While prenatal care is recommended for all pregnancies, health workers say it is critical for girls whose bodies may not be ready to carry a child and for women older than 35 who face more risk for gestational diabetes, premature delivery, and stillbirths.
Kouma Bana Nimaga is a midwife at the Bankass health centre – 700km east of the capital Bamako – which sees the most complicated pregnancies from surrounding villages. Most of her patients have never been to a health centre, she told IRIN.
“They arrive to me in a complete state of catastrophe, so tired and worn down at the end of their pregnancy. You find the infant is on the edge of survival. [In these cases], the only legacy women leave for this world are stillborn babies.”
The director of Koulogo health centre almost 40km away, Ousmane Fomba, told IRIN that he has referred “more and more” high-risk pregnancies in these age groups to Bankass. “It is not uncommon to see 35- and 40-year-old women or 12- and 13-year-old girls pregnant.” He said that as more girls travel to work in Bamako or in neighbouring Côte d’Ivoire, early pregnancies have increased.
“And the mature expectant mothers tell us that they do not feel they can say no their husbands who demand intercourse or children,” he said. The medical director said though the centre offers family planning education, “old mentalities endure.”
In 2006 119 babies of every 1,000 live births died by age one, and more than 900 women died for every 100,000 live births in 2005, according to the government. Though the maternal mortality rate decreased by almost half in 2006, lack of access to clean water and health care still put the country in “a state of health emergency” according to the UN Children’s Fund (UNICEF).
They do not feel they can say no to their husbands who demand intercourse or children |
Even for women who give birth in a health centre the situation is not much better, said the head of the Bankass referral centre, Mamadou Guindo, who told IRIN the health centre does not deserve its designation. “We do not have inpatient facilities or electricity. The only generator we have does not provide enough energy. We do not have enough [medical] materials or anaesthesiologists.”
He said the centre often must refer patients to the hospital in Mopti more than 100km away.
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions