18% Opening Prayer. Introduction

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1 This is the third study on maternal health. The final study will look at maternal and child health among Canada s Aboriginal Peoples. M AT E R N A L a n d C H I L D H E A LT H : M a l a w i b y K a r e n B o k m a Low contraceptive use, high fertility, and poor newborn outcomes go hand-in-hand. Mothers in Malawi have six children on average. Opening Prayer Pray for global support for maternal and child health programs: Dear Lord, you know every child by name, and you care about each one s past, present, and future. Guide your people to continue to care about these little ones and their mothers by investing in the gift of health for all. We pray this all in Jesus name. Amen. Introduction Malawi is one of the least developed countries in the world. Since gaining independence in 1964, the country has gone through difficult political and 18% of babies are born too early in Malawi. financial periods. Today, the government of Malawi depends heavily on outside aid to meet the country s substantial development needs. Three-quarters of the population live on less than $1.25 a day. Malawi s economy and a significant percentage of the population depend heavily on agriculture. As the negative effects of climate change, such as droughts and floods, are expected to worsen, additional stress will be placed on families and the economy. HIV prevalence rates in Malawi are some of the highest in the world, with women and children bearing a heavy burden. In recent years, the Malawian government and non-governmental Maternal and Study Child Health 24 Glad 1 Tidings July/August 2013 Study 2 Maternal Health in Afghanistan in September/ October 2013 Study 4 Maternal Health among Canada s Aboriginal People May/June 2014

2 organizations have made significant efforts to prevent the transmission of HIV from mother to child during pregnancy and delivery. Added to this, high birth rates and a rapidly rising population pose risks to the ongoing development of the country. Malawi s population grew by 32 per cent between 1998 and Estimates say that the population could reach 23 million by 2025, and 37 million by 2050, if families continue to have, on average, six children. In recent years, Malawi has made progress on many of the Millennium Development Goals (MDGs), with a heavy focus placed on improving maternal and child health and mortality rates. However, Malawi still has one of the highest maternal and neonatal mortality rates globally, mostly due to difficult circumstances during childbirth. Although some of the most important interventions for safe pregnancy and delivery are quality health facilities and the assistance of a skilled health worker, many women in Malawi do not have access to these health services. Most women live more than 25 km from the nearest health facility. Because of this distance many women do not have skilled birth attendants present during labour and delivery. Combined with little access to family planning and proper nutrition, this puts women and children at an increased risk for deadly complications and birth related disabilities. But change is happening. Christina s Story Christina Gizimani is a 28-year-old mother of two. Her first baby was delivered at home. When a safe motherhood committee was established in her village, she was interested in joining. Safe motherhood committees are democratically elected and consist of 10 members five women and five men. The committee teaches communities about the importance of maternal health care and delivering at hospitals or January/February

3 Since 1990, infant morality has decreased by 44 percent. Part of this is due to Malawi s investment in kangaroo mother care a technique where preterm newborns are held, skin-to-skin, by an adult. 26 Glad Tidings health facilities. The committee also keeps money to be used to pay for transport to health facilities in the event of an emergency. Approaching the end of her pregnancy, Christina thought she had more time remaining, but labour came quickly. Without hesitation, she went to a safe motherhood committee member, and they hired a bicycle ambulance that rushed her to the hospital to deliver her baby safely. Christina knows that she and her husband would not have been able to afford this transportation themselves. We survive on less than half a dollar a day and we had no money. I could have lost my baby, or even my life. Community involvement is key and makes it sustainable. I was helped by my community through the safe motherhood committee, she observed. I see that my firstborn s survival was by grace, because delivering at home is very dangerous. The work that is going on to improve health care services was evident to Christina. When I arrived at the hospital they welcomed me! I was treated with love, and I received the necessary care and treatment. It is no use delivering at a traditional birth attendant or at home the hospital is best. Working to improve the quality of mother and child health services, as well as overcoming cultural barriers that prevent women from receiving essential pre- and postnatal care, is crucial.

