Childbirth particularly perilous in Guinea-Bissau
Hours later, the 32-year-old mother lies listless on her side as sweat beads trickle down her back. She has lost a lot of blood, and the maternity ward is stifling, with no electricity to whirl the rusty ceiling fans to life.
Across the courtyard, first-time mother Aissato Sanha is following doctor's orders — she is spending the final three weeks of a high-risk pregnancy in a bed literally a dash from the delivery room. But she is young, maybe too young, in her teens, and she has high blood pressure.
Both women are up against the same challenge: Guinea-Bissau is one of the deadliest places in the world to give birth.
Despite some progress, childbirth is still a perilous endeavor across sub-Saharan Africa, and Guinea-Bissau stands out for its dire statistics. A woman has a 1 in 19 chance of maternal death in this tiny country, compared to about 1 in 2,100 in the United States.
'Give life without dying'
Amid the maze of packed beds at the Gabu Regional Hospital, Djau's distraught relatives cluster around her bed in the tiny ward. The room reeks of iodine and bed pans. The howls of labor pain form a chorus with the cries of newborns swaddled in rusty bassinets.
“Give life without dying,” reads the poster taped above the chairs where women deliver their babies. It is apt — Guinea-Bissau's maternal mortality rate is the fourth-highest in the world, after Afghanistan, Somalia and Chad. But few can read the sign anyway, because 60 percent of women here are illiterate.
Most women still prefer to have babies in their villages, where they sit in a stew of warm water and banana leaves as matrons coax labor along. However, if anything goes wrong, they are often far from a hospital.
As in many parts of western Africa, Guinea-Bissau's hospitals are few and far between. A journey of just 11 miles can take three hours by foot, or cost up to 10,000 francs (US$20) for a car, should one happen to be available.
Even if a mother gets to a hospital, families must purchase anesthesia drugs before emergency operations can take place. While Djau is hooked up to an IV, a brother is sent out to buy medicine to stop the blood loss.
He comes back with a plastic bag of drugs from the pharmacy, but the midwife tells him he's been given the wrong one. He sets off again, as their sister paces tearfully in the courtyard.
Medics explain that Djau is hemorrhaging badly because she didn't deliver the placenta after giving birth at home. Around 4 p.m., she suddenly begins to convulse in her bed.
Their family cries of grief that echo through the ward indoors, where her husband wipes tears from his face as the midwife checks for a pulse one last time. The midwife covers her body and face with the same orange, brown and blue wax print fabric she had been wearing around her waist.
Not long after Djau's death, Aissato Sanha shuffles over to the maternity ward with her mother by her side. She's given her age as 18, but the midwife believes she's as young as 15.
It is a triumph for health workers that Aissato is here at all.
The hospital has a House of Mothers, a building just a few minutes' walk away from a delivery room, where women count down the anxious days to birth under close medical supervision.
Outreach teams from a program operated by Caritas and Catholic Relief Services now regularly head into remote villages to identify high-risk pregnant mothers and relocate some closer to medical services. The teams also train traditional birthing matrons, helping them to determine when it's time to get women to the hospital.
Such efforts have made inroads in sub-Saharan Africa: The United Nations reported recently that the number of women dying from pregnancy and childbirth has nearly halved over the last two decades.
But even now, and even at the hospital, it is touch-and-go. Generators only hum to life when a surgery is being performed. There is no power for refrigeration to store blood donations, and no electricity to run incubators for babies who have come too soon.
A typed list pinned to the bulletin board in the hallway shows the grim statistics at Gabu hospital alone: Four mothers died here in January, seven in February and three in March. There were no totals kept for April, when a military junta seized power, or for the chaotic month of May that followed.
As the sun falls, the head midwife at the hospital works with only a flashlight tucked under her chin and sometimes the glow of a candle on a nearby countertop to guide her.
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