LUSAKA, Zambia (WOMENSENEWS)-- Rudia Chiwala, 23, is pregnant with her second child. She waits for her delivery in a shelter for pregnant women at Nagoma Mission Hospital, a rural health institution in Mumbwa, a semi-urban district in central Zambia.
It took her two hours to walk here, which she thought best to do before she was on the brink of delivery and in need of help.
Chiwala has been at the shelter and away from her family for almost a week. She's not sure when her delivery will be, so she patiently waits with her mother beside her.
"I had to go here for me to have a safe delivery," she says. "I am so scared to deliver at home where there are no trained personnels."
Chiwala's hair is braided, and she wears a black T-shirt. She adjusts her chitenge, a traditional Zambian cloth that is wrapped below her protruding belly. Her chitenge extends below her feet, a symbol of honor for a rural woman.
Getting enough food is a challenge, since the shelter leaves that up to the women. She and her mother wait for family members to make the long walk and bring them food.
Chiwala says the long walk to the shelter was difficult during pregnancy and made her feet swell afterward. But she says she's happy she made it to the hospital in advance.
"There are times when women deliver on the way to the hospital," Chiwala says.
To avoid that risk, many rural women make the trip a month before they are due.
In rural areas, nearly half of families live outside an eight-mile radius of a health facility, according to the Ministry of Health.
Maternal shelters, such as the one hosting Chiwala, are a relatively recent innovation that the government now offers women who live far from health facilities. The government also drafted a plan last year to increase access to care.
But for now, rural women are forgoing maternal care or making long walks like this and waiting in shelters.
The maternal mortality rate in Zambia decreased by 19 percent between 2001 and 2007 and currently stands at 591 deaths per 100,000 live births, according to 2011 government statistics. But there is little hope that the country will have lowered that rate by 75 percent by 2015, the target set by the Millennium Development Goals, a U.N. global anti-poverty initiative.
Quality Care is Key
The key to reducing preventable maternal deaths is access to quality care before, during and after childbirth, according to the World Health Organization. Maternal deaths are higher in rural areas, where this access is especially limited.
Hubert Siame, environmental health technical officer at Nagoma Mission Hospital, says approximately 240 pregnant women come to the hospital every month.
Dr. Mavuto Zulu, acting medical officer in charge of the hospital, says that antenatal care is crucial for the mother's and baby's health.
"We encourage women to come for antenatal services to be able to detect early illnesses on the mother," he says.
Zulu says antenatal care can detect problems such as HIV as well as implement prevention of mother-to-child transmission strategies. Mothers can also transmit malaria to their babies if they don't take malaria prophylaxis, a preventative treatment, early enough.
Zulu further says that antenatal care can also detect hypertension in mothers, which is important because this can eventually lead to eclampsia, or seizures in pregnant women. He says it's also important that pregnant women are up to date with their vaccinations, such as tetanus.
Because of the distance to hospitals from the women's homes, Zulu says that it's important that women also come well in advance in order to be there before they go into labor.
He adds that the government must recruit more staff in the existing clinics because most of the rural clinics do not have trained personnel.
Long Walks and Waits
Bertha Kamudoli, 38, and her husband are farmers. Tall and outspoken, she has five children. Like Chiwala, Kamudoli is also awaiting her delivery at the shelter. But her walk to get there was even longer – four hours.
"I cannot manage to wait until I feel the labor pain 'cause I may deliver on my way," she says.
Kamudoli says there are no clinics near her home in Kalindi village, and she couldn't count on finding a driver and a vehicle to take her to the hospital in an emergency.
She acknowledges the difficulty of staying at the shelter so far from home for so long.
"We have to find our own foods, firewood and cook for ourselves," she says. "We have to come with enough food, but sometimes the food can finish before you deliver, and home is very far."
But she says she has no other choice.
"Being near the hospital is the only way we can have a safe delivery," she says.
Another woman staying at the shelter is Patricia Mutanga, 30, who is eight months pregnant. She too has traveled a long way.
"I had malaria and some complications of the fetus not lying in the right position," Mutanga says.
Because of the complications and distance of her home from the hospital, she must stay here until she has her baby.
"I cannot go back home," she says, "as I was advised by the doctor to stay here in the women's shelter for a month until I deliver."
This time, she came by bus. But another time, she walked.
"If I do not have enough money for transport, I have to take the two-hour walk to the hospital for antenatal," she says.
She says this dissuaded her from seeking the care she needed during her pregnancy.
"Because of the distance, I had only been to antenatal once," she says.
She says she rarely sees health workers in her area, making the hospital the only option for formal care. Like the other women at the shelter, she must obtain her own food, pushing her way to the nearby market.
"I would have liked to deliver at home, but I do not trust some traditional birth attendant," she says. "I want to deliver at a hospital where trained people can help me deliver."
Dando Mweetwa reports for Global Press Institute's Zambia News Desk. She aims to give a voice to the voiceless through her articles in order to incite social change.
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