Juma in hospital. Before I had to pay for and find transportation to go to hospital. I don’t think I could have afforded it this time.”
Initiatives like this across all four countries made a difference to the number of HIV-positive women coming through the doors of health facilities. “Since the start of this project health facilities that were seeing five mothers a week for delivery are now seeing more than 20,” says Leonard Okello, Country Director at Alliance Uganda.