As an OB/GYN and global women's health professional, I have worked and talked in countries across the globe. I have seen first-hand how difficult it can be for women to access quality obstetric care during pregnancy and childbirth, which can mean the difference between life and death for women, especially during an emergency. I recently travelled to Zambia where I had the opportunity to hear from people on the front lines of the effort to reduce maternal mortality.
In Zambia, Merck for Mothers is working with Saving Mothers, Giving Life (SMGL) – a five-year public-private partnership focused on dramatically reducing maternal deaths in Sub-Saharan Africa. SMGL is working both at the facility level – to strengthen the skills of healthcare providers, renovate facilities, and procure essential supplies, among other activities – and at the community level to educate women and improve access to care. This has already led to a substantial increase in the number of women receiving care and giving birth at facilities rather than at home.
Yet, the work is far from over. One challenge that we noted during the trip is the state of maternity waiting homes (referred to as maternal shelters in Zambia). These are temporary residences, located near emergency obstetric care facilities, where women who live far from a health center and have limited access to transportation can stay during the late stages of pregnancy until they go into labor. They are particularly important in Zambia because of its geographic landscape, the remoteness of communities, and poor roads.
In Zambia, we spoke with women staying at a waiting home and others who wanted to use them despite the fact that they are often run down and lack even basic amenities, such as beds, food, and cooking equipment. Both groups of women reported that improving these shelters should be a priority, and that extended families could watch their other children when they are away. Some women were also enthusiastic about the idea of contributing to the management and upkeep of the shelters. Local SMGL teams reported that attention to maternal shelters would help fill a key gap in the program and enhance access to care for hard-to-reach women.
Merck for Mothers has decided to focus its program in Zambia on maternity waiting homes, and is identifying ways to improve them in a sustainable way by fostering community ownership and/or entrepreneurial approaches to their management. This will encourage more women to use the shelters so that they can give birth with a skilled health provider in a facility, increasing their chances to have a safe, healthy delivery.
My experience in Zambia underscored to me how important it is to see what is happening on the ground at the community and clinic level so we can design targeted programs to improve the quality of care women receive. We must understand the challenges health providers face and listen to the women if we are to make a meaningful impact on women's lives, in Zambia and other countries alike. Our partnerships are making headway in building both essential infrastructure and the capacity of health workers to deliver affordable quality care to women, and our insights from the field will continuously strengthen our evolving programs.