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Walking a Marathon to Give Birth

Marathons take place in many cities across the country every week. Athletes ranging from running hobbyists to professional racers will lace up their sneakers, pin on their bibs and set off on an ambitious 26.2-mile journey, often sponsored to run for an inspiring humanitarian cause. And with each completed race comes a sense of ultimate fulfillment – that unique combination of emotional catharsis and physical accomplishment from having achieved a daunting athletic feat.

Now imagine you're pregnant, poor and sponsor-less, and a marathon-length distance stands between you and the nearest hospital. Suddenly that daunting athletic challenge may become a matter of life and death.

This scenario is in fact a reality for millions of women around the world. Every year, around 300,000 women and 2.8 newborns die during pregnancy and childbirth – more than half in sub-Saharan Africa – and many of these deaths occur because women live miles away from the care they need during childbirth and lack the transportation they need to get there. In most cases, women will find a way to give birth safely – maybe at a nearby clinic, maybe at home with a skilled birth attendant or maybe on the side of a road because they couldn't make it to the facility in time. But sometimes, when women experience a life-threatening complication like severe bleeding or obstructed labor, they need emergency care at a well-equipped health facility. Without it, they could become another tragic statistic.

In Zambia, for instance, the majority of people live in rural communities, where health facilities are sparse, roads are unpaved and transportation is unreliable. Only half of families live within three miles of a health facility, and may have to cross rough terrain to get there. Even if a pregnant woman makes it to that local clinic, she could still be at risk if she has a serious complication, as most rural clinics do not have the trained staff and equipment to handle a childbirth emergency. And so she has another marathon ahead of her to reach the quality care she and her baby need to survive.

In fact, two out of three births in rural areas take place more than 15 miles from a hospital or clinic that can provide basic emergency care. It's no wonder Zambian women die at rates worse than 135 other countries.

Fortunately, there are solutions available to help women overcome this distance challenge. Residences called maternity waiting homes offer women in remote areas a place to stay in the late stages of their pregnancy. Built just steps away from high-functioning hospitals, waiting homes allow timely access to skilled doctors, midwives and nurses to manage a potential complication and prevent it from becoming life-threatening. These waiting homes enable women to take their marathon journey earlier in their pregnancy and in their own time, lowering their risk of an untreated emergency and increasing their chances for a safe childbirth and newborn survival. When women and newborns are provided integrated quality care throughout their life cycle, the results are profound. More women survive childbirth, more newborns grow into healthy children and families thrive.

Of course, building these homes doesn't always solve the problem, especially if women don't want to stay there because they are in poor condition, lack cooking facilities or are unsafe – which is too often the case. That's why it's so encouraging that local groups are taking new, creative approaches to make maternity waiting homes more appealing to women. With support from MSD for Mothers and the Bill & Melinda Gates Foundation and Africare – in partnership with the University of Michigan – and Boston University – in partnership with the Zambia Center for Applied Health Research and Development – are working with local villages to build or upgrade waiting homes and turn them into community-managed enterprises. Twenty-four local communities are testing out a variety of income-generating activities – like selling produce or hand-made goods – to ensure that the homes are financially sustainable, adequately maintained and sources of pride for women. Ultimately, if successful, these new models for maternity waiting homes could usher in a new solution to save women's and newborns' lives in Zambia and beyond.

As thousands of marathon runners cross the finish line this season, we should celebrate their achievement and cheer on their causes – 26.2 miles is no small feat for any human. But we should also be reminded of the millions of others who embark on similar-length journeys just to give birth.

After all, the finish line for them is the starting line for life.

Naveen Rao, M.D., leads Merck for Mothers, Merck's signature initiative to reduce maternal mortality around the world. Dr. Rao returned to the United States in 2011 after six years in India, most recently serving as Head of Medical Affairs for Merck's Asia-Pacific region. Prior to that role, he served as Managing Director MSD Pharmaceuticals Ltd., India, a subsidiary of Merck, where he established centers of excellence in clinical research, medical affairs and regulatory affairs. Dr. Rao is Board Certified in Internal Medicine and is a Fellow of the American College of Physicians, a member of the Board of Overseers of Columbia University's Mailman School of Public Health and he chairs the Maternal Health Pillar of the MDG Health Alliance, an effort supporting UN agencies to improve the health of women and children.




Jerker Liljestrand, M.D. Ph.D., is Senior Program Officer, Maternal Health, Bill and Melinda Gates Foundation. Dr. Liljestrand is an obstetrician-gynecologist, originally from Sweden, who started off his career in international health as an obstetrician working at the district level in Mozambique. He has worked in the field of Sexual and Reproductive Health and Rights (SRHR) in over 30 countries and for various organizations including WHO, the World Bank, UNICEF, and most recently USAID in Cambodia where he focused on maternal-newborn health and family planning. He has done extensive teaching, research and project work in SRHR, spanning HIV/AIDS, adolescent SRHR, gender-based violence, and strengthening midwifery and health systems for maternal-newborn health.