LUSAKA, ZAMBIA – Rudia Chiwala, 23, is pregnant with her second child. She waits for her delivery in a shelter for pregnant women at Nagoma Mission Hospital, a rural health institution situated in the heart of Mumbwa, a peri-urban district in central Zambia.
“I had to go here for me to have a safe delivery,” she says. “I am so scared to deliver at home where there are no trained personnels.”
Chiwala has a youthful face and a light complexion. Her hair is braided, and she wears a black T-shirt. She adjusts her chitenge, a traditional Zambian cloth, that is wrapped below her protruding belly. Her chitenge extends below her feet, a symbol of respect and honor for a rural woman.
Chiwala has been at the shelter and away from her family for almost a week with only her mother beside her. She’s not sure when her delivery will be, so she patiently waits.
“My days are almost due, and I cannot wait and sit at home because the hospital is very far,” says Chiwala, walking around for exercise.
The distance between her home and the hospital also makes it difficult to secure food. Although the shelter offers pregnant women a place today, the women need to to obtain their own food. Chiwala says that she and her mother must depend on the meals that their family brings them, which can take a long time.
Chiwala is familiar with the lengthy walk her family must make.
“I walk two hours to access antenatal services and because there is no clinic nearby, I opted to come to the nearby hospital and had to walk two hours for the sake of our unborn child.”
She says it was a difficult journey to walk to the hospital as a pregnant woman.
“The following day, my feet would be swollen,” she says.
And Chiwala is not the only woman trekking long distances to ensure a safe delivery in rural areas here.
“Most of us women are advised to deliver at the hospital because of certain complications,” she says. “Traditional health attendants do not have enough knowledge when it comes to helping a woman to deliver at home.”
But the lack of hospitals and health facilities near the women’s homes also make commuting to the hospital a risk.
“There are times when women deliver on the way to the hospital,” Chiwala says.
Pregnant women in rural areas who want to deliver their babies in hospitals say they must come stay at maternal shelters for a month leading up to their due dates. The nearest facilities are far from their homes, and many must walk despite being pregnant. The daunting journey decreases the number of pregnant women who receive antenatal care, which doctors say is crucial to the baby’s and mother’s health. The government drafted a plan last year to increase access to care, but for now, women must wait.
The maternal mortality rate in Zambia decreased by 19 percent between 2001 and 2007, currently standing at 591 deaths per 100,000 live births, according to the Ministry of Health 2011 Action Plan. But the plan still deemed lowering the maternal mortality rate by 75 percent by 2015 the unlikeliest target for the country to meet of the Millennium Development Goals, a U.N. global anti-poverty initiative.
In rural areas, nearly half of families live outside a five-kilometer radius of a health facility, according to the action plan. The so-called maternal, or mother’s shelters, are a new tool intended to offer women who live far from health facilities a place to stay in order to ensure safe deliveries.
The key to reducing preventable maternal deaths is access to quality care before, during and after childbirth, according to the World Health Organization. Maternal deaths are higher in rural areas, where this access is especially limited.
Bertha Kamudoli, 38, and her husband are farmers. Tall and outspoken, she has five children. Like Chiwala, Kamudoli is also awaiting her delivery at the shelter. But her walk to get there was even longer.
“I walk four hours to access antenatal services,” she says.
To arrive at the hospital in time for her appointments, she used to leave her home as early as 6 a.m., which she says is not a safe traveling time.
“It is so frightening when you walk alone in the early hours of the morning,” she says, “and you are not sure what you can meet on the way. Sometimes, am afraid people can attack me.”
Because of this long, strenuous and unsafe commute, she says she couldn’t obtain regular checkups during her pregnancy and now has to stay at the shelter as her due date approaches.
“Because I am due to have a baby this month, I had to come and wait for the delivery,” she says.
Kamudoli has been at the shelter for about two weeks.
