When Aisha (not her real name) went into labour in Gabu, 160km east of the capital Bissau, she did not know she was pregnant with twins. The first delivery went smoothly, but she needed a Caesarean section for the second. But the doctor had bad news: the hospital’s generator was broken, so she needed to drive four hours to Bissau for her operation.

With no ambulance available, she would need to pay up to US$30 for a taxi, plus up to US$109 for the operation, in a country where more than 60 percent of the population lives on about two dollars a day, according to the World Bank.

According to Dr. Carrington, an obstetrician who works at Simao Mendes hospital in Bissau, Aisha’s story is not unusual in a country with a handful of ambulances, next to no medical equipment and only one fully-functioning maternity ward.

Pregnancy spells a death sentence for 1,100 out of every 100,000 women in Guinea-Bissau, according to the UN Development Programme, making it one of the world’s deadliest places to be pregnant.

“In two minutes a women here can die for a simple reason that elsewhere could so easily be solved,” Catarina Furtado, Portuguese actress and the goodwill ambassador for the UN Population Fund (UNFPA) told IRIN.

Only one hospital

In Guinea Bissau, if a woman has a birthing complication, only the capital’s Simao Mendes hospital has a doctor, equipment, medicine and a working generator, able to treat her.
Dr. Carrington, who works at Simao Mendes, says there is a a lot of room to improve. When asked to list the biggest problems facing his ward, he laughed. “Where do I start? Look around you, we don’t have enough facilities, I work in a tiny office in a terrible building and I have to see up to 50 women a day...And I am not well-paid.”

But, he added, he would never leave the country to practice overseas.

Barriers to care

Ministry of Health adviser Antonieta Martin, says the problem is not only the lack of doctors and clinics, but also a shortage of trained midwives and adequate medical equipment.

The country’s one fully functioning hospital has few surgical tools. Most health facilities, as is the case for most of the country, have no electricity. The few that have generators often cannot afford the fuel to run them. Fuel costs, at US$1.43 a litre, have reached record highs.

Cultural practices can block lifesaving care, says Martins. Most men must approve a woman’s giving birth in a clinic, permission which can be hard-to-earn because of the taboo of being treated by male doctors, who form the majority of health staffing in Bissau.

When things go wrong in the birthing process at home, Martins estimates 65 percent of women cannot access the help they need.

‘Roadmap’ to bring down mortality rates

UN Population Fund (UNFPA) programme officer Mamadù Bamba Gning told IRIN, “We need to change everyone’s minds when it comes to maternal mortality. Most women don’t even consider going to a clinic to give birth because they don’t think they’ll get what they need there.”

The government has pledged to the UN Millennium Development Goal target to cut maternal mortality by 75 percent, which means 825 fewer women dying per 100,000 births by 2015.

The Portuguese government has been funding to train doctors in obstetric care, to staff health centres with trained midwives, to better equip health clinics and to raise community awareness about the importance of medically-assisted births.

The Ministry of Health plans to buy bicycles for small towns to help get women in labour to local health centres, which can be up to 20km from women’s homes.

The government wants to entice doctors to work in rural areas. “We need to give rural doctors telephones to make quick referrals, cars, and to pay them enough, to entice them to stay,” said Martins. “Taking our efforts to all regions across the country is the only way we can make progress.”

The UNFPA has pledged is currently building regional hospitals Oio and Gabu in eastern Guinea-Bissau, which will be equipped to perform emergency procedures .
The two-year old initiative has led to lower maternal mortality rates in some clinics, but access to care remains inconsistent. The majority of women in Bissau can access a doctor versus as little as 10 percent of women in some rural areas, says Martins.

This leaves pregnant women like Elisete Cabral de Almada grateful to live in Bissau. “At least there is a good doctor here – we have to wait all day to see him, but I’m lucky that I can come here at all. I’d never give birth without help. Luckily, I’m not forced to because I live near this hospital.”

IRIN