Nuru at Chikande House, where she waited for 2 weeks to deliver. Photo Credit: Anna Sawaki, WRA Tanzania.
Judith arriving at Katsande Home from the home of her relative, for her check up. Photo Credit: Anna Sawaki, WRA Tanzania.
Working Together to Save Lives
What would you do if you were pregnant and knew that the hospitals in your town or city could not save your life if there was an emergency during labour? Could you sit idly by knowing eclampsia, a ruptured placenta, or an obstructed birth would lead to your certain death? Could you rest easy knowing that a breach birth would mean the death of your child? This is the situation that many mothers in the Dodoma region of Tanzania face.
Knowing that it is only through self-care, and the support of the community and the government, that women can assert agency over their personal health choices, White Ribbon Alliance Tanzania’s campaign for safe motherhood urges the government of Tanzania to prioritize the development -and continuous funding — of facilities and staff capable of providing Basic and Comprehensive Emergency Obstetric Care (B/CEmONC) in all health centres nationwide.
WRA Tanzania staff often visit ante-natal clinics to collect information on the everyday realities of mothers in Dodoma. They ensure that the work they do is driven by the voices of mothers and citizens so that the government can take action that specifically addresses their needs and demands. A visit to Chikande House, a Maternity Waiting Home, near Dodoma Regional Hospital brought our attention to two cases of mothers who, despite immense difficulty, exemplified the life-saving benefits of self-care for maternal and newborn health. The steps Nuru and Judith each had to take when trying to access their right to quality, equitable, and dignified health care shows that WRA Tanzania’s campaign is coming at a critical moment for Tanzania’s mothers.
Nuru, an 18-year-old mother, had arrived at Chikande House from a distant village 3-hours away by bus. She stayed at Chikande House for two weeks before giving birth. Her decision stemmed from the fact that the dispensary where she had been receiving pre-natal care was only staffed by two people, both of whom were overworked and exhausted. “The health centre that I was advised to go to is more interior and does not have comprehensive emergency services,” she says, and it has neither blood stores nor an operating theatre.
Self-care, in the form of Nuru’s self-awareness and health literacy, guided her to make the more difficult but safer decision of going to Chikande House. Had she not realized the flaws in her dispensary’s referral and made appropriate decisions to prioritize her own health, it is unclear that Nuru would be alive today. Possessing the agency to challenge a medical authority, and by making informed decisions which prioritized her health as a mother, Nuru’s self-care choices allowed her to avoid risk and save herself from a life-threatening situation.
Of course, the fact that her family had the financial flexibility to accommodate her absence was pivotal in her decision to travel to Chikande House. For a woman’s absence — a mother’s absence — means the absence of a breadwinner and caretaker in the family. This is not an accommodation that all families can make, at least not without significant consequences. This was extremely true for Judith.
At 52, Judith was already the mother of 5. Because she had experienced severe bleeding during the delivery of her last child predisposed her to hemorrhage during her next birth, Judith was aware of the need for CEmONC services. Referred to Dodoma Regional Hospital, she journeyed away from her family to be close to the life-saving services while waiting to give birth.
Significantly more distressing than the fear of waiting, however, was the burden her absence placed on her family. “It’s sad that my second born, who is only 15-years-old, is performing a mother’s duty,” Judith said. “While I am away she has to take care of her siblings. The situation is difficult for her to the extent that she cannot balance studies and family duties. I have been away from home for three weeks now.”
In order to save mothers just like Judith from having to make the impossible choice between personal health and their family’s future, WRA Tanzania advocated for the government to ring-fence the CEmONC budget at national and subnational levels. It is because of their campaign that Tanzania now has a budget in place that prioritizes the lives of Tanzania’s mothers and babies.
WRA Tanzania’s National Coordinator Rose Mlay expanded on just how successful their CEmONC budget campaign has been by sharing that, because of their advocacy efforts, the government’s Minister of Health’s “2017/2018 budget targets the availability of oxytocin, magnesium, sulphate, and safe blood services including blood banks and satellites for blood donation. In addition, there is a plan to upgrade 150 health centers to provide CEmONC with funds from the World Bank and from within the government. Out of the 700 health centers in the area, we currently have 117 providing CEmONC. When the Minister’s plan is implemented this year, we will have 267 out of 700 health centers, which will be 38% compared to the current 16.7%. The target is to reach 50% by 2020.”
Judith accessing her right to safe, quality, equitable, and dignified health care should not burden her daughter’s education. Indeed, if a mother making the correct decision for her own health harms her daughter, a cycle of unavoidable negative outcomes for mothers and women has been allowed to form — a cycle which pulls girls away from education, perpetuates early pregnancies, and facilitates maternal mortality; a cycle which opposes the principles and pillars of self-care, namely agency and risk avoidance. One part of breaking this cycle is access to CEmONC, which must be quick, convenient, and easy.
Nuru, a young mother, received poor counselling, but was saved by her own quick thinking and her family’s flexibility. Judith, an experienced mother, knew she needed to have CEmONC services at hand but her family’s inability to accommodate her absence resulted in negative outcomes for her daughter. Barriers to accessing safe maternal health care are many and varied. They do not discriminate between people and must be eradicated for the good of all mothers, families, and communities.