by Jasmine Vallve

In Simiyu region of Tanzania, the rates of maternal and newborn mortality are high, at 556 per 100,000 births and 29/1,000 births respectively. As a result, the Tanzanian government has identified Simiyu as a priority region for action to reduce these rates. (In Canada, the rates are 7.4/100,000 and 3.5/1,000 births, and an estimated 2.2 higher rate in Indigenous communities.)

During my last visit to Simiyu to see our Uzazi Uzima project, I learned about the role of the community and men in ensuring women have safe deliveries. Uzazi Uzima means safe deliveries in Swahili, the language commonly spoken in Tanzania. I drove 80 kilometres from the town of Bariadi to Halawa Dispensary (which is in Busega District) to hear first-hand how the community is participating in improving childbirth. Busega is full of rolling hills and large boulders which make for a beautiful but bumpy drive. Check out this short video I took of the journey.

In this community, I met a woman who was motivated by a community health worker (CHW) to attend her first pre-natal visit at a dispensary with her husband. A dispensary is a community-level health facility, similar to a walk-in clinic in Canada. CHWs are chosen by their community to provide basic health care education and to serve as focal persons in promoting the use of health facilities to the community. CHWs are a key agent of change in encouraging communities to use health facilities, particularly in remote or rural areas.

During the pre-natal visit, the woman was informed that she had pre-eclampsia, a condition that can develop during pregnancy where the mother experiences high blood pressure and a high amount of protein in the urine. It can impair the functioning of the mother’s kidney and liver. Left untreated, this can result in the baby being born prematurely, or in some cases, the death of the mother and child. Untreated pre-eclampsia is one of the major risks of maternal death for women in Simiyu if they don’t attend pre-natal care visits to receive a diagnosis and ongoing care. Pre-natal care screens for various conditions that may affect the health of a pregnant woman. The Uzazi Uzima project works in part to improve access to health facilities as well as increase the attendance of pre-natal visits.

The health care workers counselled the woman and assured her that her pregnancy would be safe as long as she took medication and attended pre-natal visits regularly. They encouraged her husband to attend appointments with his wife so he could support her during the remainder of her pregnancy.

After this diagnosis, many of the women in her family disagreed with the health worker’s recommendation to get ongoing health care at the dispensary. This was because other women in the community had the perception that the dispensaries were not able to handle complex births. Her family wanted her to travel 15 kilometres to the regional hospital, instead of the dispensary which was only seven kilometres away. Traveling 15 kilometres from her home would be difficult, as she has no way to get there other than walking or hoping she can get a ride from someone who has a motorbike.

The woman explained that she wasn’t worried about her condition because of the frequent checkups with the health care workers at the dispensary. When she went for her pre-natal visits every two weeks (with her husband attending many visits as well) the health staff at the dispensary counselled her on how her blood pressure was progressing and also started preparing her for the delivery. Her husband also followed the health care workers’ instructions and closely monitored his wife’s health. This created a level of trust between the couple and the dispensary staff. As a result, the woman and her husband acted against her family’s wishes and decided to deliver at the dispensary. After the successful delivery of a baby boy, the new mother returned to her community and explained how the dispensary supported her and made her feel safe. Actions like these are important in changing perceptions about seeking care at health facilities such as dispensaries.

Delivering a baby in health facilities is key to preventing maternal deaths due to treatable conditions. But preventing maternal deaths is the responsibility of the whole community. If the CHW hadn’t motivated the couple to attend the facility, she may have suffered from complications. CHWs and other community leaders play a vital role in changing perceptions towards giving birth in a health facility. Their deep connections with their community put them in a strategic place to motivate community members to change their beliefs and behaviours. By having an understanding of the root causes of some of these behaviours, they can have a more engaging discussion with the community. For example, they can educate women and men on reproductive health issues and dispel damaging gender norms which influence a woman’s decision-making power based on their strong understanding of the context behind gender inequality in the region.

Hearing the experience of this woman touched on another key factor for success for safe deliveries: involving men in reproductive health so they are also informed on best practices to prevent maternal and newborn deaths. Men tend to be the decision-makers of the household in Simiyu, which includes giving a woman permission to give birth in a health facility. It was both the CHW and the dispensary staff who worked together to motivate the husband to attend pre-natal care visits regularly, to keep an eye on his wife’s health, and to have the baby in the dispensary. This illustrates that it is the whole community’s responsibility to keep mothers and babies healthy.

About Uzazi Uzima

The Uzazi Uzima (Kiswahili for ‘Safe Deliveries’) project is a partnership among Amref Health Africa and Marie Stopes, with Deloitte as a service partner. The project/initiative is focused on reducing maternal mortality and morbidity rates in Tanzania. With support of $10.2 million from the Government of Canada through Global Affairs Canada, this four-year project aims to directly reach 348,567 women and adolescent girls and 334,515 men and adolescent boys in six district councils in the region of Simiyu.

The partners are working together with communities in Simiyu to: improve the knowledge and skills of health workers to provide sexual and reproductive health and rights, maternal care and family planning for women and adolescent girls and boys; refurbish health facilities and dispensaries, including infrastructure for clean water and sanitation; strengthen gender responsive health management systems; increase the use of health services through community outreach and advocacy; and, strengthen community and government engagement.