Every village should have one midwife - UNFPA official

Almost five months after Cyclone Nargis claimed five of her six children, Thein Thein faces having her seventh baby without any proper care.

Thein Thein, 38, has few safe delivery options as there is no midwife in her village, Waboegone, comprising 100 people in about 20 households, which can only be reached by a five-hour boat journey and a 30-minute walk.

Pregnant women in rural areas usually give birth at home with the help of a village midwife, who is rarely properly trained, or a health attendant from a local health centre.

A nurse from the nearest town - Pyinzalu in Labutta Township at the southern part of the Ayeyarwady Delta - comes to Waboegone village every month for maternal health services.

"I might need to go to the nearest town to deliver the baby as there is no midwife here," said Thein Thein.

Pregnant women in the hard-to-reach cyclone-hit area are among the most vulnerable of survivors of the category four storm that left 140,000 people either dead or missing and 2.4 million badly affected.

"Ideally, every village should have one midwife who is government trained for 18 months but one midwife has to cover five to 10 or more villages on average throughout the country," Thwe Thwe Win, the UN Population Fund's (UNFPA) national programme officer, told IRIN.

"The Ministry of Health seeks to fill the gap with Auxiliary Midwives [volunteers trained for six months]," she explained.

UNFPA has given drugs and reproductive health kits to local hospitals and health centres in the cyclone-affected area as well as providing funding support for in-service training for midwives.

The organisation has set up three maternal waiting homes in Bogalay, Labutta and Daydaye but pregnant women in hard-to-reach areas still face difficulties giving birth.

Mobile clinics

Win Mar lives two hours' walk from the nearest town – Pyinsalu. A health attendant lives in town and only comes once a month.

Photo: cm/IRIN

In cyclone-affected Labutta, a young woman holds her baby while her children look on

"If the health attendant is not here when it is time, I will have to go to Pyinsalu to give birth," Win Mar said.

"Because of difficult access and the need to travel so far, it is very difficult for these women to attain health services," Dan Baker, country representative for UNFPA, told IRIN in Yangon.

With doctors from the Myanmar Medical Association, UNFPA has set up mobile reproductive health teams to cover remote areas of the delta.

"We've been trying to cover remote areas with reproductive health teams, which set up a temporary clinic for a day or two where they can do pre-natal exams or address other health concerns," Baker said.

"Our idea is to get as close to people as possible. We've shown the donors that there is definitely a need and we can be effective in those areas … now we need the money to make that happen."

Birth plan

Thwe Thwe Win suggested mobile health teams help women draw up a birth plan. "The health team usually visits a village at a time and they do a follow up [consultation] if necessary. Antenatal care alone is not enough. About 15 percent of pregnant women are likely to face difficulty when giving birth," she said.

"It is important for pregnant mothers to have a birth plan about where they want to deliver and how," said Thwe Thwe Win.

But both Thein Thein and Win Mar could not prepare much for the birth. "What can we prepare while Nargis left us only hands?" Win Mar asked.

As many of them are Christian, most of the assistance has come from Christian associations and they are still highly dependent on donations.

Fortunately both have husbands and other relatives left in the village.

Win Mar said: "They will carry me for two hours' walk using a blanket as a cradle between two bamboo poles when the time comes to go to Pyinsalu town for giving birth."

cm/mw