“I Couldn’t Bear to Lose Another Woman”: Three Stories of Quiet Courage

Imagine, for a moment, that you are a woman in rural Malawi, a landlocked country in southeastern Africa and one of the most impoverished countries in the world. Now, imagine you are expecting a child.

Chances are good that you live at least a few hours away from your closest health facility. So you may or may not have received any prenatal care or gone to any doctor’s appointments during your pregnancy.

That also means that, when you go into labor, you might decide that your best option is to give birth at home — the same thing your mother did when you were born.

Of course, there is a lot that can go wrong when a woman gives birth at home without the help of a doctor or midwife or access to lifesaving drugs and medical equipment.

So it’s very possible that, long after your contractions begin, you realize that the labor isn’t progressing as it should. You’ve seen this happen to other women before, and you know that both you and your baby are at serious risk. You may not know the technical term — “obstructed labor” — or be familiar with the statistics, but you know from your own experience that it’s one of the major causes of maternal mortality.

Staying at home is no longer an option, so your family finds a bicycle. You climb on behind your husband for the long, bumpy trip to the health facility. When you arrive, the midwives can tell immediately that you need a C-section, but since there is no one qualified to perform one at this rural health center, you are referred to another hospital — which means another long bike ride and another delay in getting the care you need.

But the second hospital can’t help either. Their electricity is out — a frequent occurrence in Malawi — and the staff can’t perform surgery without lights in the operating room. Even though they know you’re at risk for a deadly uterine rupture, they have no choice but to refer you to a third hospital.

By now, every second counts. You’re exhausted and in so much pain that things around you seem blurry. But you know that what happens in the next few hours will mean the difference between life and death for both you and your baby.

This is a story that repeats itself over and over again, and not always with a happy ending. One out of every 36 women in Malawi dies from complications related to pregnancy or delivery. Almost everyone I’ve met in Malawi personally knows a woman whose pregnancy ended in death.

But the good news is that this story is starting to change.

Malawi has cut its maternal mortality rate in half since 1990. And Malawians across the country — from President Peter Mutharika to community midwives in the most impoverished villages — are committed to getting the number of women who die in labor and delivery even lower.

In 2012, the government began implementing a national Safe Motherhood Initiative aimed at ensuring that all women and their babies are within reach of quality, lifesaving care when it matters the most, so that no more women or newborns suffer deaths that could have and should have been prevented.

When I visited Malawi in June with our foundation CEO Sue Desmond-Hellmann, we got to meet some of the men and women who are putting this plan to save women and children into action. Here are some of their stories.

Sarah Briton

When Sarah Briton was born nineteen years ago, she was delivered at her parents’ house in her village, not at a hospital or health facility. But Sarah wants her own children to have better opportunities than she did — and the best possible start in life.

That’s why, when she became pregnant with her first child earlier this year, she decided she wanted to give birth in a health facility. She knows that having access to quality care at a facility is her best chance at bringing a healthy baby into the world. And she knows that a healthy baby has the best chance of excelling later at school, at work, and in life — something every parent wants for their children.

But Sarah also knew that getting to a health facility would be tricky. So when she learned that she had the option to go to a maternity waiting home, she brought the idea up with her husband.

Maternity waiting homes are a safe (and free) place for expectant mothers from rural villages to stay in their last months of pregnancy. Most importantly, they’re located just steps away from a health facility so that, when a woman goes into labor, she and her baby are already in reach of the care they need.

Sarah’s husband agreed that this sounded like a good idea. So, in May, Sarah traveled for five hours — by bus and by foot — to a new maternity waiting home in the Area 25 section of Malawi’s capital city of Lilongwe.

As I learned when I visited, the maternity waiting home in Area 25 offers much more than just a place to stay. It also provides lessons on a variety of topics that are important to expectant mothers in Malawi, from making baby clothes to HIV prevention to proper breastfeeding techniques.

When I met Sarah, she was in her sewing class working on a blue and pink flowered top for her baby. I loved seeing that the women were learning new skills that will continue to be useful after they go home.

During her time at the maternity home, Sarah has also had the chance to learn about options to help her plan and space her pregnancies. She has never used contraceptives before, but now she has the information she needs to make the decisions that are right for her family. Sarah wants her children to be happy and healthy — and having the ability to plan and space pregnancies is an important part of that.

Sally Kuchawo

Sally Kuchawo’s father dreamed that one of his eight children would follow him into a career in medicine. So when Sally decided to become a midwife, he was thrilled.

