South Sudan: Working to reduce the maternal death rate

In Northern Bahr el Ghazal, Southern Sudan, where most people have very little access to health care, Médecins Sans Frontières (MSF) runs a mother and child health program. In the maternity ward of Aweil Civil Hospital, MSF teams work to reduce the maternal death rate.

In the bustling maternity ward of Aweil Civil Hospital in Southern Sudan, sits 22 year-old Mary. She is about 9 months’ pregnant, due to give birth any day. This is not her first pregnancy, but it will be her first safe delivery. Mary has been pregnant twice before, and gave birth to both her babies at home. Both of her labours were long and difficult. Both times, she was alone, without assistance. Both of her babies were stillborn.

Mary’s clear determination to deliver a healthy child safely has now brought her to the hospital, where MSF runs the maternity services. She has been here for one month, refusing to leave, patiently awaiting her due date.

“I decided to come to the hospital because of the conditions at home,” says Mary. “It is safer here. I will wait here until the baby can be delivered safely. I will be happy if this child survives, I was sad when my other two children died, and I want this one to live.”

With the access to free, quality pregnancy and delivery care that MSF provides, Mary eventually gave birth, by caesarean section. “Mary has quite a severe spinal deformity, and her pelvis and spine would probably not have coped with a normal delivery, especially if she was at home,” says MSF midwife, Janet FIELDS. “The decision to provide her with the c-section was essential. The great news is that both she and her new baby are happy and healthy.”

Despite the tragedy of losing her first two children, Mary’s story is one of the fortunate ones. Her insistence on delivering in a hospital has meant she has fought the alarming risk that so many women in this region face: one in seven women in Southern Sudan will die during pregnancy or childbirth. In a region still recovering from the decades-long civil war, where health infrastructure has crumbled or is non-existent, and where there is a significant dearth of skilled health workers, it is estimated that only one quarter of the population has access to even the most basic form of healthcare. Women and children are the most vulnerable in this situation. Many pregnant women in labour, for example, have to walk for hours or even days to reach a health facility due to a lack of roads or unaffordable transport options. If they do make it, it is often too late for them or their child.

“In Southern Sudan the situation is critical,” says Janet. “In pregnancy, it is common in remote areas that a woman’s labour is prolonged and therefore obstructed and there are limited resources to help them through that difficult complication. There are also so many unpredictable things that happen in labour and delivery so having a hospital where those issues can be managed appropriately, and having the supplies and the staff is very important for the health of the mother and the baby.”

MSF has been working in Aweil Civil Hospital, in Northern Bahr El Ghazal State since 2008. It is the only hospital in the state, serving a population of approximately 750 000  people. The program was launched in order to respond to the health needs of women and children, and also to respond to seasonal emergencies in the region as they arise, such as outbreaks of meningitis or malaria, and peaks of malnutrition. In the paediatric and maternity units of the hospital, MSF medical teams provide pregnant women and children under 15 with free, quality healthcare.

Globally, it is recognised that the five major causes of maternal mortality are infection, high blood pressure, haemorrhage, obstructed labour and unsafe abortion. In Aweil Civil Hospital, the presence of MSF and therefore the provision of skilled health staff, drugs if necessary and appropriate equipment, serves to combat these causes. MSF’s 2010 maternity statistics for Aweil show that 93 percent of births were normal, vaginal deliveries. For the smaller percentage of women who presented with difficulty, one of the most common complications that teams saw was post partum haemorrhaging.

“Just yesterday, a mother came in for what we assumed was a normal delivery,” continues Janet. “She had a quick labour and delivery and within 30 seconds of the delivery of the placenta, she started bleeding. We had already given her oxytocin, a drug which helps with bleeding, but as the bleeding didn’t stop, we immediately had to give her another medication in her leg, and also start an IV on her. We also did a lot of uterine massage. It took a long time for the bleeding to stop, but eventually it did.

The thing that is scary about that story is that this woman would most certainly have died in the village. The people who may have been helping her may have certain techniques they can do which is great, but they wouldn’t have had the ability to give her the medications we gave her that saved her life. This woman has four other children to take care of. Because she was here, her life was saved.”

There are so many stories like these in Aweil, where the presence of skilled staff and access to drugs and equipment means that women’s lives can be easily saved. Over the past three years of working in the hospital, MSF has assisted in reducing the maternal death rate to 0.6%. With a rate of 14 percent in southern Sudan, the impact of the program and the importance of having women deliver in the hospital has been made abundantly clear.

Since beginning its program in 2008, MSF has seen an increasing number of women coming to the hospital for antenatal consultations and to deliver their children. In 2010, over 37,000 antenatal consultations were carried out, and over 3,000 women gave birth at Aweil Civil Hospital.  

MSF has been providing emergency medical-humanitarian assistance in Sudan since 1979. Currently, MSF runs 13 projects across 7 states of Southern Sudan, providing a range of services, including primary and secondary healthcare, responding to emergencies as they arise, nutritional support, reproductive health care, kala azar treatment, counselling services, surgery, paediatric and obstetric care.
South Sudan