Increasing access to skilled care in Rwanda: Raising a network of empowered midwives

In 2008, Rwanda was ranked amongst the world’s highest countries where mothers die during childbirth. Statistics show 2,770 mothers died at childbirth, approximately one death every three hours. Rwanda is the most densely populated country in Africa with a population of about 10 million people and an average birth rate of 5.5 percent. This hasn’t lessened its appalling maternal death rate. The range of complications during pregnancy, childbirth and the postpartum period have given rise to a number of strategies by the Government of Rwanda to reduce population growth while at the same time increasing nationwide access to care of those most affected— rural Rwandan women. Besides health provisions like annual medical insurance, new ambulances in every district, construction of health centres in every sector and equipped district hospitals, expectant mothers find it difficult to reach the nearest health centre. Roughly 23 percent of patients (including women in early labour) must walk more than one hour or further than 5 kilometres to reach the nearest health facility. As a result over 48 percent of Rwandan women deliver at home under risky conditions in the absence of a skilled medical worker or midwife. They die from haemorrhage, infections, eclampsia, and obstructed labour as well as malaria and HIV/AIDS, which contribute significantly to maternal deaths. Even where the facilities are within reach, less than four percent of women make four recommended antenatal care visits; only 10 percent come for postnatal care. This issue of limited access to health centres can greatly be turned into an advantage for Rwandan women. Already, the Ministry of Health has equipped community health workers with mobile phones in every constituency, making it easier for them to report emergencies and make regular check-ups on patients incapacitated by severe diseases. The results have been positive. This approach also provides a strong basis for safe motherhood. If in the same will and vigour, maternity clinics equipped with computer literate personnel and trained midwives were built in every village, a new dawn of a life-saving workforce would sweep across Rwanda. Even though Rwanda suffers from an acute shortage of midwives – only slightly above 100 qualified midwives exist in the entire country – the trend can be changed. The White Ribbon Alliance—Rwanda is slowly raising public awareness about the need to not only financially support, but also provide, quality educators and instructors with the necessary equipment to build up the number of midwives in Rwanda. These midwives would work closely with the community health workers to report cases of incapacitated pregnant women who would be referred to district hospitals in cases of emergency. Women would also feel more comfortable going to maternity clinics, rather than to the traditional midwife whose equipment is usually rusty and infected. These trained midwives would provide door-to-door antenatal and prenatal checkups where necessary, hence reducing the risks of mothers dying due to avoidable complications at birth. They would provide the care needed and ensure that mothers undergo the compulsory testing for HIV/AIDS so as to avoid mother-to-child transmissions at birth. These midwives would be the voice of the community, sensitising, educating, and creating awareness about family planning, safe pregnancies and childbirth. The challenge of ignorance would be awash with the provision of mini-literature in their local language—Kinyarwanda, with illustrated instructions on pregnancy and childcare. After all, an educated mother is a good one! Since issues vary in different communities, midwives will be able to do their own research about the challenges and solutions to achieving safe motherhood in each community. This will draw more women to feel free to socialise in and around maternity clinics, and word will go forth like a wild fire about the good that comes out of giving birth in the presence of skilled midwives. Learning from success stories in the developed world where only one in 30,000 women die at childbirth, Rwanda’s safe motherhood story will change for the better. The issue of distance should never be reason for needless maternal morbidity and deaths. Instead it should be a wakeup call for the installation of maternity clinics that are showered with skilled, caring and trustworthy midwives. Gloria Iribagiza is a journalist for The New Times and a White Ribbon Alliance Rwanda member who will be attending the WIE symposium in NYC on September 20glo.irie@gmail.com

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Increasing access to skilled care in Rwanda: Raising a network of empowered midwives