For Sally, being a midwife is much more than just a job: it’s a mission. And she is using all of her skills and training to make motherhood safer not only for her own patients but for women all across Malawi.

Like many people in Malawi, Sally has personal experience with the tragedy of maternal mortality. Her own sister died of a pregnancy-related complication.

But Sally has dedicated her career to shifting this status quo. And, a few years ago, the death of a woman she’d never even met pushed her to do even more.

Sally was visiting a family member in the hospital when she saw a young girl, only about sixteen years old, lying unconscious on a soiled mattress. She learned from the girl’s family that the girl had recently given birth and suffered complications after a C-section. The hospital was so overwhelmed and understaffed that the girl was getting very little attention. When Sally asked why no one had changed the girl’s soiled bedding all day, the midwife on duty just said, “How many hands do I have?”

Before she left the hospital, Sally gave the girl’s family her phone number and asked them to keep her updated. When they called a few days later to tell her the girl had died, Sally sprang into action.

“I couldn’t bear to lose another woman,” Sally said.

So she went straight to the Ministry of Health to tell them what she had seen. I thought the way she put it was so powerful: “Someone had to speak up for these voiceless mothers.”

Sally’s visit to the ministry led to a whole new chapter for her. Through people she met that day, she was offered a new job training young women from rural villages to serve as midwives, bringing lifesaving skills to communities with little access to healthcare. One hundred and forty-five of these community midwife assistants have already graduated from the program. Two hundred more are in training.

I was particularly excited about this program because, in addition to saving lives, it also transforms them. For young women in rural areas, the chance to become a midwife gives them the opportunity to serve their communities and also to lift themselves out of poverty. Sally’s favorite part of the job is seeing the changes in these young women. By the time they graduate, she says, they have not only new skills but also a whole new confidence in themselves.

That’s one of the reasons why when you ask Sally whether she likes her new job, she says no.

“I don’t like my job. I love my job.”

The work that Sally and these community midwives are doing across Malawi will have ripple effects. More midwives in more places means that that more women will have access to care during labor and delivery. Improved access to care means better outcomes for women and their children. Better health outcomes means that more women will live longer, healthier, more productive lives — able to take care of their families, contribute to their communities, and help build a better tomorrow for their country.

Timothy Bonyaga

“No one should lose a woman.”

That’s how Timothy Bonyaga answers when you ask why he works with the Ministry of Health to mobilize communities to make pregnancy and childbirth safer for women and children across the country.

Timothy was born and raised in central Malawi, near the border of Zambia, in a family of eleven children. He, too, knows the pain of losing a woman firsthand: four of his sisters died from maternal health complications.

Over his career, Timothy has worked as a primary school teacher and a clinical officer (which, in Malawi, is similar to a physician’s assistant) and has personally delivered many, many babies. Today, he draws on that background to help move his country toward the interrelated goals of “healthy mothers, healthy babies, and a healthy Malawi.”

A key part of Timothy’s job is helping communities understand that maternal health isn’t just a women’s issue. Men and boys — especially local leaders and village chiefs — have a role to play, too. I was so glad to hear that men are increasingly receptive to this message. The chiefs Timothy works with recognize that maternal mortality is a serious problem in their villages, and they want to do their part to stop it.

Another important part of his job is encouraging more families to begin using contraceptives. Contraceptives are an important tool to save women’s lives, Timothy explains, because they help women avoid getting pregnant too early, too often, too frequently, or too late — all factors that increase the risk of life-threatening complications.

The good news is that Timothy says he has seen a lot of positive changes in the country over the last five years. Community mobilization efforts have reached 10,000 men and women and 3,000 influential village headmen and chiefs. More families are using contraceptives. There is more male involvement in pregnancy and delivery, and more women are delivering in healthcare facilities instead of at home. For all of these reasons, he is optimistic that the trend lines in Malawi will continue to move in the right direction.

I’m optimistic, too.

Sala, Sally, and Timothy are all part of a bigger, broader story of progress in Malawi. There are so many Malawians all across the country who share Sala’s determination to create more opportunities for their children and Sally’s and Timothy’s commitments to ensuring that a better future begins with them.

All of us have a role in making this better future a reality.

We should be impatient for action when we imagine the challenges facing expectant mothers across Malawi today. But our impatience should motivate us to come together to imagine what is possible for Malawi tomorrow.