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.