Imagine you are nine months pregnant, ready to give birth. You feel your contractions start. You are excited and afraid, but mostly you are in pain, praying that everything will go well. You also know that the nearest health facility where you can safely deliver your baby is four or more hours away, across mountainous terrain, much of which you’ll have to travel by foot.
This is the difficult reality for many women in Lesotho. “For all of my three deliveries, I walked two hours to the main road and then continued by minibus to the hospital,” says Mantebaleng Ntelekoa, a young mother from a rural area in Lesotho’s mountains. “I usually started walking when my contractions started, and it took a long time, because I had to sit down every time I had a contraction. One of my children was born premature at seven months, so I am glad I made it to the hospital.”
But not everyone is as lucky. With a high prevalence of HIV and limited access to maternal care, Lesotho suffers one of the highest maternal mortality rates in the world—620 deaths per 100,000 live births, or about twice the global average. More than 50 percent of those deaths are attributed to HIV-related complications. The government of Lesotho has set a target to reduce maternal deaths to 300 per 100,000 live births by 2015, and is working on an accelerated action plan to reach the far-off Millennium Development Goal for Maternal Health. Yet, at present, the health situation for many expectant mothers in the small southern African mountain kingdom remains uncertain.
Mortality rates in very rural and isolated areas are especially high. Lack of transportation, often-impassable terrain, and fees charged at major hospitals keep many women from accessing antenatal care, lifesaving HIV treatment, and services for the prevention of mother to child transmission of HIV.
The Doctors Without Borders/Médecins Sans Frontières (MSF) team in Lesotho supports rural health facilities in 10 different locations across the districts of Roma and Semonkong to ensure that more women from remote areas have access to antenatal services and safe deliveries.
The St. Leonard clinic in Semonkong has a small maternity ward and a mothers’ waiting lodge where expecting mothers can stay as they approach their due dates, ensuring they will be able to deliver their babies with the assistance of a trained midwife. New mothers can stay after giving birth until they are ready to return home with their newborns.
“I sleep in the waiting lodge with the mothers when I am in Semonkong, and the atmosphere is quite amazing,” says MSF midwife Marleen Dermaut. “There is a lot of chatting and giggling, the women feel safe and enjoy each others’ company. After all, they are all in the same position, experiencing the wonder of new life and, away from their duties for a couple of days, are able to just focus on themselves and their new babies.”
On average, there are six women at the facility at all times. Since last year, the number of assisted deliveries at St. Leonard almost tripled from seven to twenty deliveries per month. This increase is likely due to a combination of increased health promotion by health center staff in the area and MSF’s donation of an ambulance. “The ambulance takes women to the hospital in case of emergencies during labor or after delivery,” says Dermaut. “The hospital is still a two-hour drive away from St. Leonard, which can be a long time in an emergency situation. In fact, it already happened that a baby was born in the ambulance.”
In addition to supporting maternity services in Lesotho, a team of MSF health promoters visits communities regularly to test people for HIV and tuberculosis (TB). In order to reach as many people as possible, MSF also trains community health workers to identify and test for these diseases, and when to refer community members to health facilities.