By Amanda Joy

Right now, all around the world, there are thousands of women who are giving birth today. Roughly 250 babies are born every minute. Each woman will have her own unique experience, her own set of circumstances. For some of those women they will be surrounded by support, provided as many comforts as possible, and greeted with great encouragement. They have spent the last nine months undergoing testing and screens, receiving counsel and education, eating for two.  They will have picked out names and thrown parties to honor this life changing experience.  And there will be some who will birth in their homes with a few helping hands, or none, their comforts minimal and their knowledge based on personal experience and local traditions. Today, there will be endless versions of every birth scenario all over the globe.

Regardless of where she is in the world, each one with her individual variables will want for the same thing, to have a healthy baby…and to be a healthy mother.

Then, of those women from every corner of the earth who have grown a human and labored today to bring them into the world, hundreds of them will die.

It is a truth that we all know, that women have always died in childbirth and that it is only through the advancement of healthcare, nutrition, hygiene, technology, and education, that the number of women dying each day isn’t higher. For the privileged majority we have cheated death and the legacy of birthing women throughout history. We will know that it is always a possibility but will experience a safer reality.  But for some mothers it is not a history, it is not a far off fear pushed aside for the logistical concerns of where, when, and how to birth.  It is at the forefront: this will be their life and death moment.

Those mothers whose pregnancy and birth outcomes are the most threatened are concentrated in our low-income regions of the world.  While each mother might want for the same healthy result, her geographical and social demographics will greatly influence her pregnancy and birth outcomes.

The majority of maternal deaths occurring each day are happening in only a handful of countries.  Close to 60 percent of pregnant and birthing mother fatalities are in ten countries, with the largest numbers existing in Sub-Saharan Africa and India. For women not living in low-income regions, with strong healthcare systems and limited political and social restrictions when accessing support, their probability of dying from the leading causes of maternal mortality is small.  A mother in a developing country is 300 times more at risk of dying during pregnancy and childbirth than a mother in a developed country.

             “…A  women in Eastern Africa faces the highest risk of maternal death 1 in 12, compared with only 1 in 3700 for women in North America. No other health indicator varies so dramatically between developed and developing  countries.” JoshiandKushwah

Women living in rural areas, or those with limited resources and accessibility to considerate and competent care are the women that are dying today in the hundreds, leaving behind their babies, other children, families and communities.

Almost all of these women’s deaths are avoidable, almost all of them could have their healthy outcome.

           “The majority of maternal deaths are preventable: About three quarters of all maternal deaths are caused by postpartum hemorrhage, hypertensive disorders such as pre-eclampsia/eclampsia, infections, unsafe abortion and other delivery-related complications. In theory, all of the major causes of maternal death can be treated with effective and timely clinical interventions…Non-communicable diseases also play an important and growing role, contributing underlying causes to deaths that occur during pregnancy, delivery and the postpartum period.”MHTF

While the causes of deaths can easily be identified and qualified, the context and circumstances an at risk woman experiences are complex.  We may understand how women die, but the root causes of why they die are multifaceted.  Whether she’s malnourished, has restricted access to comprehensive family planning methods, limited healthcare infrastructure in her area, or experiences religious, political, or social discrimination, the compounded affects are that over 300,000 women will be gone this year, over a million children motherless.

Understanding that sustainable communities can only exist through the promotion of the health and well being of it’s citizens and that every mother counts, it is the communities that are answering the call to meet pregnant and birthing women’s need where ever they may dwell.  Health workers who are trained “members of, selected by and accountable to the communities in which they work,” (SarahHodin) are reaching every woman they can to provide basic maternal care and make referrals as necessary to higher levels of intervention. Community health workers (CHWs) have “received no formal professional or paraprofessional or tertiary education,” according to the World Health Organization.  But what they do have is personal experiences and knowledge of the cultural nuances that exists in the regions they attend.  They know the people and what religious, political, and social practices exist that make servicing pregnant and laboring mothers a challenge.  They are familiar and are capable of reaching out to help women when they are their most vulnerable.

In Burma, Ethiopia, Kenya, Nigeria, Tanzania, Uganda, Afghanistan, Nepal and Rwanda implemented programs using CHW have shown great benefit in the lives and well being of pregnant mothers, improving not only birth outcomes, but the overall health of women and their children (SarahHodin).  They are called Lady Health Workers in Pakistan, and they travel to the most isolated of mothers offering care, while themselves experiencing discrimination and harassment for performing services viewed as un-islamic to community leaders (HafsaAdil). Striving for the betterment of their women populations, CHW are walking the front lines of maternal health care, showing great compassion, understanding, and even great courage. 

Every pregnant woman deserves to engage in motherhood with the resources and opportunities necessary to be successful, so that she might build up her own family and her own community. With the aide of Community Health Workers penetrating into those outlying places, more and more vulnerable mothers, who otherwise could have died, will have their healthy pregnancy and birth outcomes. The miracle of birth will always come with some inherent risk. It is perhaps that risk that compels us all to appreciate it’s sacredness and the great efforts put forth by each woman to make it transpire.  But in those moments where the line between life and death appears the most obvious and fragile, might every mother live to tell her own birthing story.