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Friday, 11 May, 2001, 13:24 GMT 14:24 UK
Fighting for life in birth
Malian birth table
Health centres use birth tables like this one
Fatimah was a 15-year-old, living in the Malian capital, Bamako.

Like millions of other teenage girls in Mali, she was already a wife and a mother-to-be.

By the time she got here it was too late

Doctor at community clinic
And like the vast majority of young Malian women, she had neither the money, nor permission from her husband, to seek prenatal care.

She went into labour at home.

After 24 hours she was still in agony and her family finally took her to a community health centre. There they learned her pelvis was too narrow and the foetus was no longer alive.

She required a Caesarean section to remove the baby. Her family sent her by public transport to the hospital where such an operation was possible.

On the way, her uterus ruptured and she bled profusely.

'Too late'

"By the time she got here, it was too late," says Professor Amadou Dolo, chief gynaecologist at the Point G Hospital in Bamako.

'We might have saved her if we'd had her blood group on hand. Or if she'd been brought in earlier.

Malian mother being looked after
This Malian mother of twins is lucky to get neonatal care
"Or if she'd had prenatal care that identified the complications earlier. Instead she died."

Dolo says such unnecessary deaths of mother or child - or both - are for him, a "daily occurrence" and a "shame for humanity".

Big problem

The statistics on maternal and neonatal mortality in Mali are grim.

According to Unicef figures, in a single day 1,200 women in the country fall pregnant. Of those 230 will develop complications and 20 will die.

Two hundred of the babies will not survive past four weeks.

The situation on the continent as a whole is not much better. Mali's minister of health, Traore Fatoumata Nafo, says that in the west only one woman in 1,800 dies in childbirth.

In Africa that ratio is one in 16, by far the highest in the world.

Thirteen years ago in Nairobi, Unicef launched a "Safe Motherhood Initiative" to draw attention to the "silent tragedy" and to spurn African leaders into action.

But the same tragedy persists today.

To save a woman's life costs only $79 but when a woman dies, her funeral costs alone range between $500 and $1000

Professor Angela Sawyer-Kamara
To help get this message to some of Africa's most powerful men, Unicef and health officials in West and Central Africa have enlisted the help of some of the continent's most powerful women - the first ladies of west and central Africa.

After meeting in Bamako, first ladies from Benin, Burkina Faso, Gabon, Ghana, Guinea, Mali, Nigeria and Senegal, promised to do all they can to slash maternal and neonatal death rates in the region by half in a declaration they call "Vision 2010".

"Our idea was to get the first ladies to plead the cause," says Rima Salah of Unicef. "They are important role models for African women."

But the idea of this meeting of first ladies is highly controversial.

One prominent Malian journalist says that first ladies are "completely cut off from the reality" and "not role models for anyone".

Other journalists at the Bamako meeting note that with the exception of Mrs Wade of Senegal and Mrs Kufuor of Ghana, the first ladies in attendance are spouses of presidents who have ruled for many years.

Mrs Kufuor
Ghanaian first lady Mrs Kufuor is a midwife herself
They are therefore seen as largely to blame for the problems that lead to maternal mortality - lack of education among girls and women, poverty and poor health care.

There was also some scepticism about the enormous costs of the luxury accommodation, heavy security, and the presidential honours accorded the first ladies in Bamako.

But Unicef officials defended their decision to enlist the first ladies.

Without divulging the actual cost of the meeting, deputy director of Unicef Robert Froid said it was an "investment" because these women could exert influence and bring the issue to the attention of their husbands who have the power to act.

Froid said: "Some of the first ladies were visibly shocked by what they learned here."

Professor Angela Sawyer-Kamara, head of a west African network for safer motherhood, says the problem is often not lack of resources but misplaced priorities.

Our idea was to get the first ladies to plead the cause

Rima Salah of Unicef
She points out that to equip a community centre with facilities for safe deliveries, costs about $39,000 and can save 400 lives a year.

"To save a woman's life costs only $79," she says, "but when a woman dies, her funeral costs alone range between $500 and $1,000."

Senegal's first lady admits that the first ladies' "Vision 2010"' could be "an illusion". But she hopes rather it will be "the start of something real' to end what she calls the "scandal" and "torture" of maternal mortality in Africa.

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See also:

02 Nov 99 | Health
Drive to cut maternal deaths
08 Mar 01 | Africa
Africa's forced marriages
23 Nov 98 | Health
The causes of maternal death
07 Apr 98 | WHO
Dying for a baby
07 Apr 98 | WHO
Deadly facts and figures
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