4 Biblical Reflection Read Luke 2:4 7 and Genesis 35: Describe the circumstances in which the women in these scripture passages find themselves. Was their health, or their child s health, affected? Can you think of anywhere in the world where women are giving birth under similar circumstances? What is likely to happen to them without the right care? What then should our response be in situations where the health of mothers and babies is in danger? What Our Church is Doing Presbyterian World Service & Development (PWS&D), the development and relief agency of The Presbyterian Church in Canada, is partnering with the Uchembere Network to benefit thousands of mothers and their children. PWS&D is working to lower birth rates, increase access to obstetric services, and empower women and communities in their health-seeking behaviour. Through community health sessions, men, women, and health care workers are learning about the needs of mothers, newborns, and children, as well as the importance of maternal health. Facts on maternal, newborn, and child health Malawi National population: 16 million (2013 est.) Life expectancy: 54 years Rural population: 80% Human Development Index 1 : 170 out of 187 Maternal mortality: 460 deaths per 100,000 live births (2010) Under-five mortality: 92 deaths per 1,000 live births (2010) Infant mortality: 58 deaths per 1,000 live births (2010) Canada National population: 35 million (2013) Life expectancy: 81 years Rural population: 19% Human Development Index 1 : 11 out of 187 Maternal mortality: 8 deaths per 100,000 live births Under-five mortality: 6 deaths per 1,000 live births Infant mortality: 5 deaths per 1,000 live births 1 The Human Development Index measures wellbeing as it relates to health, education and income. January/February

5 PWS&D is improving the quality of mother and child health services by creating emergency communication networks and training birth attendants. Bicycle ambulances are helping women reach health care facilities for safe delivery. Anne Mataka recalls the story of Mary, a 26-year-old mother of two. She was pale and weak, so we asked her to speak with a midwife who then referred her to the Mulanje Mission Hospital. The project through the safe motherhood committee supported Mary throughout her pregnancy, including bicycle transport to the hospital. Now both the mother and baby are healthy and have returned home. Thirty-six villages across Malawi have established safe motherhood committees, like the one Anne describes, with the support of PWS&D. These committees are strengthening the systems that allow women better access to vital health services during an emergency. Community members spread awareness and encourage women to seek prenatal care and deliver their babies in a health facility, increasing the likelihood of a safe pregnancy and delivery. I m really glad the referral system can save so many lives, Anne concludes. This is why I have been telling so many women in my village, If you face any kind of emergency during pregnancy, we can help. The lack of male involvement in reproductive health issues has also been an issue. To address this, male motivators are trained to encourage men to support their pregnant wives. Training is also conducted on women s and human rights, reproductive health, and family planning in order to empower women to make informed decisions that will improve their overall health and wellbeing. These efforts are ensuring that there is increased access to health care for women who had previously been restricted due to cultural limitations, such as barriers put in place by men, or insistence on using traditional birth attendants at home rather than skilled health practitioners in a health facility. Jesse Mtika has seen the difference in her community: We have seen a great change because of this program. Women were delivering their babies in the bush, but not now. We have learned not to use traditional herbs to induce labour because it s harmful. Women are empowered to pursue issues related to their own health. 28 Glad Tidings

6 Maternal deaths have decreased in our village because of this program. * PWS&D s maternal health program in Malawi receives generous support from the Canadian government through the Department of Foreign Affairs, Trade and Development (formerly CIDA). To Think About Read Genesis 35:16 20 again. Rachel died giving birth. The image of her weeping and refusing to be comforted is also invoked in Jeremiah 31: Whose voices cry out for maternal health in our world? In your community? Going Deeper Encourage your church to use PWS&D s Sunday School resource on Maternal and Child Health. Tied to the Healthy Babies, Happy Moms Sunday School Challenge, this is an opportunity to educate children (Grade K-8) on the important issues related to maternal health. (Available online at WeRespond.ca/ssc-companion-kit.) Closing Prayer Let s pray today for the health of women, children and families around the world. Let us pray that in building healthy families, all God s people may be empowered to strengthen their communities and nations. Almighty and ever loving God, giver of life, protect the health and safety of all women in childbirth and the children that they bear. Inspire your people to work for an end to the deadly conditions that cause maternal and child deaths in the world. Help build strong and healthy families and communities so that all may do your will on earth until the day when you gather us into one heavenly family. Lord of life, hear our prayer. Amen. January/February