In Somaliland, only a third of women giving birth have any kind of skilled personnel with them -- and, in rural areas, the numbers are much lower. Now, a three-year-long programme co-funded by the European Commission that targets maternal and newborn health in Somaliland and Puntland, is slowly changing this reality.
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By Athanas Makundi
Having a baby still poses one of the greatest risks to the lives of women in Somalia. In Somaliland, only a third of women giving birth have any kind of skilled personnel with them – and, in rural areas, the numbers are much lower. Newborns die because of low birth weight, premature birth, asphyxia, birth injuries, septicaemia and neonatal tetanus.
It is estimated that more than 22,000 mothers and newborns will be helped by a three-year-long programme co-funded by the European Commission that targets maternal and newborn health in Somaliland and Puntland.
BOROMA, Somaliland, 29 November 2013 – Layla Darhir groans. Midwife Foosiya Omer quickly shifts her full attention to the 28-year-old, who has been in labour for six hours.
Ms. Darhir arrived at the clinic at dawn. She shares a room with four other women in the newly constructed maternity wing at the Central Maternal and Child Health Clinic in Boroma Town, Somaliland.
23 year old Ifrah Abdullahi is mother to a healthy five year old who was delivered at the Borama General hospital in Somaliland. She received antenatal and postnatal care from a local health clinic which is supported by a programme co-funded by the European Union and its partners. In Somaliland, only a third of women giving birth have any kind of skilled personnel with them.
“I’m going to check if her cervix has dilated enough,” says Ms. Omer, who is in charge of the morning shift. She is moving Ms. Darhir to the delivery room. “It is a routine check we do for all these women in labour, to see if they need inducing.”
In the delivery room, heavy contractions kick in. The assistant midwife quickly rushes in with a trolley of instruments.
“Push, push,” shouts Ms. Omer, massaging the swollen abdomen. Ms. Darhir gives birth. The midwives swiftly move in to tend to the baby. Ms. Darhir lies back, spent, smiling, eyes fixed on her first-born child, a healthy boy. She will name him Adam Yusuf Farah.
Across town, an ambulance donated by the Government of Japan for a European Commission and UNICEF joint project on sexual and reproductive health wails through the streets of Boroma. Marian Muse is being rushed to hospital. The mother of seven has no history of pregnancy complications – but, this time, she is bleeding heavily and will require an emergency caesarean section.
“She has developed placenta abruption,” says midwife Safia Hassan, who is monitoring Ms. Muse’s blood pressure in the ambulance. “It is when excessive bleeding occurs before the birth process begins, and, in such situations, we consider this an emergency case,” she explains.
At Boroma Regional Hospital, a team is ready. “We have many challenges with cases like Marian, because usually these women take a long time to reach the hospital,” says Dr. Farah Ismail, an obstetrician/gynecologist in charge of caesarean surgery at the hospital. “The delay either results in the death of the foetus or puts the mother into a risky position.
“[D]espite the availability of transport, cases like these need to be spotted early on and action taken quickly.”
A place for high-risk pregnancies
At Dilla Maternal and Child Health Centre, 50 km outside Boroma, Fadiyo Isaq is about to give birth. Although she has delivered her four children at home, health workers have warned her that this pregnancy might put her life in danger.
”I almost died from excessive bleeding in my previous pregnancy, “says Ms. Isaq. “This time, I decided to come here for medical attention in case it happens again.”
“Bleeding is the most common and one of the most serious problems we see with mothers who come to the clinic,“ says Safia Dhimbil, the midwife in charge of Dilla centre. “The community still thinks this is normal; they don’t see it as a problem unless a woman dies.
“Often, the bleeding is a result of the female circumcision that the woman has undergone,” she adds.
Upgrades that work
In Somaliland and Puntland, maternal health has seen great progress because of ongoing work by UNICEF and its partners supported by the European Commission. The programme is upgrading 14 maternal and child health centres as basic emergency obstetric and neonatal care facilities (BEmONC) and linking them, with local referral hospitals, as comprehensive emergency obstetric and neonatal care facilities.
All of these facilities are now open around the clock and have solar power and running water.
The upgraded maternal and child health clinics and hospitals have become a lifeline for women with high-risk pregnancies who come to be monitored regularly. The number of women giving birth at Dilla Health Centre has shot up in the past two years. The first five months of 2013 saw, on average, 100 deliveries a month.
“Previously, the maternal mortality rate was very high, and there was no delivery system for pregnant women in our health centres,”says Regional Medical Officer, Somaliland, Dr. Abdirahaman Jama. “But, since the upgrade of the Somali Reproduction Health was started, we can carry out normal deliveries at the health centres – and the number is going up all the time.”
A cadre of well-trained health workers
To reduce maternal and child mortality requires a comprehensive package involving facilities, equipment, care and well-trained personnel. The programme includes training for doctors, qualified nurses and midwives and community health workers.
Retired birth attendant Adar Mihile talks about how she used to walk long distances to assist women giving birth at home. She says that, even with 30 years of experience, there were times when she could only watch as women died during labour. “Sometimes, I would only get to the woman when it was too late to help,” she says. But things have changed.
“I have learned how to take care of a woman during pregnancy, especially the first three months,“ says midwife Foosia Mohamed Hassan, who works in postnatal care at Dilla centre. “I also know the common problems a woman faces during pregnancy and how to manage them, especially in the second and third trimester.”
Traditional birth attendants are now linked with the upgraded facilities. They can help persuade women to go to health centres and hospitals for antenatal check-ups and to deliver.