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When pregnancy is a death sentence for women

A physician-journalist reflects on the stubborn problem of maternal mortality around the world.
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A woman and her baby at the maternity ward in MSF's field hospital in Doro refugee camp in Maban county, South Sudan. (Nov. 2012). (Florian Lems/MSF/Courtesy)

Last December, as intense civil fighting erupted in South Sudan, I spoke with several doctors and nurses about its impact on the health of the 11 million people who call the country home. The problems accessing health care in South Sudan were already vast, and the emergence of violence would only make things worse – perhaps no more so than for expectant mothers.

I was working in New York with the communications team at Doctors Without Borders/Medecins Sans Frontieres (MSF), which provides vital care across South Sudan and nearly 70 other countries around the world. As part of my role, I debriefed MSF aid-workers like Miriam Czech, an American nurse who had just returned from a mission, and considered their experiences for sharing more widely with the media and public.

For three months, Czech had trained local nurses to provide better care for pregnant women. But the challenges were great. Czech told me about a frail 24-year-old woman who had walked three days from her village to the maternity unit in the city of Aweil. The woman was in the ninth month of her pregnancy, and her husband had to carry her part of the way because she also was suffering from terminal tuberculosis. Czech helped the woman give birth to a baby boy, fragile at only 1.2 kilograms — less than half the cutoff for low birth weight. But the mother could not endure the stress of childbirth.

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With a surge of cash from donors, maternal mortality has dropped by a third in Zambia and Uganda. Can the program be sustained?
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Thomas Frieden, director of the Centers for Disease Control and Prevention, speaks at a Saving Mothers, Giving Life event in Washington DC on January 9, 2013. (Center for Strategic and International Studies/YouTube)

Brenda Mweetwa was a janitor, not a nurse or a midwife. But she had heard her late husband, a doctor, talk about delivering babies. That was enough, in the understaffed health clinic where she worked in Mabombo, Zambia, to make her the most qualified candidate to help out when a pregnant 16-year-old showed up in labor.

Fortunately, she wasn’t on her own.

As part of a mentorship program administered by Boston University, a certified nurse midwife was standing by to talk Mweetwa through the two-hour delivery over the phone, said Donald Thea, the professor who heads up the effort. When, after producing a healthy, squawking set of twins, the mother started hemorrhaging, Mweetwa harkened back to a training session she’d attended just two days earlier. With a condom and a catheter, she cobbled together a device to stop the bleeding and saved the mother’s life. 

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Nigeria: where giving birth can be deadly

ABUJA — Nigeria is confronted with many challenges to improve health care for women in childbirth, including ignorance, isolation and corruption. 
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