Page last updated at 13:06 GMT, Monday, 26 October 2009
Maternal mortality across the world


Karen Allen visited Pitala where the maternal mortality rate has apparently been cut to zero

In a country where a staggering number of women die in child birth, the BBC's Karen Allen discovers one Malawian village where a novel solution - a bicycle ambulance - has apparently helped to wipe out the problem.

Nearly half of all children in Malawi are born without the assistance of a trained health specialist.

They rely instead on traditional birth attendants like Dailes Silage, the wise old woman of Mangochi village.

One woman dies every minute during childbirth, yet almost all of these deaths are preventable.

In 2001, the UN set itself the goal of slashing maternal mortality by 75% by 2015, but it is nowhere near meeting that target.

Health ministers from around the world are meeting in Ethiopia to work out how to make up for lost ground.

The BBC is publishing a series of reports to mark the occasion.

She often gets summoned at the last minute when it is too late to make the journey to hospital.

But she is not medically trained and her "labour suite" is a spartan mud hut with a mat on the floor for a bed.

She delivers about seven babies a month and she says not a single woman has died in her care.

Nevertheless, she admits it is far from ideal.

"The main problem is that the community here doesn't have the money to hire a car to get to the nearest hospital," she says.

"And traditional birth attendants usually care more about the women than the staff at the hospital."

Emma Aliki (right) and her five grandchildren
Emma Aliki cares for her five grandchildren after her daughter died in childbirth

Nationwide, some 16 Malawian women die every day in childbirth or from related complications - the second-highest figure in Africa behind Sierra Leone.

A woman is 14 times more likely to die in childbirth in Malawi than in a developed country like the UK.

Malawi is not a conflict zone and it has a stable government.

Midwife Barbara Mlewah shows Karen Allen around Mchinji District Hospital

But much of the country suffers from high levels of illiteracy and grinding poverty.

For those personally involved, like Emma Aliki, the consequences are devastating.

She cares for five grandchildren, aged between two and 10 years old, whose mother Mwalimi died just days after giving birth at home.

"It was a normal delivery... but three days later my daughter developed complications and died," she says.

It is almost certain that 30-year-old Mwalimi suffered from massive blood loss and an infection, which led to her death.

Her mother believes she would still be alive had she given birth in a hospital.

Mwalimi was the family's sole breadwinner.

Cultural battles

Yet despite childbirth in Malawi being like a medieval curse, the country's fortunes are slowly beginning to turn around.

Nurses' union leader Dorothy Ngoma
We have more Malawian doctors in Manchester than in the whole of Malawi
Nurses' union leader Dorothy Ngoma

Maternal deaths are now following a downward trend.

They currently stand at 807 deaths per 100,000 live births.

During a recent visit to the country, former Irish President Mary Robinson, now a prominent women's rights campaigner, praised the steps taken in Malawi.

"The first thing you need is political will," she said.

"We need to ensure women have access to emergency obstetric care, and we need to address cultural and legal battles that keep women as second-class citizens without a voice in their own country."

Malawi has gone some way to achieving some of this, although campaigners are warning against complacency.

In the village of Pitala, not far from the capital Lilongwe, maternal mortality rates have fallen to zero, according to anecdotal evidence given to the local UN agency.

Village chief Margaret Thole explains that they have started to tell people in the village of the importance of delivering in a hospital.

The message is reinforced with billboard-like inscriptions on the village trees.

But cultural norms dictate that in Malawi the first-born should be delivered at home.

"We can prepare for it early and the hospital can deal with any complications," she says.

"It's now the main role of the birth attendant to visit the women and deliver this message."

And with the closest health facility some 30km (18 miles) away, Pitala village now has its own bicycle ambulance to ferry patients to hospital.

It is not rocket science, but it is a start.

One of the biggest obstacles to forcing maternal death rates down is the shortage of specialist staff.

Malawi recently trained 200 doctors but now only 50 remain.

Most have been poached by countries that can offer them more pay.

Dorothy Ngoma, head of the main nursing union in Malawi, says countries like Britain have to take some responsibility for Malawi's appalling record on maternal deaths.

A mother and baby in a Malawi hospital
In hospital complications can be dealt with quickly

"We have more Malawian doctors in Manchester than in the whole of Malawi," she says.

"There are more than 200 of them. Imagine if those doctors came back and spread out across our hospitals here, how many women's lives would be saved?

"That is why Great Britain should be our primary target for support."

Africa is hopelessly behind on delivering on two of the key targets set out in the millennium development goals - reducing maternal deaths by 75% by 2015 and ensuring universal access to reproductive healthcare.

What is clear, though, from Malawi's bitter experience is that this is not simply a problem of its own making.

BBC graphic

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