In the Shoes of a Rural Mother:
The Ideal vs. Reality
Living and working in a rural community during my time as a Global Health Corps fellow opened my eyes to harsh realities that I would have otherwise flipped past in a newspaper without thinking deeply about. I started my health information technology journey unaware of how exactly I would fit into the maternal health realm. Some of my “blank” moments included deciphering unusual statistics like “438 deaths per 100,000 live births” or complex technical jargon in this field.
As a program operations specialist, I spearheaded maternal health education in rural eastern Uganda with my co-fellow. This involved getting immersed in the community, mentoring mothers, children, and men, and working with village health team workers, health centers and stakeholders in different capacities. Every aspect of my work exposed me to the complexities in the health care system and the enormous challenges that my fellow Ugandan people have to deal with every day.
In the course of my work I met Joyce, a 28 year old mother of two who narrated that she had no idea when she first became pregnant because she was using injector plan, a popular family planning method in Jinja District. She started noticing fetal movement, dizziness, and fatigue, so she decided to go to the health center where she discovered she was six months pregnant. However, Joyce never returned to the health center for antenatal care because she didn’t feel the need to do so. Besides, her neighbor Zahara, a 30 year old mother of three who had recently lost her baby during delivery, told her that the nurse midwife at the center refused to attend to her on time because she didn’t have a plastic sheet and a pair of gloves, let alone money to buy any of the required items. Afraid of going through a similar ordeal, Joyce decided to deliver with a Traditional Birth Attendant (TBA) near her home because like her neighbor, she didn’t have money or the required items. She had a painful delivery and tragically lost the baby during the process.
The hope and dream for maternal and child health care for women in the world is rosy, with teachings and emphasis on couples planning ahead of time to get pregnant then visiting the health facility to get advice and start taking prenatal vitamins like iron and folic acid to prepare the mother’s body for a baby. Then the couple gets pregnant and attends all the antenatal care visits and all services are given to them with benefits like mama kits, mosquito nets, educational sessions, and pregnant couple support. The mother eats well and follows through with all best health practices for pregnant women, including delivering in a health facility. Qualified health workers attend to her every step of the way until the baby comes, regardless of whether or not she has money and other resources. This or something close might be happening in some places, especially in urban centers, but what about that mother living in a rural area, where the best she has is access to a health center that can barely provide pain killers to patients? This is the woman who represents the majority of Ugandan mothers!
The reality for many woman is not far from Joyce’s story. Many mothers get pregnant without planning or intending to do so. By the time they access health facilities, it’s late in the pregnancy, so the mother and baby miss out on supplementary nutrients that the body needs for healthy development. Some mothers attend antenatal care visits but most do not know that it is important for them to go. Others are afraid of accessing the health facilities because they lack of money for transport or other required items or may fear getting tested for HIV/AIDS or being turned away if they do not go with their husbands who, in most cases, are unavailable. Like Joyce, they don’t find out how the baby is faring or learn how best to take care of themselves in order to give birth to healthy babies. While focusing on the mother’s role, let’s not forget the importance of having the husband totally involved. In many cases, the men are completely absent and the mothers have to carry the entire responsibility of taking care of themselves and their families.
The thorn crown lies in the choice of where to deliver. Like Joyce, most mothers are afraid of accessing the health facility because they are afraid of being turned away or neglected by midwives the same way Zahara was, as they do not have money for items like gloves, plastic sheets or razor blades (which cost about .03 USD). The mothers then decide to visit TBAs who will warmly welcome them, take very good care of them, provide doula services, give them food and help them deliver at no cost at all and without asking for any of the items they ought to. Even though they risk losing their children, contracting diseases and infections, they would rather bow to the tradition of delivering at home with a TBA than deal with the wrath of an angry midwife in a health facility.
I realize that I do not need a medical degree to set off a wave of change in the lives of mothers and their children. With collaboration, it is possible to keep the wave moving so that tragic stories like Joyce’s can be transformed into tales of victory for mothers all over the world.
Every morning during my fellowship, I walked through the dusty, or sometimes heavily mud-covered road to work with my co-fellow, thinking about the 16 women who would not set eyes on the next beautiful Ugandan sunrise because of maternal complications that cost their lives. I thought (and still think) about their babies who would not live to celebrate their first month of life, wondering whose fault it is and whether opening the minds of mothers and fathers with education so they can make informed choices is good enough.
The dilemma that mothers like Joyce face each time they make choices surrounding birth sits heavy on my shoulders. The number 16 resounds in my mind as a reminder that safe motherhood is not the reality for many women. I realize that I do not need a medical degree to set off a wave of change in the lives of mothers and their children. With collaboration, it is possible to keep the wave moving so that tragic stories like Joyce’s can be transformed into tales of victory for mothers all over the world.
