Bana Nimaga, "It was a miracle for me, the new mother and her family."

For more than one decade, midwife Kouma Bana Nimaga, 41, told IRIN she has delivered babies in Mali’s rural northern villages with scarce health supplies. Mali’s maternal mortality and infant mortality rates have improved in recent years, but not enough to lift the country out of what UN Children’s Fund calls a “state of health emergency”. Bana Nimaga has worked at a health referral clinic in Bankass, 700km northeast of Mali’s capital Bamako since 1998.

“It is not everyone who can accept to work under such difficult conditions. We feel forgotten by health authorities, receiving no verbal or written recognition. Yet we are the ones who are putting out an enormous effort every day to save lives.

“Last year I provided pre-natal care to a woman who was having her sixth child, the last two of which had been delivered by caesarean section. When she was ready to deliver, I was faced with the dilemma whether to guide her through a vaginal birth or caesarean, given I did not know why she had been forced to deliver through caesarean [in the past].

“After eight hours of labour, I delivered her baby vaginally. It was a miracle for me, the new mother and her family. How was it possible after two caesareans that she could give birth naturally without complications? I felt as if I had passed some exam.

“These are the women who do not go to health centres. There are no records. 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.

“Half to 80 percent of neonatal and infant deaths happen in the home. Our communities need more health education, especially on maternal and infant health.”

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