© D. Perez

Poverty, severe pollution, faulty sanitation and sewerage, inadequate hygiene and ubiquitous violence make life in the urban slums of Cairo particularly hazardous for pregnant women and mothers with infants. Many of these women deliver with untrained, illiterate traditional birth attendants (called ‘dayas’) who work outside the formal health system, with inherent risks to mother and baby. To better understand the role of dayas and the obstacles that keep mothers from delivering in health centers, Mothers at Risk and the Association for the Development and Enhancement of Women (ADEW) surveyed hundreds of mothers and scores of dayas in two of Cairo’s largest slums, Manshiet Nasser and Masr El Quadima.

Our survey shows that women prefer to deliver with dayas because of their convenience, accessibility, personalized care, and affordability. In addition to deliveries, dayas are also trusted members of the community who provide advice on a wide variety of issues of direct relevance to women. Dayas refer women to health clinics for prenatal checks, encourage breastfeeding, healthy nutrition for mother and baby, and visit the women periodically after delivery. Notwithstanding these positive attributes, our survey indicates that dayas may, by commission or omission, put mother and baby at risk, due to their lack of training to handle unexpected complications and inadequate hygiene. There is little contact between dayas and doctors and considerable mutual mistrust.

Mothers at Risk and ADEW will be sharing the results of the survey with public health officials and medical professionals, and will jointly devise a program to promote an increase in overall health awareness among women in the slums and deliveries at health centers. We believe these goals can be achieved in part by promoting new, officially-sanctioned roles for the dayas in community health promotion and in advocacy for institutional deliveries.

For more information on this project, visit www.mothersatrisk.org
or contact Becca Nasrallah at: Beccanasrallah@mothersatrisk.org

© AECID

Nicaragua has one of the highest adolescent fertility rates in the world. Adolescent childbearing is linked to higher maternal and infant mortality, less education for mother and child and an elevated risk of poverty. Mothers at Risk is supporting a community outreach program to ensure pregnant adolescents receive proper prenatal care and deliver with skilled personnel; and to help reduce the number of unwanted adolescent pregnancies through information and awareness-raising.

Our program is in Jinotega, a rural area in northern Nicaragua where one quarter of the population are adolescents. Our partner in Jinotega is the Casa Materna Cihuatlampa, a maternal waiting home for women from remote areas with high obstetric risk. It shelters an average of 300 mothers yearly, almost 5000 women in its 15 years of operations. A quarter of the women it shelters are adolescent who have low use of prenatal care services and high drop-out rates from school. More generally, there is limited knowledge of sexual and reproductive health issues and family planning, in particular among those from rural areas.

The Mothers at Risk-sponsored program involves training fifty community promoters (midwives, health promoters and youth leaders) in maternal, sexual and reproductive health issues who will subsequently go into the communities to raise awareness through workshops, focus groups, visits to schools and presentations in communities. They will make sure pregnant adolescents are monitored by health professionals and deliver in medical centers with skilled cared assistance. The program aims to reach around 4000 people.

For more information on this project, visit www.mothersatrisk.org
or contact Kathleen Beckmann at: kathleenbeckmann@mothersatrisk.org

© T. Higgins

Peru has one of the highest rates of maternal mortality in Latin America, and it is rural women who are at the highest risk. In one of these rural areas, the Upper Amazon region, Mothers at Risk conducted a Safe Motherhood Assessment in collaboration with the local Yantalo Foundation. Almost 500 women as well as local health staff and traditional birth attendants participated. The goal of the survey is to understand women’s experiences with maternity and reproductive health and their access to care.

The survey shows evidence of several challenges. While prenatal care is available, it is incomplete and is accessed inconsistently by expectant mothers, and there is an enduring minority of mothers who have no prenatal care at all. There is a very low rate of postnatal check-ups and significant gaps in maternal and reproductive health awareness. There is a high incidence of teenage pregnancies, and domestic and sexual violence are pervasive in the community.

For more information on this project, visit www.mothersatrisk.org
or contact: Cristina Samitier at: Cristinasamitier@mothersatrisk.org

© D. Perez

‘100% Oumahat’ is a young, pioneering shelter for unwed mothers, the only of its kind in the north of Morocco. ‘Chevrefeuille’ is one of the longest-standing Belgian shelters for pregnant women and mothers with small children, with a growing population of displaced and immigrant Moroccan women. Mothers at Risk has connected these two organizations in an exchange program to strengthen their capacity to support mothers. We organized a two-day workshop between 100% Oumahat and Chevrefeuille covering issues of common interest, which ranged from effective crisis management within the shelters, to motivation, training and retention of staff, fostering the mother-child relationship and lobbying for legislative and policy changes. During the workshop, the participants were received by the Belgian national federation of shelters.

Here is what 100% Oumahat Presdient Claire Trichot had to say about the exchange:

"After 3 intense and fascinating days, thanks to all of you, we return to Tangier with the spirit ‘oxygenated’ and a full heart…completely energized! We have had some marvelous exchanges and we leave feeling like we have accomplished so much more than our original objectives. You cannot imagine just much we are now full of hope and certainty about our choices and our daily struggles".

For more information on this project, visit www.mothersatrisk.org
or contact Rachel Hammonds at: Rachelhammonds@mothersatrisk.org

© A. Grunfeld

Pregnancy out of wedlock carries a heavy social stigma in Morocco, where single mothers and their babies are often shunned. In Tangiers, Mothers at Risk sponsors scholarships for mothers to participate in a professional training program with the goal of securing a job to sustain themselves and their babies. Fatima, 23, is one of these mothers. She has a healthy baby girl named Jamila, who was born against all odds. Her mother dotes on her, and earns enough at her new-found work to support the two of them. But Jamila and Fatima’s future looked quite different only a few months ago.

Fatima comes from a rural family of modest means. She attended school until she was in her teens, but financial pressures made her leave her village in northwestern Morocco, Tiflit, to look for work. She found a low-paying job at a factory in Tangiers, 300 kilometers away from home. It was during that time that Fatima became pregnant. With the father not assuming any responsibility, abortion illegal, and pregnancy out of wedlock stigmatized and penalized by law, Fatima was out of options. She kept her pregnancy a secret from her family and had no support networks to rely on. By the time she was eight and-a-half months pregnant, she was alone, jobless, with no prospects of income, and with no place to live. Fatima feared delivering alone at the hospital where it was not unlikely that staff would notify the police of her status, and she saw no alternative to abandoning her baby after birth.

It was at this juncture that she found her way to 100% Oumahat, Mothers at Risk’s local partner and the only shelter of its kind in the north of Morocco. It offers emergency accommodation for women like Fatima, as well as a comprehensive support program to encourage a safe and healthy pregnancy, a positive mother-child relationship and the mothers’ self-sufficiency. Fatima spent the days before her delivery caring for the other mothers’ babies and participating in the family-like environment of the shelter. And when she delivered and held her daughter for the first time, she decided beyond any doubt to keep her and to raise her by herself despite all the odds. As soon as Fatima had recovered from her delivery, she started participating in a professional training program, sponsored by Mothers at Risk. The certificate Fatima graduated with opens up employment opportunities for her in the formal economy. She has already secured a full-time job and has moved with little Jamila to their own rented apartment, the home for their small family from now on.

For more information on this project, visit www.mothersatrisk.org
or contact Rachel Hammonds at: Rachelhammonds@mothersatrisk.org

© D. Perez

In Nicaragua, our local counterpart is Francisca Espinoza ‘Panchita’, a tireless advocate for women’s welfare and Director of the National Network of Casas Maternas (Maternity Homes). Casas Maternas shelter at-risk expectant mothers from isolated rural communities until the birth of their baby. Francisca’s trailblazing work to create and expand Casas Maternas has saved countless lives of mothers and newborns. Francisca was at the forefront of the creation two decades ago of the Casas Maternas, which together now provide comprehensive medical care and temporary shelter for thousands of rural women.

For Francisca, ‘every woman who leaves the Casa with her baby in her arms and a safe delivery behind her is a victory; that is our daily reward; it is what keeps us going despite the challenges”. These challenges include a growing trend of young girls victims of rape and expectant mothers victims of domestic violence seeking shelter at the Casas.

Francisca manages the Casa Materna in her hometown Jinotega, where the project with Mothers at Risk is taking place, and she oversees the work of 60 other Casas. Francisca was recently awarded the Health and Dignity for Women Award by Americans for UNFPA for her ability to mobilize communities in support of maternal health and prevent unnecessary suffering among generations of women.

© Susana Espinozaz

Since May 2010 Nicaragua has suffered unprecedented rains that have caused 59 deaths and have displaced over 9000 people. The situation is due to worsen, as October is traditionally the month of heaviest rains. The impact has been great on Casas Maternas, maternal waiting homes. Casas Maternas are essential to ensuring mothers from remote areas with high obstetric risk can have a safe delivery at a medical facility. Casas have very limited resources and old, run-down infrastructures, which have been greatly affected by the rains and floods. Among the Casas Maternas with the most severe damage is the Casa Materna in Ocotal, the first such Casa to be established in Nicaragua.

© Susana Espinozaz

© LA PRENSA/B. PICADO

The “Global Strategy for Women’s and Children’s Health”, recently launched by the UN Secretary General Ban Ki-moon, sets out an international roadmap to save women and children, recognizing that their health is key to progress on all development goals. The document was developed with leaders from government, international organizations, business, academia, philanthropy, health professional associations and civil society.