Many people have requested an up-to-the-minute description of what is about to happen in rural Tanzania: reducing deaths of mothers and babies beginning with the formation of women's groups in remote rural communities.
Here is a short résumé:
In the UK, one mother in 10,000 dies in relation
to giving birth – about one every two years. In rural Tanzania, by contrast, nearly
1 in every 100 women dies in childbirth, and up to 10% of children do not reach
their fifth birthday. In this vast but peaceful country, the reasons are many and
interconnected: lack of access to health care; social inequality; lack of
education; chronic disease; malnutrition; long distances to travel when sick;
poor family planning; and poor transport. Underlying it all, 90% of the
population live on $2/day or less.
How do we in the privileged world help mend such
awfulness? It is not as simple as trying, from 5,000 miles away, to fix the problems
with water, nutrition, sanitation, education, transport, or antenatal care. Sadly,
Africa does not work like that. The ambulance breaks down. The family planning
service is not used. The Traditional Birth Attendant continues to watch
helplessly as the woman bleeds to death from a ruptured uterus, or dies in
convulsions from eclampsia.
In this litany of tragedy, however, a new and hopeful song
is emerging: the voice of women.
Engaging with rural African women, and finding what they
think about their own problems, is a complex and difficult task. But giving
them a voice in their own communities, and allowing small rural villages to set
their own priorities, is finally making a substantial impact on death. In
Malawi, this approach produced a 74% reduction in maternal death, and a 41%
reduction in death of babies.
This stunning achievement is perhaps less surprising when
you consider how many of the causes of untimely death of mothers and babies
would be in part influenced by maternal choice: seeking help early; breast
feeding; immunisation; better nutrition; take-up of antenatal care and family
planning; etc.
Can Malawi’s success be exported to its northern
neighbour? We intend to find out! Berega Hospital serves a vast and
inaccessible territory of rural Tanzania with a population of 217,000. There
are 8,500 births/year, of which only 1000 occur in a health facility. After two
years of planning, a new project now hopes to reduce tragic deaths, and to
bring sustainable and multi-faceted enrichment to the lives of the women of
this area.
The project is called: EMBRACE: ‘Empowering Women & Babies to Receive Adequate Care & Equality’. (In Swahili: Tushikamane: ‘We are working together in solidarity’.) Through empowerment and education of women – including young pregnant women, as well as Traditional Birth Attendants, Village Health Workers, Hamlet Leaders and key women – the project will seek to help these remote villages find their own way forward into the twenty-first century.
In each hamlet, working with existing authorities and
structures, a women’s group be formed. It will begin by listening to the
stories of women of child-bearing age: remarkable mothers who give birth and
raise children far from any modern help. It will then seek to explore the roots
of the problems of maternal and child mortality. As the conversations delve
deeper into the problems, gradually others are drawn in to make their
contribution: the men; the community health workers; teachers; existing
charities and NGOs; Governmental initiatives; etc.
At the end of a defined process, each group will identify
local needs, and will set out locally-developed potential solutions – many of
which will go beyond health: eg tackling education, transport, water,
sanitation, food, agronomy, family planning and poverty.
The resulting synergy between the women, the village
structures, and any agencies already trying to help, will provide a mechanism
through which to channel future help. Already, charities both here in the UK,
as well as locally in Tanzania, are waiting eagerly for these women’s groups to
be functioning throughout the area.
Greg Kabadi, the Tanzanian lead for Tushikamane, has
spent fifteen years in public health projects designed to reduce the toll of
death in his countrywomen. It has been a long, tough road. Now, however, having
just returned from observing the Malawi success, he is truly optimistic of a
new start. Finally, he believes, sustainable progress may now be made against
the anachronistic tragedy of death at birth.
For more information see:
email: email.lozza@gmail.com
