The New Route to Safer Childbirth in Rural Senegal

GOUDIRY, Senegal — It’s a long way — 70 kilometres along a hot and dusty dirt road — from the village of Goudiry to the regional hospital in Tambacoumba. For many of the women who tried to get there in the throes of labour, often in donkey carts, it was an eternity.

Until April 2001, eight out of ten women with complicated pregnancies didn't get to help in time, and many of them died in childbirth, according to Isabelle Moreira, a reproductive health programme officer at the UNFPA office in Dakar. That was before the tiny health clinic in Goudiry was expanded into a much larger, well-equipped obstetric care centre, with UNFPA support. 

The bright orange walls of the centre — the only building in sight — rise up from the harsh beauty of this remote part of the country near the Mali border. At the entrance, a lively painted sign talks about healthy mothers and children. The centre itself is a hive of activity, lit up by dozens of colourful and brilliantly patterned boubous and headwraps, and by the smiles of the women who wear them.

Some are here for prenatal checkups or ultrasounds. Some are learning about HIV and other reproductive health issues as they wait to see a nurse or midwife. Some are balancing young children on their hips. Three women have just given birth.

" I give thanks to God that I am alive. But I know it was the operation that saved me. "

Soukoba Sissakho, who has delivered a healthy boy, Kumba, is visibly relieved and very grateful to be alive. Her first two deliveries had taken place at home. They had been long and difficult, and she would not have lived through the third, she is convinced, without the Caesarean section that was performed here. "I give thanks to God that I am alive," she said. "But I know it was the operation that saved me."

Already, the clinic has saved more than 100 women who would otherwise have counted among the grim maternal mortality statistics for the county. Senegal’s maternal mortality ratio is nearly 500 deaths per 100,000 live births. In the rural areas, where a woman’s social status remains closely tied to her role as a mother, women give birth to five or six children on average.

With each child, the women’s chances of dying increase. In many parts of rural Africa, one in 19 women die as a result of pregnancy or childbirth. Severe bleeding and eclampsia are the leading causes of maternal death in Goudiry. Early marriage, female genital cutting and sexually transmitted infections are additional factors that complicate childbirth for many of the women here.

The women of Goudiry are more fortunate than many in the country. Senegal averages only one gynaecologist per 30,000 women of reproductive age — and most of them work in the capital. Goudiry's centre, a pilot project supported by UNFPA as part of its focus on improving pregnancy outcomes, is a model emergency obstetric care facility, with the equipment and personnel needed for handling blood transfusions and Caesarean sections.

In Senegal as a whole, Caesarean sections represent only about 1 per cent of deliveries. Complications requiring the operation, however, occur in 5 to 15 per cent of all pregnancies. That means that many women who do not have the procedure die as a result of obstructed labour, or sustain a fistula, an injury to the birth canal that leaves them incontinent.

Fortunately, more women in Goudiry are now getting Caesareans when they need them, according to Dr. Fanding, a highly respected doctor from the community who has received specialized training in emergency obstetric care. More than 50 Caesarean sections have been performed in the centre in its first year of operation, he tells a group of visitors, as he shows off the clinic’s new medical equipment and the gleaming surgical theatre.

An anaesthetist, 17 nurses and several trained community workers offer outreach services, including information about reproductive health issues. They also deliver contraceptive supplies, provided with support from UNFPA, to the surrounding areas. The area served by the centre is vast, but unfortunately, the two ambulances out front aren't working.

Getting the ambulances fixed and building more centres like the one in Goudiry are essential to making substantial progress towards the internationally agreed target of reducing maternal mortality by 75 per cent by the year 2015. This indicator of improved reproductive health is one of eight Millennium Development Goals identified by the Member States of the United Nations as requiring priority attention. It is an ambitious goal, but one that can be achieved with tools already available, if the political will can be mustered.

Reducing maternal mortality has long been a priority for UNFPA, as part of its mandate to protect reproductive health. The Fund's strategy includes reducing unwanted births (which could reduce maternal mortality by 20 per cent or more), ensuring skilled attendance at birth, and providing emergency obstetric care to all who develop complications in childbirth. The Goudiry centre is actively working on all three fronts.

But there is also a social and cultural aspect to this that cannot be ignored. People need to know how to protect their reproductive health, and to be encouraged to do so. UNFPA is working to bring the full weight of respected cultural and religious institutions to this cause. Recently the Fund supported a regionwide meeting of imams in Senegal to gain their critical support to the challenge of making motherhood safer.

Once they were sensitized to the health problems that early pregnancy can cause, the imams in rural Senegal committed themselves to speaking out against early marriage and to promoting the idea of responsible sexual behaviour. "It is not good for a girl to be given in marriage before she is physically ready, and it is not good that our people are getting infections," said one imam in Tambacoumba.

"We support this noble mission to improve the health of our people and we are willing to translate this into concrete actions. We thank UNFPA and all the partners for undertaking this. We are with you and we are behind you."

-- Alvaro Serrano, Mari Tikkanen, Janet Jensen