South Africa is a middle-income country and the richest in sub-Saharan Africa. It spends more on health per person than any other on the continent, and it provides this healthcare free, including services for pregnant mothers.. Despite these facts, according to the recent Human Rights Watch Report, our maternal mortality has more than quadrupled over the past decade (from 150-625 deaths per 100 000 women).
Rural women bear the brunt of these statistics due to lack of transport and inaccessible facilities.
I recently attended a conference at which, "how women access care" was being discussed. A recurrent issue identified, was that care was often inaccessible to women. The dialogue that followed focussed on how better roads were required, how more infrastructure was required to enable women to access care, and how this was very costly.
For a long time, this problem has been looked at from this perspective. Perhaps it is time to look at it from a different angle.
Instead of building better roads at great expense, maybe it is time to take the midwife back to the women.
Think of it this way. Think of yourself going into labour at night or maybe on the weekend. Think that your family has no vehicle. In fact there are very few vehicles in your village. Think that the at your last checkup the midwife had talked about how important it was to take your antiretrovirals through your pregnancy, and that in labour she would give you some medicine to stop the HIV being transmitted to the baby. Think of the nearest hopsital being 60km away and having no way to get there at night. Think of phoning the ambulance, but then remember how long you waited for them in your first labour. Remember the many stories of other women from the village, who have waited many hours for an ambulance, and who have given birth before the ambulance came. Think of the many women who have lost babies. Think of maybe walking the 15 minutes to the police station in labour, some women say that ambulance might come sooner if the police call the ambulance. That is if the police are there.
Then think about the little blue house next to the park. Think of the warm, friendly Thursday mornings, when all the women come for their checkups. Think of the comfortable double bed, the quietness of the birth house. Maybe you should phone Nomzamo and tell her that you think the pains have started. It is 2am but the pains feel strong, you do not want to walk in the rain to the police station. You remember the way you were treated at the hospital when you gave birth to your first child, how impatient and harsh the nurses were. How will they be this time? Maybe you will call Nomzamo, she will know what to do. She told you you could call at any time, she will not be angry and she will fetch you in her car and take you to the birth house. There is a shower and toilet there, and you will be able to labour with privacy and Nomvula will look after you with Nomzamo. Yes, perhaps you will call.
When you think of it this way, although we do need roads, they suddenly do not feel as important as taking the midwife to the women.