Going the Distance With Moms

Without transport, women can't get to a healthcare facility unless they walk. For anybody who has been through labor, ask yourself this: Could you walk 5k, 10k, even up to 40k when you're nine months pregnant or in labor? Why should any mother have to?
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During the past few months we've been talking a lot about distance. We've become slightly obsessed, what with our running challenges for maternal health, inviting people around the country to do marathons or run/walk 5ks with us, and asking readers to check out our short film, The Walk. But, on behalf of those we advocate for around the world, distance can literally mean the difference between life and death. That's why we chose to give one of our very first grants to benefit a Saving Mothers, Giving Life program that ensures pregnant women can actually reach a health facility when they go into labor. Why is transportation such a big priority when our goal is saving lives at birth? Because frequently, lack of transportation causes critical delays that lead to senseless deaths of mothers and babies, especially in rural areas. Without transport, women can't get to a healthcare facility unless they walk. For anybody who has been through labor, ask yourself this: Could you walk 5k, 10k, even up to 40k when you're nine months pregnant or in labor? Why should any mother have to?

Last week we traveled through central and western Uganda looking at early results of investments made through the Saving Mothers, Giving Life partnership. EMC is proud to be a founding partner of SMGL. We're even more proud after seeing and hearing from our implementing partners in Uganda that we're getting closer than anyone expected to our goal of reducing maternal deaths by 50 percent in four districts here in Uganda and in four districts in Zambia. In order for this partnership to succeed, everyone involved must believe in our shared mission. While we fully acknowledge that believing in this ambitious goal requires a leap of faith, we've now seen that it's achievable and that's encouraging for all of us.

When you attempt to address something as ingrained as maternal death in a region that's all too familiar with it, changing women's mindsets is among the more challenging components of addressing social determinants to health. But those minds are changing rapidly. Since this program started in March 2012, thousands of women now know that pregnancy and childbirth don't have to be a death sentence. In a country as vast as Uganda, solving the transport barrier is as critical as other more obvious interventions like increasing the number of health workers and improving skills and capacities of health facilities. Far too many women start labor without any idea how they'll physically get to lifesaving care if they need it. And when they do it's usually too late. One fairly quick-fix solution we recognized from the start was the "Boda For Mothers" transportation voucher system that insures pregnant women can get a ride to the nearest health facility to deliver their babies safely.

Here's how it works: Pregnant women purchase a "Boda for Mothers" voucher for 1,000 shillings (less than 50 cents). A "Boda Boda" is a motorcycle taxi. Ideally, she's also been educated by a Village Health Team (VHT) and received four prenatal checkups. When she goes into labor, she calls a designated Boda Boda driver who transports her to the nearest health facility. Riding on the back of a motorcycle may not sound appealing when you're nine months pregnant and in labor, but it sure beats the alternative -- walking. On the last day of our trip we drove to a remote part of western Uganda to see some of the more remote facilities in practice. The distance from our hotel in Kabarole to our destination was 120km (about 80 miles). If you're on a paved, maintained highway and you drive like me, you can cover 80 miles in an hour. If you're a runner, 80 miles equals about three marathons or 12 hours of running. But here in Uganda during the rainy season, traveling 120 km on pothole-ridden dirt roads takes almost four hours of slow, difficult driving in a 4x4 vehicle. When we finally arrived at the village in Mahyoro we met Florence. Holding her beautiful 5-month-old son, she explained how the voucher had been her ticket to a functional referral and a healthy delivery. Her VHT member, Sarah, met with Florence regularly and discussed the importance of antenatal care and delivering with a skilled professional. She sold Florence a voucher and encouraged her to call either herself or her Boda driver when she went into labor. Even though Florence's ride was a mere 7km, traveling on a boda, in labor, over bumps and bends and around people and bicycles, it was quite a feat. When she finally arrived at the Health Center it was determined that because of her baby's size and position, she needed more advanced care at a higher-level facility. She was loaded onto a three-wheeled ambulance called an E-ranger for another 60km ride to the referral hospital. Her healthy son, "Promise," is testament to what a difference transport makes. Seeing this program work in a place like this was incredibly reassuring not only because it's being utilized by so many mothers, but also because its thorough design and implementation encourages women to travel the distance. The program is working. Mothers no longer have to worry about whether they can get to skilled providers. Now they know if they can get to a staffed, well-supplied clinic, they can feel confident that when its time to deliver, if they need a medical intervention they'll be referred and transported properly. We know this is just the beginning. We know there are endless complexities that will require our focus if our goal is to make a long-term lasting impact. But for now, we can pause and reflect that this program is giving mothers tremendous peace of mind. The EMC community has made our participation in this possible. This has truly been a case of moms helping moms. That's the way it should be and the way we hope it will continue.

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