“It’s not just having an operating room,” said MSF midwife Erika Sawyer. “It’s having an operating room with sterile equipment that’s available 24/7, that has all of the supplies you need, and blood in the blood bank. That is the kind of quality care that we’re trying to focus on more and more right now.”
“Access is a huge issue,” said MSF midwife Liza Ramlow. “In northern Zambia, for instance, where you would have to get on a bicycle for two to four hours in order to get to a small, rural health center, where there certainly wouldn’t be a cesarean section, for example, but you maybe could get transport to the district hospital, where there would be one.”
A woman’s previous experiences with inadequate or disrespectful care at local clinics can also prevent her from coming to a facility to deliver. “It’s essential that we have respectful maternity care,” said Ramlow. “There are lots of women who do not feel welcome in the systems that we have now.”
In many places with broken health systems, women rely on traditional birth attendants (TBAs). With an uncomplicated pregnancy and delivery, an attended home birth can go well, but when a woman needs skilled care, it’s a different story. In South Sudan and Bangladesh, Ramlow worked alongside TBAs who were trained by MSF to identify and recognize the signs of complications during delivery and to help those women reach the MSF hospital quickly.
The panel highlighted the importance of women’s access to contraception, which historically was not seen as a medical humanitarian priority. “We know that if all women who wanted contraception—which is several hundred million—had access to it, maternal mortality would actually be reduced by about 30 percent,” said Feedman. “If you don’t get pregnant, you’re not going to die in pregnancy or childbirth.” Sawyer and Ramlow pointed out that MSF has made strong progress in offering women access to a variety of modern contraception methods in recent years.
Unsafe abortion as a forgotten emergency was also discussed. It remains one of the five leading causes of maternal mortality. “I lived in Kenya for eight years,” said Jones. “I heard some of the most horrifying stories you can imagine about young women—women of all ages really—having illegal, backstreet, horrifying abortions. Seven women every day die in Kenya and more than 320 were injured every day from unsafe abortion.”
Globally, the number is far higher. According to a comprehensive report published by the Guttmacher Institute in 2018, at least 22,000 women and girls die each year after having an unsafe abortion, but the actual number of deaths is unknown since so many of them are never reported. “We’re in the time of the Global Gag Rule right now, and MSF—because we don’t take money from [the US government]—can say whatever we want,” said Sawyer. “It feels extremely invigorating and refreshing because we’re one of the only NGOs [nongovernmental organizations] being very active about the fact that we provide safe abortion care as a means to reduce maternal mortality, and that it’s vital.”