“I cannot manage to wait until I feel the labor pain 'cause I may deliver on my way,” she says.
Kamudoli says the problem is that there are no clinics near her home in Kalindi village. It would have been difficult to find a vehicle to take her to the hospital in an emergency.
But she acknowledges that it’s difficult to stay at a place far from home for so long.
“We have to find our own foods, firewood and cook for ourselves,” she says. “We have to come with enough food, but sometimes the food can finish before you deliver, and home is very far.”
But she says she has no other choice.
“But [what] can I do when I need a safe delivery?” she asks. “So being near the hospital is the only way we can have a safe delivery.”
Another woman staying at the shelter is Patricia Mutanga, 30, who is eight months pregnant. She says she traveled 20 kilometers to the hospital because it is the only health institution near her home.
“I had malaria and some complications of the fetus not lying in the right position,” Mutanga says.
Because of the distance, she must stay here until she has her baby.
“I cannot go back home, as I was advised by the doctor to stay here in the women’s shelter for a month until I deliver.”
This time, she came by bus. But another time, she walked.
“If I do not have enough money for transport, I have to take the two-hour walk to the hospital for antenatal,” she says.
She says this dissuaded her from seeking the care she needed during her pregnancy.
“Because of the distance, I had only been to antenatal once,” she says.
She says she rarely sees health workers in her area, making the hospital the only option for formal care. Like the other women at the shelter, she must obtain her own food, pushing her way to the nearby market.
“I would have liked to deliver at home, but I do not trust some traditional birth attendant,” she says. “I want to deliver at a hospital where trained people can help me deliver.”
Hubert Siame, environmental health technical officer at Nagoma Mission Hospital, says approximately 236 pregnant women come to the hospital every month.
Dr. Mavuto Zulu, acting medical officer in charge of the hospital, says that antenatal care is crucial for the mother’s and baby’s health.
“We encourage women to come for antenatal services to be able to detect early illnesses on the mother,” he says.
Zulu says antenatal care can detect problems such as HIV as well as implement prevention of mother-to-child transmission strategies. Mothers can also transmit malaria to their babies if they don’t take malaria prophylaxis, a preventative treatment, early enough.
Zulu further says that antenatal care can also detect hypertension in mothers, which is important because this can eventually lead to eclampsia, or seizures in pregnant women. He says it’s also important that pregnant women are up to date with their vaccinations, such as tetanus.
Because of the distance to hospitals from the women’s homes, Zulu says that it’s important that women also come well in advance in order to be there before they go into labor.
Although Kamudoli says she is grateful for the services she receives at the hospital, she also acknowledges the challenges that she must face to benefit from these services – walking long distances, spending weeks away from home waiting for her delivery and looking for food when her family doesn’t arrive on time. She says that more local care could solve these problems.
“We need a clinic, which will provide antenatal services for women in Kalindi,” she says. “Our new government should build a clinic within where us women will not have to walk long hours in accessing these services.”
Zulu says it is also the responsibility of the government to recruit more staff in the existing clinics because most of the rural clinics do not have trained personnel.
“We are really suffering as pregnant women in areas where clinics are very far,” Chiwala says. “We need help so that we do not walk long distances to have a safe delivery with skilled personnels. Our government should look into this and come to our aid.”
Through the Ministry of Health, the hospital also provides antenatal services to pregnant women at the clinics in the surrounding area, Siame says.
“We follow pregnant women in our catchment area and ensure that women access antenatal services,” he says.
But Siame admits that there are some areas that the hospital can’t reach, especially during the rainy season, when the roads are impassable and the streams are full.
The Ministry of Health 2011 Action Plan launched a detailed strategy for improving maternal care. Key interventions included expanding the Focused Antenatal Care and Emergency Obstetric and Neonatal Care programs in order to increase the number of pregnant women receiving care. The main strategy to reduce the maternal mortality rate is to ensure that skilled personnel conduct deliveries when complications arise.
