Motherhood Prenatal Care

HEAL Africa's Safe Motherhood Prenatal Care and Micro-Insurance program is an extremely innovative initiative that increases access to health care for birthing mothers. Women of reproductive age pay into maternity micro-insurance groups that ensure that they can receive proper medical support through pregnancy, delivery and neo-natal care. The insurance groups are locally managed on a micro-level, with each member paying into the program and each member receiving the needed support from an appropriate, health facility when it is their turn to have a child. The appropriate level of medical care might be care from a retrained traditional birth attendant, the local health center, or a local hospital. Early screening and prenatal care is essential to identifying high-risk deliveries and assessing the needed care levels for birthing mothers.

Each maternity micro-insurance group starts with 8-10 members and a small grant of money for them to manage for their own childbirth costs. They receive training in family planning, in managing a small business, and in the concept of a Solidarity Group. Their local midwife, a traditional birth attendant, is trained in new and updated ways to care for their health and refer them to the local clinic if needed. Solidarity Group members save money from their small businesses, pooling some of it to pay back their original grant. Once the grant is repaid they will pay it forward to form another group. Meanwhile they meet weekly, get to know each other and develop trust. Their husbands become involved in the classes on family planning. They arrange to work together to transport the wives who will need to go to the clinic to deliver, it may be two days walk. Many social issues are addressed. When one woman gets pregnant and it is time to deliver she won't need to worry that she will be replaced by her in-laws if she leaves home. She won't worry about being accused of deserting her children; her friends will make sure that the family is fed and taken care of. Her husband will understand and support her getting good care because they've already saved the $4 they will pay to the nurse, and the $1 to the traditional birth attendant, which will be paid if she delivers safely.

The process is creating new ties in communities that have been split by war and mistrust. It provides a valuable service to the midwives who have been well-trained, equipped, and now work in cooperation with the nurses in the clinics, and not in competition with each other. The nurses in the clinics also receive training and equipment that will help them provide good service to the women of the community.

It is a situation where everybody wins. Birthing mothers are assured that they will get the care they need, traditional birth attendants receive updated training and inclusion in the process of midwifery, and all work in cooperation with the clinics. And, once the group members pay back their original start up grant, it is paid forward to start another maternity micro-insurance group, expanding access to maternity care for another 8 to 10 women. What's not to love?

In 2008 this program helped to form 253 Solidarity Groups for maternity insurance, 173 of which appear sustainable. 784 Solidarity Group leaders (2-4 per group) were trained on managing income generating activities.In this program, income generation grants are given to a solidarity group of women of reproductive age who plan activities for earning a steady stream of income. Pooled resources produce savings that support these women through pregnancy, delivery and neo-natal care. In 2008 activities focused on reinforcing the capacity of 94 healthcare workers and traditional birth attendants (TBAs) with training in Safe Motherhood and Family Planning (FP). Safe Motherhood began in 2000 in response to the question: Why do so few women deliver in a health center (26%), The responses to this question enabled HEAL Africa staff to design a most unique community-based program to reduce infant, maternal and neonatal mortality through safe childbirth practices.

The stated obstacles preventing women from having a safe delivery were:

• Lack of trained staff for a safe delivery using a cartogram
• Lack of decent facilities with functioning equipment for safe delivery at the level of health centers and hospital responsible for emergency obstetric care
• Lack of finance in the family economy to pay five dollars and safe delivery
• Traditional attitudes and approving home birth and opposition by mothers in law to delivery in a health centre
• The power and influence of the traditional birth attendants
• Distance to hospitals able to give emergency obstetric care, and lack of transport
• Fear of the unknown felt by village women. Will they be criticized by their in-laws if they leave their families for health care?
• Who will care for the children in her absence? Her husband? Or her garden?
• The Safe Motherhood program addresses two needs; informing and supporting mothers at risk, and training and supporting health workers and caregivers who assist birthing mothers.

The Safe Motherhood program addresses two needs; informing and supporting mothers at risk, and training and supporting health workers and caregivers who assist birthing mothers. Because it is our primary concern that women give birth in a safe environment with proper assistance, Safe Motherhood distributes free baby kits with supplies for newborns to mothers who deliver at a registered clinic, serving as an incentive for mothers to deliver in a safe environment.

Many programs designed by medical people start with medical services, albeit at a local level. The words awareness raising are used with tiring frequency, and are understood as telling women what to do. The telling is usually done by experts from the outside, who then leave the community on their motorbikes and go on to the next village. Nothing changes, no one is convinced, no obstacles are removed.