From cyclones to safe births, midwives stay and deliver in Madagascar

MANANJARY, Madagascar – “I’m so proud and happy to have helped this young girl to give birth safely today,” said Marie Nancy Christiane, gazing at the new mother and daughter after supporting the delivery on 5 May – International Day of the Midwife.

Ms. Christiane helped 17-year-old Noelinirina Samoeline to deliver baby Noelia inside a UNFPA emergency maternity tent set up in Mananjary, in Madagascar’s southeastern Vatovavy region. The tent is standing in as a temporary maternity ward for the regional referral hospital, after the main building was destroyed along with thousands of homes and health centres during the Batsirai and Emnati cyclones that ripped through the area at the beginning of this year.

Many remote communities have limited or no access to health services, and Madagascar currently has just one qualified midwife per 7,000 people – a shortage that is endangering the wellbeing of new and expecting mothers. Fewer than half of all deliveries are attended by skilled health personnel and some 60 per cent of all births take place at home.

Part of Ms. Christiane’s job is advising women and community workers on the importance of giving birth in equipped health facilities. And her work has been paying off: The percentage of deliveries attended by skilled medical staff has almost doubled in the Vatovavy region since 2018, jumping from just over 20 per cent to nearly 38 per cent of all births in 2021.

"More and more women are seeking medical assistance at the very first sign of labour," she said. "This tent is so well equipped that it looks like an actual maternity ward. We help to  deliver babies in very hygienic conditions, while ensuring that pregnant women are treated with dignity and receive the quality care they need."

Saving lives in her community 

The temporary maternity ward in Mananjary was opened in February 2022, and in its first three months of operation 58 deliveries were carried out safely thanks to the skills of midwives and nursing staff. 

Ms. Christiane said she feels a professional as well as a personal responsibility to the women and girls in her community. "Ms. Samoeline is still very young and this is her first child, so we suggested postpartum contraception for the couple as well," she added. 

The role of a midwife stretches far beyond the moment of childbirth, to include care before and after the delivery itself, family planning advice – including for adolescents – preventing female genital mutilation and supporting gender-based violence survivors. Contraception and sexual and reproductive health information are much harder to come by in crises such as climate disasters, and humanitarian settings have also been shown to heighten women’s vulnerability to gender-based violence.

A goal for universal access to reproductive health 

Now heading a team of midwives, Ms. Christiane was recruited under a UNFPA project that in 2021 supported the government in training over 90 midwives. This is just one of many ongoing midwifery training programmes, which are critical in a country where an average of seven women and three teenagers die every day from pregnancy and childbirth-related complications. 

UNFPA in Madagascar also works with national authorities, the police and local communities to raise awareness of gender-based violence, which includes teenage pregnancies and child marriage. Although the legal minimum age for marriage in Madagascar is 18, some 40 per cent of girls in the country are married off before that. An alarming one third of all women in Madagascar are reported to have experienced physical or sexual violence at some point in their lifetime.

UNFPA supports more than 120 health facilities in Madagascar in providing emergency obstetric care: In 2020 alone the agency assisted over 50,000 safe deliveries and reached some 1.5 million women and girls with sexual and reproductive health services. A further 1.1 million were supported through UNFPA gender-based violence prevention and protection programmes.