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Every day about 800 women across the globe die from complications related to pregnancy or childbirth. In 2013, the total number of such deaths was 289,000. Almost all of these deaths occurred in low-resource settings, in developing countries.
The risk of dying during pregnancy and childbirth in sub-Saharan Africa is 1:31, while in Canada it is 1:10,000. Most of the deaths could have been prevented. This disparity in maternal and perinatal mortalities, between developed and developing countries, is greater than any other commonly used measure of public health status.
Mothers die from postpartum hemorrhage (27%), hypertension (18%), obstructed labour/ectopic pregnancy/blood clot (11%), infection (9%), and indirect causes, such as HIV/AIDS, malaria and anemia (18%). The remaining 9% of maternal deaths are due to abortions (8%) and miscarriages. Frequently women die in unclean conditions, alone, in terror and agony without trained assistants, or access to proper life-saving care.
In 1981, Canadian OB-GYN Robert Walley began working to improve pregnancy outcomes in sub-Saharan Africa, starting in Nigeria. For over 20 years, Dr. Walley and the organization he founded, MaterCare International (MCI), have been providing an approach to reducing maternal mortality that works and that doesn’t involve promoting abortion or flooding villages with contraceptives.
MaterCare specializes in providing mothers with care that respects their dignity and offers life and hope. They do so in response to invitations from bishops in Kenya, Nigeria, Ghana, Sierra Leone and East Timor, among others. In the Apostolic Vicariate of Isiolo, Kenya, MCI has embarked on a demonstration project that is providing essential obstetrical care to rural communities, training programmes for doctors and midwives, e.g. in natural family planning and safe delivery techniques, training for traditional birth attendants, and an emergency transport system. MCI has also worked in Nigeria, Ghana, Sierra Leone, Rwanda, Haiti and Timor Leste.
Dr. Walley explains that his greatest life-changing experience as an Ob-Gyn occurred when he was at a mission hospital in southeastern Nigeria in the early 1980s. In over 40 years of practice in Newfoundland, he had never witnessed a “direct maternal death,” i.e., a death that resulted from causes directly related to pregnancy and delivery. He recounts:
Dr. Walley notes that on numerous occasions the international community has discussed the urgent need to reduce maternal mortality (MM), beginning with the first Safe Motherhood Conference in Nairobi back in the 1970s, and most recently with Millenium Development Goals 5 to reduce deaths by 75% by 2015. But none of the goals have ever been reached because the world forgets that MM is about the death of a mother and not about preventing her from being a mother.
In Dr. Walley’s experience, the only solution to maternal survival is for women in childbirth to be cared for, one at a time, by experienced doctors and midwives, in safe, clean facilities, with adequate equipment, but also with transport able to go to a mother when life-threatening complications arise. It does not depend on the provision of contraceptives and abortion, but that is always the solution proposed by the UN and non-governmental organizations (NGOs).
With frustration, Dr. Walley relates his experience attending “many large expensive conferences called to solve the tragedy of so many deaths, where many pundits, philanthropists, bureaucrats, international development specialists and politicians seem to me to talk about the subject in the abstract, about money and programs, etc. Not one of them, I venture to guess, has ever witnessed a maternal death and the death of the unborn child.”
MCI’s approach – which enjoys the full support of numerous bishops in Africa – has been to develop a model of rural essential obstetrics which takes into account the lack of adequate maternal health care, poor facilities, lack of staff, lack of equipment and transport, poor roads and even the lack of community involvement, especially from women’s groups:
Through the generous (albeit limited) support of Canadians, and from governments, churches and foundations overseas, MCI developed a demonstration project in Isiolo county, Kenya. He explains:
“We begin at the level of villages, where 80% of mothers presently deliver and where most deaths occur. ‘Project Isiolo’ is training traditional birth attendants to recognise and refer high risk mothers to the nearest rural clinic. So far only one of six such clinics has been built, staffed by midwives, but it is 225 Ks from the base hospital. However, it has saved lives. Transport is provided with a motorbike ambulance, and a 4X4 ambulance equipped for most obstetric emergencies. It brings the hospital close to the mother. The base hospital staffed by midwives and obstetricians provides care for all complicated cases. Isiolo is a poor arid area and has a population of 180,000. There is only one operating theatre for the whole County of Isiolo and only 37% of mothers receive pre-natal care. We were invited to help, back in 2005, by the late bishop who found us on the Internet and in desperation asked for help. Isiolo county is the most neglected area in Kenya (by the government and by NGOs). It has the highest MM in the country: 790/100,000.”
Dr. Walley laments that despite all the advances in fetal/maternal medicine, abortion and birth control have become the basis of maternal health care. While governments and private agencies spend billions of dollars on reproductive health programs, only a small fraction is spent on life-saving emergency obstetrical care. MCI has been refused government funding countless times, as it does not provide “reproductive health” and because it is “too Catholic and too close to the Pope.”
For some years, MCI has proposed an innovative, proactive approach to funding – Whic Dr. Walley describes as a sort of maternal “Marshall” plan. The original Marshall plan was developed in 1947, he explains, to respond to the devastation of Europe following the World War II and in response to the threat of domination by the tyranny of Soviet communism. In the 21st Century, he believes that maternal health care is threatened by a tyranny of the culture of death. At first sight, the idea of mobilizing the international community to reduce MM may seem unrealistic, but Dr. WAlley points to a precedent, in the 1980s, when the full extent of the world AIDS pandemic was realized and the international community and the Church came together to find ways to treat and prevent the disease.
Such a response is needed now to eliminate the tragedy of maternal mortality and ensure that the good words and intentions are translated into practice in the service of mothers, their children and their families.
Dr. Robert Walleyis the founder and Executive Director of MaterCare International. An obstetrician-gynecologist practicing in Newfoundland, Canada, he is also Professor Emeritus of Obstetric and Gynecology. The Holy See honored Dr. Walley with the Pro-Ecclesia et Pontifice award.
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