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

Mariama Bashir, the general manager of Zinder's maternity hospital, is a strikingly beautiful young woman in traditional African dress who sits behind a desk in a cramped office with a whirling fan. In between a constant stream of interruptions from harassed-looking midwives, she delivers the statistics with an air of weariness. Of 2,600 babies born here last year, approximately one in six was dead at delivery or died soon afterwards. In addition, a total of 61 mothers lost their lives.

This is shocking stuff: in Uppsala, where there are 4,000 births a year, two to three babies will die annually and one woman will die, on average, every seven years.

But there is more to the horrors of Zinder. Many of the women who come here will have travelled long distances, often in agony, to reach the hospital: some, Bashir says, come from villages as far as 50km away.

The commonest problems that bring them here are pre-eclampsia, eclampsia itself (which causes fits) and women whose pelvises are too narrow to allow the baby out (especially common in teenage mothers). For the many women who need instrumental deliveries, the hospital has two sets of forceps and one ventouse.

"But the ventouse is not in good condition," Bashir says. "We need a new ventouse. But then, we need many things."

Bad and costly

More shocking still is the fact that unlike Sweden, where excellent maternity care comes free of charge, Niger's women have to pay for the privilege of their substandard, inadequate services (while healthcare fees have been abolished in principle, they are still enforced in practice). And although the sums are paltry by Western standards -- an antenatal check-up is 1,000 CFA (US$1.89); a new-baby check-up is 5,000 CFA; a cesarean is 17,000 CFA -- the amounts are impossibly large for impoverished families in a country where the average per capita income is 127,000 CFA a year.

In the village of Yawouri, outside Zinder, nurse Abdulaye Hachiou explains that women often fail to seek help in labor because they -- or their husbands -- fear the expense.

"You get husbands who say their wives can't be brought to the clinic because they don't want to pay the bill. And then the wife gets worse and they say, well there's no point in taking her now, she's going to die anyway," Hachiou says.

Removing healthcare fees, says Save the Children, would save women's and babies' lives in Niger.

But that is far from the whole solution. The country needs more trained midwives, well-equipped antenatal clinics (one I visited shared its only blood pressure monitor with the district nurse -- if she was using it, the blood pressure of mothers-to-be went unchecked), more obstetricians and a modern maternity unit in every town.

In a perfect world, Niger would also have a vigilant system of postnatal care and beyond that -- but equally important -- clean water, a decent standard of living and good healthcare.

But that would be in a perfect world. So must childbirth continue to kill women and babies, on the sort of scale it did 200 years ago in the West?

Not necessarily, says Save the Children. Anne Tinker, the Washington-based author of the report, says she believes seven out of 10 of the lives currently lost could be saved if a few low-cost measures were put into place. Education, she says, is key.

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