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A Comparison of Maternal Mortality in Malawi, Rwanda, Niger and Uganda » Women's Courage

A Comparison of Maternal Mortality in Malawi, Rwanda, Niger and Uganda

March 8th, 2013 by robsan24 Leave a reply »

There is no doubt sub Saharan Africa is the most dangerous place to give birth in the world.    This week I will be reviewing research done on Malawi, Rwanda, Niger and Uganda. The research specifically addresses the question of why Rwanda and Malawi have been more successful at improving maternal health than the other two countries mentioned.

The most common causes of maternal death are as follows: severe bleeding (post-partum hemorrhage), infections (sepsis), high blood pressure, obstructed labour and unsafe abortions.  Most of these ailments are preventable or manageable, and certainly should not be causes of death.

Several key things are contributing to the issues listed above. Women often are slow to seek professional medical attention leading to a late diagnosis. This can be caused by a lack of financial resources, ignorance or other issues. Transportation is often a prohibiting factor as well; it can take long periods of time to transfer women to health facilities that have adequate resources to treat them. This means that emergency care is often unavailable. And even when women reach appropriate facilities the quality of is often poor

Family planning is desperately needed as well to prevent unwanted pregnancies. Not only would family planning keep women safer from complications but would allow them to have more sustainable financial situations as well.

Rwanda, Malawi, Niger and Uganda are all similar in that there is a general scarcity of resources and all receive a large amount of external aid. However progress in addressing maternal health mortality has been uneven across the four countries. Malawi and Rwanda have made much better progress. Interestingly when we look at health expenditure per capita, Uganda has actually increased the most but still had little improvement; Niger is similar.

In Rwanda, family planning, antenatal care and deliveries in health centers are all on the rise. But why? It seems to be an effective response to a public education campaign. The campaign stresses the importance of the activities listed above fore the health of the mother and her children. A system of fines has even been imposed on women who fail to attend antenatal care or deliver in health centers.

How is Rwanda addressing the problem of transferring women to appropriate health facilities? They have implemented a health insurance scheme which coves 90% of the cost of ambulance transfers. Voluntary community health workers have been issued with specifically programmed mobile phones so they can contact health facilities for referrals and advice.  This efficient and cost effective system is cutting down on maternal mortalities due to transportation problems.

Rwanda’s infrastructure is better suited to ensure that quality of care is high. Their clinics are not over run and sanity is kept as a priority.  But why is Rwanda able to accomplish this and its transportation improvements? Firstly because of policy. Performance standards are being enforced, ensuring that care is professional. Second is problem solving initiatives. Rwanda has groups that are specifically targeting the key bottlenecks that are crippling the Ugandan and Niger health systems. This targeted approach allows Rwanda to improve their system while still operating at low costs.

In Niger a presidential decision abolished fees for pregnant women to receive healthcare, and while the policy was likely done with good in mind, the decision nearly led to the collapse of the health system. The appropriate research was not done and triggered a massive increase in demand. A demand so high the system could not keep up.  Rwanda on the other hand has had a strong policy of encouraging citizens to subscribe to the nationwide heath insurance scheme, which has proven successful.

Overall we see with the success of Rwanda in many of these areas that the massive issues facing sub-Saharan Africa are indeed fixable problems. With specific-problem solving, policy involvement, education initiatives and cost effective solution, real change can be made to the field of maternal health, and healthcare in general.



  1. Casey says:

    I really enjoy learning about different approaches side by side. I think it is essential to compare effective and non effective strategies in order to make progress in the future. Your blog really stresses the importance of good infrastructure and incorporates a lot of what we have talked about in class.

  2. Marianne says:

    Thank you for such an interesting post! I liked that you compared the differences between numerous African countries. You definitely highlight the crucial role policy plays in ensuring adequate health care. I definitely think Rwanda is an anomaly in terms of African countries that have provided effective social services, particularly targeted towards women. This is largely due to President Kagame’s decision to make social services a priority. I found it interesting that the Rwandan government imposes fines on women who do not seek prenatal care. After reading your blog post, I tried to think about ways in which countries could be pressured to prioritize effective health policy, particularly when it comes to maternal care. I think that your blog really highlights the fact that ultimately, the most lasting form of change, is change in government policies. While NGOs often play a significant role in improving maternal health, I do believe that the greatest hope for large-scale change is through government. Thanks for such an interesting post!

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