The White Ribbon Alliance for Safe motherhood (WRA), an international coalition of governments, organizations and individual members who globally advocate for lowering maternal and child mortality rates met from 10th to 15th July, 2011, in Bali, Indonesia.

This was at the ‘WRA National Alliance Workshop’ to strengthen advocacy efforts at various country levels.

Rwanda is one of the 15 National Alliances and Jeannette Kagame, The First Lady of Rwanda is the Patron of the country’s National Alliance. A six member delegation led by the Vice-President of the Senate, Hon. Maria Mukantabana participated in the five day workshop.

According to Theresa Shaver, the President and Executive Director o WRA, National Alliances  are important because they can collectively change the statistics of maternal mortality globally and get the political commitments that maternal and new born health have never had before especially in Sub-Saharan Africa and South Eastern Asia.

"Maternal mortality in several places remains shameful—it has actually increased in some places and not decreased. This is something we need to collectively make sure that it becomes a political priority,” Shaver said.

"This is something that we do not need to only find cures or research about, we know what to do, we know how to do it because it has been demonstrated in some countries that have shown a decrease in maternal mortality,” she added.

"Our hope is that as we continue to grow as a global community and stronger as National Alliances, we are able to share openly and maintain the spirit to inspire other countries on how to meet and address the challenges that they are facing in order to become stronger and get the political commitment so that no woman dies needlessly during child birth,” Shaver explained.

As countries fast track toward attaining MDG5 to reduce maternal and Child mortality rates by 2015, a 40billion USD global commitment was made at the UN Summit to support these efforts. Rwanda has committed to increasing Health Sector spending from 10.9 percent to 15 percent by 2012. Over the past years, studies have shown that Rwanda’s health care reforms have led to the reduction of maternal and child mortality rates from 750/100,000 in 2005 to 383/100,000 deaths in 2009. In 2010, a 16 percent reduction in maternal mortality was registered.

Dr. Felix Sayinzoga, working with the Maternal and Child Health Department at Ministry of Health, also an institutional member of WRA-RW, attributes these improvements to the 90 percent countrywide coverage of Rwanda’s Public Health Insurance policy (Mutuelle de Santé) as well as the increased number of community health workers in every village.

"Every village has at least four community health workers who sensitize people to go for pre-natal and post-natal care. These are trained to manage the third stage of labour in order to reduce post-partum hemorrhage as well as administer Misoprostol (Cytotec) for women who deliver in community health centres or on their way to the hospital,” Sayinzoga said.

Additionally, maternal death audits in all health facilities across Rwanda have been introduced to track indicators in this area. Dr. Sayinzoga says Maternal Mortality is a priority because it is one of the indicators that will achieve MDG5.

"Every person and organization should work together to reduce maternal mortality especially through advocacy.”

However, the limited number of midwives in Rwanda is still a challenge. There are only five Nursing and Midwifery Schools in the country, producing an average of 100 midwives annually. Currently, there is a ratio of one midwife for every 100,000 pregnant women.

According to Andre Gitembagara, President of the Nurses and Midwives Association, also Project officer of WRA RW, Rwanda has less than 300 professional midwives and is short of 2,400 midwives, who are needed to sustain the hospitals and health centres.

"Midwives are important because they are involved in direct community mobilization, safe motherhood sensitisation and assisting in deliveries,” Gitembagara said.

He cites the limited number of midwifery schools and expensive tuition for private candidates as the reason students are discouraged from joining the profession.

"There is a need to invest in Midwifery education if we want to see reduced maternal deaths and also practicing midwives need motivation in the form of various incentives in order to make the profession attractive,” he explained.

Maria Mukantabana, also the Chairperson of WRA-RW, said that the participation of Rwanda in the National Alliance workshop is important especially since it involves the amendment of Affiliation Agreement, a document that shapes the structure and management of the alliances.

"This learning experience shows that several countries, people and institutions including the media should be involved when it comes to informing and changing the situation of safe motherhood in their countries,” she said.  

Jeremie Zoungrana, Chief of Party, MCHIP (Maternal Child Health Integrated Program) said that maternal mortality is an issue that must be addressed by all governments across the world.

"Rwanda is already doing a lot of things to address maternal mortality at the national level but we need to reach and involve more people at the communities. Through having a preventive mechanism and the promotional action of the beneficiaries, we can improve our situation,” he said.

"Achieving results as a national alliance is not just about quantity, it’s about the quality of the message we pass on to others that brings about change in the community, country and world at large,” Zoungrana said.

As Theresa Shaver emphasized, "through everyone’s participation through holding everyone accountable for their pledges and commitments to reduce maternal mortality, action translates down to the community level where women are dying. Even though some countries are severely off target that they cannot meet the MDG5 target, we should applaud those countries that have made some difference and continue advocacy.

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