Fri, Oct 06, 2006 - Page 9 News List

Same world, yet worlds apart for giving birth

For mothers in Niger, giving birth to a child is a leap of faith, as they get precious little support from husbands or the healthcare system. The contrast with what's going on in Sweden couldn't be starker

By Joanna Moorhead  /  THE GUARDIAN , LONDON

It's 10am on a stiflingly hot Monday morning and I am in a delivery room with one of the unluckiest mothers on the planet.

She is Dahara Laouali, and at the moment she is lying on a narrow, dusty hospital trolley pushing her baby into the world. Although the birth is imminent -- Insa, the midwife, says that with the next contraction the head will be out -- Dahara is making no noise at all.

This is Niger, where the tradition is that mothers labour in silence. It is hard keeping quiet in the throes of childbirth: but almost everything is hard for mothers in Niger.

Dahara pushes, pain creasing her sweating face, and then pushes again -- and suddenly between her legs there is a little boy with the walnut features of newborns everywhere, and a mop of damp, dark hair. Insa gives a delighted squeal, but Dahara is still silent: as her baby is wrapped in a cloth, she turns her face to the wall and sobs quietly.

Maybe she is tired after the labor. maybe she wants to be alone. Maybe she is not ready quite yet to welcome the baby into her heart. But maybe, too, she is remembering other births, and other babies. Because this boy is the fifth child Dahara has pushed into the world and of the others, only one is still alive.

This, then, is Dahara's misfortune: and it is not just a personal tragedy, but one she shares with every other mother in her country. Niger is officially the most dangerous place on earth to have a baby: in May, a Save the Children report found that of the 125 countries it surveyed, Niger was where childbirth was most likely to end badly.

Statistically, Dahara, who is 26, has a one-in-seven chance of dying during her reproductive years as a result of a pregnancy-related complication or infection, or childbirth injury. Her baby son, lying here on the table, has a 15 percent chance of not reaching his first birthday and a one-in-six chance of not making it to the age of five. And Dahara is fortunate to have had the skills of a midwife like the cheerful Insa: across the country, only 16 percent of deliveries are attended by anyone with any training at all.

Dahara lives in a village called Bande, about two hours' drive from Zinder, the rundown former French colonial capital. To call the birth center here basic is an understatement: to the Western eye, from the outside, it resembles a neglected public lavatory. Inside are two small, grubby rooms -- the delivery room, with its trolley and rickety desk, and the recovery room, which boasts a mattress-less bed and a graying cot.

Here, Dahara and her new son -- whose name is to be Mohammed -- will stay for a couple of hours. Then, Dahara will tie Mohammed to her back and walk the kilometer or so to her village. There is no aftercare, Insa explains: no midwife will check up on mother or baby, so Dahara will have to use her own judgment if there are any post-natal problems and seek help if and where she can.

Dahara's husband has not been involved in the birth and is unlikely to play a big role in the early weeks with the baby: in Niger, birth is considered to be women's work and fathers keep their distance.

Ten days later, I am in another maternity unit. This one is in the University Hospital at Uppsala, north of Stockholm. Bande is 5,150km away, although I feel as if I have traveled from the middle ages to the middle of the 21st century. In almost every way, giving birth in Sweden is light years away from giving birth in Niger. And yet, of course, it is all ultimately about the same thing: a mother and a baby.

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