Culture And Inaccessibility To Health Facilities Jeopardizing Safe Delivery

Expectant mothers in Western Lakes State are still walking long distances to receive services from health centres making it one of the factors contributing to maternal and infant mortality.

Culture And Inaccessibility To Health Facilities Jeopardizing Safe Delivery
Midwife, Mary Nyanakot examining an expectant mother in Rumbek hospital [Gurtong photo/ Mabor Riak]

 By Mabor Riak Magok

RUMBEK, 27 November 2017 [Gurtong]-36 year old Martha Akuc has been forced to move to Rumbek town in order to easily access a health facility during childbirth as she is now expectant.

“There are some distances and places which are closer to Rumbek hospital but due to poor roads, insecurity and lack of transportation it is not possible for a woman in labour to reach this hospitals,” she said.

The remote villages do not have ambulances that can rush women to health facilities in the town. As if that is not enough, it is not a guarantee that an ambulance will reach these health facilities due to the poor state of roads and insecurity along the roads.

“There are some few health facilities in the remote villages, but there are no adequate services and trained traditional birth attendance (TBA) in those Primary Health care Centers (PHCC) and that is the reason I decided to come from Rorhnom” explains Akuac.

“Many women die with their children in their wombs because there was no vehicle that could come and transport them to health facilities. For a woman who is not able to walk, men could be the ones to carry them on their shoulders to Rumbek hospital for safe delivery but how could that happen now since insecurity is rampant. People are being killed everywhere on the way and there is no ambulance that could take women to health facilities.”

“In the past, when i was pregnant I decided to deliver in the hospital but when I finished delivery I was asked to pay some little money in the maternity. But this year, I will deliver at home because there is no money to pay for the maternity. Even though it is risky what can I do?  I have to deliver at home there. We have some traditional midwives who are untrained, although they help us to deliver safely and after deliver, we give them some motivation and appreciation like tobacco, soap white beer to other drinks.”

She explains that this practice of having untrained midwives has a t times led to deaths of either the unborn baby or the mother because some deliveries needs one to visit a health centre but cannot afford to go to one.

“Some women bleed to death and others cannot manage to deliver babies due to severe labour pains which paralyses them. Some mother die together with their babies in their wombs particularly underage girls and those who delivere more than 10 children die if they are not brought to a health facility for safe delivery, she said.

A 40 year old midwife, Mary Nyanakot Majak who works at Rumbek State hospital says child birth has become a problem in Western Lakes State.

“We have challenges with pregnant mothers in the remote villages and cattle camps which includes poor roads, lack of transportation means from remote villages to health facilities in town. Thus child delivery services were geographically inaccessible e to most of the pregnant women in the remote villages and cattle camps of Western Lakes State” said Mary.

“If you want to go to hospital for delivery, you can spend more than two days to reach Rumbek State hospital or Kiir Mayardit women hospital on foot. Sometimes, a woman might be in labour for 3-days in the remote village or cattle camp unless the mercy of God helps her deliver safely if not she or her child may die because of distance or cultural rigidity of not allowing wives to deliver in the hospital.”

The women in the cattle camps often move to far distances in search for animals pastures for grazing for a period of about 3-4 months either in Lol-manyiel (Toc-manyiel) or Toch-araaw at the border between Western Equatoria and Western Lakes States during the dry season, a place where a woman in labour cannot reach a health facility because of lack of transportation.

Meanwhile some of the men in the village prohibit their wives from visiting a hospital during child birth.

“Our husbands are the ones who deny us the chance to go to the hospital. Everybody says that the hospital is good but you know women stay under men’s control. Even if you tell him what you want, he will not allow you to go to the hospital,” said Akuc.

“The husband is the one who decides where a woman should give birth. Even if a woman has decided to deliver in the hospital the husband will say ‘no, you are just going to roam there, you must deliver here. Whom will you leave your children with if you decide to go and deliver in the hospital?’ Our husbands decide where we should deliver.”

“During my last pregnancy, I told my husband that I need to deliver in a health facility but he refused, saying that he did not want me to be seen by men while I am delivering. I delivered my twin babies at home and both died. I have always regretted for not having delivered in the hospital.”

She said women who take the decision to go to hospital without their husbands consent are considered rebellious and risk being subject to domestic violence and threats of divorce.

“We, the pregnant women are not allowed to make any preparations for childbirth and for most women; labour comes abruptly with no time to go to a health facility. We don’t go to the hospital because we don’t know the day when the baby will come. If we knew the day of delivery, we would be preparing ourselves. But traditionally, we prepare nothing. We stay like that without preparing anything until delivery. The baby is delivered like that on the floor or under a tree.” She said.

“Our Husbands are also against any birth preparations because Last time when I was pregnant, I asked my husband to buy me pieces of cloth, soap, sugar, cups, bed sheets and a baby carrier and he said, ‘why should I buy for you such items before you give birth?Those things will be bought after you deliver. He told me where on earth can clothes of a baby be bought while the baby is still in the womb? Who knows whether the baby will come out alive or dead?.” Akuc said.

Meanwhile, 25 year old, expectant Akolde Kedit who comes from the North of Rumbek County said “For my case, I am the only woman at home and there is nobody else to help me.

Therefore, my husband cannot allow me to deliver in a health facility because there will be nobody to cook for children, and all domestic work at home will remain undone.”

“Sometimes, our husbands will say that they need to take cattle to a place where there is enough pasture and water. We are then left behind to take care of the home, with nobody else to leave the children with in case we want to go to the hospital.”

According to the midwife, Mary Nyanakot Majak, there is an increase of women this year delivering in health facilities.

This number goes up to 170 per month deliveries in health centers.

“We also have cases of HIV, Syphilis and Hepatitis which needs women to come to the hospital because we are protecting the babies not to get infection. If the mother delivers at home the baby will get infection but the traditional birth attendance do not know how to protect the baby and that is why we are telling the mothers to come to the hospital. Also the PPH bleeding after delivering, for those who have delivered more than 10-children they may deliver and die at home if they are not brought to the clinic for safe delivery. We can help them prevent the bleeding,” she explained.

“My message to the people is for them to come to hospital for safe delivery and voluntary counseling and testing and we also provide drugs to women found with syphilis and HIV free of charge.”


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