The Democratic Republic of Congo (DRC) struggles with some of the highest maternal and infant mortality rates in the world. Maternal mortality is estimated at 730 per 100,000 live births (WHO, 2013), making it a dangerous place to give birth. Infants fare poorly thereafter, with infant mortality standing at 97 per 1,000 live births (MICS 2010) and increasing.
A host of cultural and clinical factors contribute to abysmal maternal and infant mortality statistics. Within the community, women traditionally give birth at home without a trained attendant. Sometimes women fail to access a facility due to lack of funds – either for transport (if any is available) to a facility (often at a distance) or to cover traditional in-kind service fees of food, livestock, soap, etc. Gender norms may also impact prospects for safe delivery, as men traditionally control household funds and may decline to invest in facility-based births.
Those women who do access facilities may experience less than optimal care. Staff present during delivery often works under trying conditions, without clean water, electricity, lighting, and proper sanitation and ventilation. Basic delivery supplies – including gloves, stethoscopes, and resuscitation equipment – are often lacking. Providers themselves, or those trained sufficiently to be effective, may also be in short supply.
ASSP has seen these challenges up close in its own work. While skilled birth attendance is increasing overall, it remains stubbornly static in some areas. A recent in-depth assessment of lagging communities surfaced some of the same challenges previously identified. The poor state of health facilities, their equipment, and supplies available deters many women from giving birth at health facilities. The lack of recovery rooms and beds was one frequently cited barrier. In addition, certain social norms and customs – such as preferring to give birth with a female traditional birth attendant rather than a male nurse or doctor – also impact uptake of facility-based births.
ASSP has facilitated close to 1.5 million deliveries with a skilled birth attendant.
To improve safe deliveries and promote reproductive and maternal health and the use of RH services, the project has piloted a number of strategies, including distribution of birth kits for mothers and newborns, advocacy and awareness-raising campaigns, and other community-based interventions aimed at promoting safe deliveries and the value of healthy timing and spacing of pregnancy, as well as renovation and construction of health facilities.
ASSP has been successful in reducing maternal and neonatal mortality as a leading contribution to improved primary health care in its 52 health zones. Specifically, ASSP has facilitated 1,470,571 million deliveries with a skilled birth attendant, increasing delivery coverage from 62% to 80%. Remarkably, in Year 5, 100% of expected births were attended by a skilled attendant. To achieve this, the project has:
1. Improved geographical accessibility of maternal and newborn health services.
2. Improved availability and quality of maternal and newborn health services.
3. Promoted the use of maternal and neonatal health services.
- ASSP has financed over 200 nurses to get a university-level degree in midwifery, an area of expertise lacking in the health workforce in Congo.
- Referral health facilities in ASSP-assisted health zones provide life-saving EmONC, increasing their ability to save pregnant women and newborns’ lives. While not all facilities are currently able to conduct caesarian sections or safe blood transfusions, the project is distributing C-section surgery kits and safe blood transfusion kits as part of equipment and supplies provisions to help upgrade the facilities from EmNOC to C-EmONC.
- Close to 1.5 million women have delivered with skilled birth attendants due to the project’s activities.
- A study conducted in partnership with the Medical University of South Carolina, IMA World Health, and Pathfinder International concluded that the use of the Safe Delivery App supported increased health worker knowledge and self-confidence in the management of obstetric and newborn emergencies after 3 months. SDA and mLearning were found to be feasible and acceptable to health workers and key stakeholders in the DRC (download full article).