Reducing maternal and newborn deaths in Southern Sudan
by Amor Almagro, UNICEF Sudan Wau, Southern Sudan, 6 October 2008 – It is another busy morning at Wau Midwifery School. A long queue of women sits outside a classroom waiting for their names to be called. Monica Baptista, 21, is one of them. Pregnant with her second child, Monica eagerly awaits her turn be called inside where she will receive ante-natal services for free. “When I was pregnant with my first child I did not receive any ante-natal care. I could not leave our house, it was too dangerous. There were soldiers surrounding our village. Now…..I walk from my house which is just a few kilometres away,” says Monica. Today’s antenatal package includes a medical check-up, tetanus immunization, provision of iron supplements and anti-malaria tables and supply of treated mosquito net for prevention of malaria. In addition, expectant mothers are counselled on HIV, nutrition, particularly exclusive breastfeeding and on the importance of having skilled attendants during delivery. “We have five midwives on duty to deliver these services. Six others are on standby in case we need their help,” says Lina Ferdinand, Wau Midwifery School Principal. Around 30 to 50 pregnant women visit the antenatal clinic in the school, two days a week. Most them are young and come accompanied by relatives. “They travel long distances, often risky because road conditions are very bad. It is also very expensive because they have to hire private vehicles since public transportation is unavailable. But they are willing to take the risk because the services we provide are not available in areas where they live,” explains Lina. The civil war left most of Southern Sudan’s health infrastructure destroyed – a contributing factor to Southern Sudan’s high maternal mortality ratio, which stands at 2,037 deaths per 100,000 live births. 80 per cent of deliveries take place at home and less than 15 per cent of births are attended by skilled attendants. Prolonged obstructed labour, severe bleeding, sepsis, eclampsia and complications related to unsafe abortions are all major causes of maternal deaths, with newborns often dying because of infection, low birth weight and birth asphyxia. “Many of our midwives left the country during the war. And of those who stayed, several of them have died or are too old to work,” says Angelina Reine Adolfo, Supervisor of the Nurses Department at Wau Teaching Hospital. For ten years until 1984, Wau’s midwifery school provided a two-year course for village and community midwives. In 1994, after years of fighting forced its closure, the school restarted its courses, with 280 village and community midwives graduating by 2006. Now, with UNICEF support, the State Ministry of Health of Western Bahr el Gazal has organised refresher training for village and community midwives. Seventeen village and community midwives of Western Bahr el Gazal State participated in the training. “This is the first time that we are able to bring together midwives from counties in Western Bhar El Ghazal since the peace agreement” says Angelina. The new week-long training covers focused ante-natal, labour, delivery and post-natal management, HIV in pregnancy, essential care for the newborn and referrals during and after labour whenever necessary. The re-trained midwives will go on to deliver “on-the-job” training to traditional birth attendants and other midwives in the Primary Health Care centres where they work. With services still overstretched, the support of traditional birth attendants to provide services in some health facilities remains essential. “It is essential that health facilities have well-trained personnel and supplies to provide the services required to meet these targets,” explains Joyce Mphaya, a UNICEF health specialist in Southern Sudan. “This re-training for midwives is complemented by training of certified skilled midwives, clinical officers and doctors who undergo a month-long training on emergency obstetric care.” For now, the importance of this approach is personified in mothers like Monica, who will benefit from increased numbers of qualified health workers, and the resulting reduction in the number of pregnancy-related and newborn deaths across Southern Sudan.
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