A Promise to the Missing Moms

When Comfort Fayiah went into labor in Monrovia, Liberia, at the height of the Ebola crisis, her family could not find a health centre where she could deliver. Many centres were closed or extremely understaffed, with health workers afraid of getting infected by the disease.

When she and her husband were turned away from the fourth hospital, she collapsed 10 metres from the entrance of the hospital in the pouring rain and began to deliver twin girls. Instead of receiving care from hospital staff, Ms. Fayiah was assisted by people on the street, some of whom shielded her from the nearby traffic.

Duworna Monibah, a nurse assistant, who was passing by on a motorbike decided to help, despite the risk of infection with Ebola. "I forgot that there was something called Ebola," he said. The first baby was already out, but the second was not lying properly. Mr. Monibah asked for plastic shopping bags to protect himself from Ebola. With these makeshift gloves, he helped the second baby come into the world.

On Mother's Day, people in many countries are honouring their own mothers and motherhood. While becoming a mother should be a joyful event for all pregnant women, an estimated 289,000 women still die every year due to pregnancy and childbirth complications that are, in most cases, treatable or preventable. And for every woman who dies in childbirth, around 20 more suffer disease, infection or injury such as obstetric fistula.

When the Millennium Development Goals reach their deadline at the end of this year, the goal to improve maternal health will be one of those lagging the most behind. Progress has been made by cutting the maternal death rate almost in half since 1990. However, this progress falls short of the target of reducing the maternal death ratio by 75 per cent.

To this day, resilient and comprehensive health systems are not in place or accessible to half of the pregnant women in the world. And where crisis strikes, such as conflict or a natural disaster, the gains made over the past years are easily wiped out.

As for the three countries most affected by Ebola, UNFPA estimates that the maternal death ratio will double to more than 1,000 per 100,000 live births in Guinea and Liberia, and to more than 2,000 deaths in Sierra Leone. These pregnant women will not be dying from Ebola, but, rather, from the simple fact that they do not get the medical care they need because they are afraid to visit, or are turned away, from often overstretched health facilities.

Giving birth can be daunting in the best of circumstances. During epidemics and crises, it is often a life-or death situation. We cannot leave a pregnant woman with only hope that either everything goes right or that, when complications arise, passers-by and people like the courageous Mr. Monibah will turn up at the last minute to help. Ms. Fayiah and her twins luckily survived. For many others in the same situation, the outcome might have been quite different.

We need to build resilient health systems that can deliver quality care. We know that investments in midwifery services are the most cost-effective. Midwives, when empowered, fully educated, well-equipped and authorized and supported to practice all essential basic life-saving competencies, as well as family planning, can help avert two thirds of maternal and newborn deaths.

As The State of the World's Midwifery 2014 report shows, addressing the vast shortages of midwives and midwifery services across low- and middle-income countries could save the lives and support the health and well-being of millions of women and babies each year.
To help achieve that, UNFPA, the United Nations Population Fund, is working in Ebola-hit Guinea, Liberia and Sierra Leone to deploy more than 500 international and national midwives, doctors and support staff to open and equip at least 20 midwife-led units per country, closely linked to referral hospitals where women can deliver safely. This response will be developed in close collaboration with the communities themselves, through community participation and community-based interventions, including mobile clinics, health education, family planning and clean delivery kits.

When world leaders meet in September at the United Nations General Assembly in New York to enshrine the new post-2015 development agenda, we need to generate the political will to drastically drive down and end avoidable maternal deaths in our lifetime. We also need strong leadership at the local level to push the agenda forward. This is a promise we need to give so that, when we celebrate Mother's Day in years to come, the mothers whose death is preventable would be with us and well.