Mixed blessings: Burundi’s free birth delivery and medical care for under-five children
Thousands of Burundian women who delivered their babies free in public hospitals after the declaration of Free Birth Delivery Services and Medical Care for Children Under Five Years, on 1 May 2006, are grateful to President Pierre Nkurunziza, but hundreds of debtor mothers like Carine Naisha Nzigiyimana had to wait a long time for freedom. For many other mothers, children and health professionals, the free services have now become, at best, mixed blessings as health facilities run out of drugs, beds, and funds for essential services.
Sixteen-year-old Carine delivered her son, Hugo, by caesarian section at Bujumbura’s biggest hospital, in April 2006, but remained in hospital detention until the end of May, for inability to pay her bills of about US$ 300. Like hundreds of debtor mothers detained for the same reason, Carine lived in the hospital corridors and scrounged for money and food from visitors until she was finally freed following public pressure. Most debtor mothers were poor under-age girls like Carine, who underwent caesarian section because their pelvis was not wide or strong enough for normal child delivery. A caesarian operation costs from US$ 60 to US$ 200, two to six times the monthly income of the average government worker, yet the population is largely rural, poor and dependent on subsistence agriculture.
Sadly, many of those who now enjoy free birth services would consider Carine lucky to have delivered safely in relative comfort before the Presidential declaration. Many pregnant women bypassed the rural health centres, which generally lack birth delivery facilities, heading for the referral public hospitals in the provincial capitals and the national capital, Bujumbura. Within a month, hospitals were turning back hundreds of desperate pregnant women and nursing mothers. Drugs, medical supplies, funds ran out, so did the patience of overworked and underpaid medical workers. Several pregnant women collapsed outside the gates of overwhelmed public hospitals and four were saved only because the Minister of Commerce personally took them to the privately-owned Polyclinique Centrale and paid about US$ 900 for their admission.
“There is urgent need for more, better-trained and better-motivated staff and for emergency medical supplies and equipment,” says UNICEF Maternal and Neonatal Health Officer Dr. Marie-Therese Baranyikwa.
UNICEF and its partners took the lead in supporting the government’s initiative and in coordinating an emergency response. They increased supplies of drugs and maternity equipment, and stepped up the training of health workers in the 10 most vulnerable provinces hosting Burundians repatriated after the 12-year civil war. They also embarked on extensive advocacy to mobilize resources from donors. However, far more resources are needed as the situation in the provinces and rural areas might be more serious than the authorities readily admit.
In Burundi, mothers who survive childbirth are usually congratulated for ‘crossing the abyss’. The country has some of the highest maternal mortality ratios in Africa and the world. Government figures for 2002 indicate that, on average, for every 100,000 live births 880 mothers died during childbirth in health centres and 1,030 in public hospitals – approximately 1 in every 1,000.
The underlying causes for such high maternal mortality ratios were identified as the four ‘too much’: too early, too close, too many and too late pregnancies, but the major problem is that very few women receive qualified assistance during child labour. This is usually due to the ‘three delays’: 1) the delay in deciding to seek treatment due to non-recognition of danger signals by the pregnant woman, her family and community, or to lack of resources; 2) the delay in reaching a health facility due to distance, lack of transportation, poor communication and referral systems; 3) the delay in receiving the necessary care in ill-equipped and inadequately-staffed health centres.
The Government has shown its good intentions by starting free birth delivery services and medical care for children under five, a first step in its Road Map for the reduction of neonatal and maternal mortality. It has also exhibited sensitivity to public opinion in setting free Carine and others detained simply for giving birth to Burundi’s children.
To turn Burundi’s mixed blessings to real blessings, much understanding and international support is urgently needed for its children, their mothers and the courageous health professionals who are in the frontline saving lives far from the headlines.
© UNICEF Burundi/2006