The Problem

The widespread and significant impact of severe maternal morbidities.  In Malawi, the maternal mortality rate remains one of the highest in the world, but this figure is eclipsed by number of women experiencing severe maternal morbidities (SMMs).  The number of women who continue to suffer weeks, months, or even years after a difficult delivery is not captured in any official statistic and generally, they receive no additional support after hospital discharge.  Women experiencing SMMs are more likely than others to experience difficulty completing activities of daily living, they often suffer financial repercussions, depression, their young children experience an increased risk of mortality, and the women themselves face an increased risk of mortality which extends up to one year following the delivery.  

The World Health Organisation defines severe maternal morbidity as “a woman who nearly died but survived a complication that occurred during pregnancy, birth or within 42 days of termination of pregnancy.”  In our programme 100% of enrolled women experienced sepsis (a life-threatening infection), 100% spent more than 21 days in hospital after delivery, 40% lost their babies during the birth process, 66% had a life-saving total hysterectomy (with a mean age of 25), 45% had severe anemia, and 6% had a fistula.

Our Solution

• family-based care
• monthly health assessments (up to 6 months)
• nutrition interventions (beans & soy)
• relevant health education
• cash transfers
• a single investment in a home-business

Impact

At each visit nurses record numerous data points including responses to a self-reported Health Related Quality of Life scale (HRQoL).   This tool measures her health in 5 areas on a scale of severity.  The areas include mobility, pain, anxiety/depression, ability to care for herself, and ability to carry out her daily activities.  Women improved in all five areas over the course of enrollment, with over 90% reporting no continuing issue in any of the five areas at the time of program discharge.   By supporting women experiencing SMMs in their homes and communities, we hasten their return to health and mitigate the impact of their morbidity.