Germany supports UNICEF work to prevent newborn deaths

Galkayo - When Ubah Abdullahi went into labour five days ago in her makeshift shelter in central Somalia, she knew there was no chance of any midwife or doctor helping her out. Her family, along with thousands of others, fled their homes last year after the drought wiped out all their animals and now live hand to mouth on a dusty plain just outside the town. She had no money to spend on transport to the clinic so when she went into labour at eight in the evening – her mother in law and neighbours rallied round. After a grueling 12 hours, her daughter arrived.

“I had no choice,” she said weakly, her tiny daughter lying next to her on a mattress on the earth floor. The small domed shelter made of rags, plastic sheets, string and branches was the only protection from the sun blazing down on Najah displacement camp.

Ubah is not alone in Somalia – seven out of ten women (72 per cent) give birth at home usually without any professional assistance any – one of the reasons that the deathrate for babies under 28 days old - known as the neonatal mortality rate - is the fourth highest in the world in Somalia. One out of every 26 babies born dies within 28 days – many on the day they were born.

However with support from the German Federal Ministry for Economic Cooperation and Development (BMZ) through the KfW Development Bank UNICEF is providing a package of health services through over 40 health facilities in Puntland. This includes providing maternal, reproductive and neonatal health care. At the same time health facilities are being constructed and rehabilitated. It is hoped this will make it easier for mothers to deliver in health facilities.

“We could save the lives of many newborns if the mothers were able and willing to attend ante natal check ups, to identify problems early, and then go to health facilities to give birth. At the hospitals and clinics, with proper medical care, the main causes of newborn deaths here in Somalia – infections, complications during birth and prematurity can be treated,” said Samson Agbo, UNICEF Somalia’s chief of health. 

In another nearby camp for the displaced, a midwife from the BMZ supported Salama Mother and Child Health Centre, comes to give Fatuma Mohamed’s newborn her first vaccination. Her baby daughter Ferdosa was born at the Centre, a few minutes’ walk away. Fatuma’s first baby had died during delivery and she had been determined to give birth in the Centre.

“I think more women would come here if they realized it was free and if they had transport,” said the midwife Rahma Mohamed. “We have mid wives on call for 24 hours. And we have to persuade women who still prefer to deliver under a tree or use traditional medicine.”

Khadar Mohamud who came to the settlement last year because of the drought is pregnant with her fourth child. She never considered giving birth in a health facility. “My other three were all born outside and I haven’t had any problems although when I go to the hospital for a check up they always tell me I have an infection,” she says.

There are many factors that mean babies born in Somalia – and particularly to vulnerable, poor mothers in camps such as this – are at risk of dying early. Babies who are born prematurely are at high risk of dying particularly when, as in Galkayo, there are no incubators. Premature babies are often born to women who have had several children – and Somali women on average have 6 or 7 – as well as to young adolescent mothers and Somalia also has a high adolescent fertility rate. The health of the mother is also key with many of the 35,000 people who arrived in the camps around Galkayo last year being malnourished due to lack of food and sickness caused by contaminated water.

After over 20 years of conflict the health system in Somalia is slowly being rebuilt, largely supported by UN agencies and NGOs with generous funding from donors such as BMZ in Puntland. However there is a shortage of skilled personnel with just one doctor, nurse or midwife to support 10,000 people.

A midwife at Mudug Regional Hospital in Galkayo town probably saved the life of 20-year-old Fadumo Abdullahi by quickly spotting she was suffering from pre-eclampsia (high blood pressure) which can lead to serious complications when she came in for an ante natal visit. She was brought into the hospital early and given a caesarian. Her daughter Farhia, is now four days old and healthy.

Galkayo is a microcosm of the problems seen throughout Somalia where it is estimated around 25,000 babies born each year die within 28 days – an average of 70 deaths a day. With Germany’s support UNICEF is focusing on newborn survival in Puntland and making important progress to improve newborn health and ensure access to quality health services for all mothers and babies.