A Global Perspective, Motherhood in Malawi

The following remarks were given by Brian G. Bowler, Ambassador from Malawi to the UN, at the American Mothers National Board of Directors meeting in New York City.

I accepted to come here today after reading about your organization and its core values.  One of your values really resonated with me:  A heart of compassion for issues and challenges facing mothers around the globe.

I know that you do not have a large global footprint, but with a very small push, American Mothers could bring a meaningful impact to the developing world.

I stand in front of you not as a mother but as a father and someone who has a mother, a wife, a daughter…and as one who has seen the pain and suffering of the mothers in Malawi as they give birth, bury their children and struggle to provide for their families on a daily basis.  Today, I bring you their story.  A story of pain, suffering and resilience. And, a story that binds you as women, all struggling to raise your families, regardless of where you were born.

Imagine for a moment, lying alone, scared and in the dark…in pain and unsure of what is happening to your body.  The nearest health center is over 20 miles away and there is no way to get there except by foot or bicycle.  This is a real scenario faced by women in Malawi every day.  In a moment that should bring them their biggest joy, they turn to a local traditional birth attendant, whose only training is often her own experience giving birth in the village.  With no candle or paraffin for light, the darkness adds to the complications.  The birth attendant doesn't recognize the symptoms of obstructed labor or understand the need to deliver anywhere except on the cold floor of the mud hut.

As days pass and the woman reaches a critical point in her potential survival, it is all too evident hat is has become too late for the unborn child.  The gravity of the situation can no longer be ignored and slowly arrangements are made to transport the critically ill woman to the clinic on a bicycle ambulance, a mere cot with 4 wheels that bounces behind the bicycle on potholed trails for hours.  Upon arrival, it is not only too late for her unborn baby, but sadly too late for her as well.

This reality happens all too often in Malawi and throughout the developing world as a lack of skilled medical personnel, compounded with a critical shortage of skilled medicine and supplies threatens this very life giving miracle.  No woman should die giving birth.

I have had the deepest honor of witnessing the birth of my son here in the United States.  While there were complications, pre-natal observation ensured that appropriate action was taken in time and even during labor when new complications arose, we were fortunate to have skilled doctors and nurses to ensure a safe delivery.

However, children in most of Africa toady face a better chance of survival than they did just a decade ago.  For example, the infant mortality rate has decreased from 76 deaths per 1000 live births in 2004 to 5 out of 100 in 2012.

During the same period the under 5 mortality rate declined to 71 deaths per 1000 live births, from 133 per 1000.  These statistics however, are still unacceptable.  No woman or child in toddy’s world should die as a result of giving birth or being born.

One of the causes contributing to these mortality rates is a lack of skilled medical personnel.  With only 459 general medical practitioners for a population of 17 million, and only 1777 specialists, including 25 obstetricians, the doctor-to-patient ratio is alarmingly high at 1:26,700.  It is estimated that only 71% of women give birth with a skilled attendant and fewer still attend or understand the affects of prenatal care.

Sadly, these statistics put Malawi as one of the riskiest places on earth to bear a child.  And, this lack of trained medical care is further exacerbated by the brain drain caused by the recruitment of our precious human resources by developed countries already capable of training their own workforce.  But, the dedicated doctors and nurses work tirelessly in Malawi utilizing their skills and talents to try to reduce the burden on their patients.

Maternity units in cities in Malawi are bursting at the seams, with pregnant women spilling over onto the floors and corridors with all beds occupied.  Some of these women will remain in labor for days.  They experience so much pain with no available medication, they often turn to local traditional medicine and herbs which can further cause damage to their weakened bodies and their babies.  Due to space retractions, they are often forced to be alone and deliver without the support of a loved one.

Imagine a situation where out of 1000 births, 5 mothers will die, and yet in another country like Sweden, only 1 woman out of more than 17,000, will have even a pregnancy related complication.  The overwhelming question is how did it get so bad?

While scenarios described are not meant for shock effect, it is the reality on the ground at present.  By having 1 doctor per 27,000 people, by having so few birthing centers, limited access to medication and prenatal care, this grave situation will undoubtedly continue.

Providing basic necessities and access to even minimally skilled care can make a he impact on these figures.  At present, we continue to work with partners to produce packages called Mama Kits which include basic but fundamental supplies to help women have a clean and safe delivery.  Can you imagine not delivering your baby at a health center because you can not afford a new razor blade to cur the umbilical cord?  Or worse, can you imaging a health center using a razor blade to do an episiotomy without any pain relief.  These are the decisions faced every day by women in rural Africa.  These Mama Kits provide women with a clean surface to deliver on, sterile gloves, a scalpel, gauze, a warm blanket and clothing for the baby and other items to give the mom and baby a fighting chance.

At present, there is hope being built around a campaign that is moving forward to encourage women to attend prenatal care and return to deliver their babies in a clinic.  Giving a woman a Mama Kit at her prenatal visit, serves a dual purpose by encouraging her to come for prenatal care and giving her all the supplies the rural clinician would need so she may return to deliver her baby in a safe environment.

Through small donations and community participation, we were able to open a 6 room maternity and health clinic in Ndongo Village, on the border of Mozambique and Malawi.  It provides basic health care and maternity services along with other services like HIV counseling and testing, TB treatment, and well child care and vaccinations.  The community, tired of traveling 2 0+ kilometers to access healthcare and seeing countless children die, asked for assistance and fully participated in the preparation and building of this clinic where they now see hope for a brighter future inside the brick walls and iron roof.

A lack of information amongst mothers and a high rate of illiteracy is a major factor to the problems faced by expectant mothers.  If mothers are well informed this will reduce the rate of birth complications and the maternal and infant mortality rates in the future.  A simple thing such as educating expectant mothers about techniques like Kangaraoo Care, which substitutes for incubators in a country where only a few exist, in the long run can make the difference between life and death.

In Malawi, so little can go a long way.  For as little as $20,000, a small health clinic with access to clean water can be built.  When comparing a figure like the $8 Billion per year spent on cosmetics in the US and the $17 Billion spent on pet food annually in the United States and Europe, the cost of a clinic is but a drop in  a very large ocean.  For this reason, we remain eternally grateful to all of our friends who have dedicated enormous efforts to reduce the suffering of women.

The gateway to my vision and ultimate goal for the women of Malawi to be healthy, well educated and empowered in all spheres of life will be permanently opened when we secure the health of all expectant mothers and consequently the future potential of their unborn children.  By raisin women’s health status, you raise the health status of her whole family.

I will be failing in my personal duty if I did not express my appreciation as well as admiration for all of you who have a heart to see that our mothers stop dying.  I know I would not be here today if it was not for someone like you who many years ago helped support a nurse or hospital that assisted in my birth.  We need to protect all mothers throughout the world, as they are our only hope to keep our human race alive.  It is only a woman that can bring life and we need to protect and cherish that miracle.