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The heroes of safe motherhood campaigns around the world are not always women or large global aid organizations working for their interests. In a district of central Malawi, a small, very poor southern African country, Kwataine, a hereditary chief in a rural area who goes by one name, has almost single-handedly made deaths in pregnancy and childbirth history in the 89 villages under his jurisdiction.
Recognizing his achievement, President Joyce Banda asked Kwataine (pronounced kwa-TAYNE) a year ago to head her new Presidential Initiative on Maternal Health and Safe Motherhood. Banda, a promoter of women’s rights and girls’ education, is only the second woman to lead a democratic government in Africa. As vice president of Malawi, she assumed office in 2012 after the sudden death of the president.
The chief says that the roots of his campaign go back much further, into the 1990s, when he was a young teacher. “I saw a woman close to my house who was being taken to the house of a traditional birth attendant,” he said. “The woman entered the house around early morning, but up until sometime around 7 p.m. the woman was still in the house. The delivery was soon over. But there was a lot of blood.” A village leader had apparently resisted pleas to move the new mother to a place where she could get professional medical attention.
The community took matters into its collective hands. “We called everybody, especially young men, to carry her to the hospital,” Kwataine said. “The woman died on the way. From then, I vowed that as soon as I become the chief I will never allow any woman again dying just because of resistance from a [village] chief.”
Kwataine said that he became the Nitcheu region’s supreme chief in 2000, and that since 2006, there has not been a single maternal death in childbirth in the villages he oversees. He spoke in a telephone interview in New York while he was attending a Women in the World conference sponsored by Newsweek-The Daily Beast, where he represented President Banda and the Aspen Global Leaders Council for Reproductive Health, of which she is a member.
His story illustrates broader trends. Under his leadership, his region has demonstrated that the persistently high levels of maternal deaths worldwide may be best confronted from the local level up. All of Malawi now knows about his programs through television and radio, and villages nationwide want to adopt his methods, with the help of the president’s initiative.
Furthermore, Kwataine has largely rejected the notion that home births are best in the short term because bringing professional midwifery into his villages would take an impossibly long time, though it remains a long-term goal. He is planning to establish 200 maternity homes instead, where women can go in their eighth month of pregnancy to remain under observation in case of potential problems and for safe deliveries when the birth occurs.
Meanwhile, the chief has instituted a system of local committees to register pregnant women and report their findings to a village headman or minor chief and monitor every woman’s condition — and the village leader’s responsibility.
A preference for “institutional deliveries” in hospitals or local health centers, a controversial idea in many places and in some women’s global health advocacy groups, has nevertheless been adopted successfully in communities worldwide where circumstances make home deliveries impractical if not risky.
In the Himalayan nation of Bhutan, where mountainous villages may be several days’ walk from professional medical care, health authorities slashed a maternal mortality rate of about 1,000 deaths in 100,000 pregnancies in 1990 to 180 by 2010, mostly because of a drive to have all pregnancies take place in formal health facilities. In Ethiopia, remote village health centers often have a reasonably well-equipped and sterile room set aside for safe deliveries, with a local, professionally trained woman in charge.
Malawi’s maternal death rate remains high, 460 for every 100,000 births, though that has fallen below a regional average of around 500, and well below countries like Nigeria, at 630; the Central African Republic, at 890, or Chad, at 1,100. Sub-Saharan Africa generally has the world’s highest maternal death rate.
Perhaps the most important trend to emerge for women in Chief Kwataine’s district is the example he makes in dealing with the men in the villages. He has required about 1,000 village leaders from numerous clans under his purview to enforce rules protecting women. Any village leader who fails in this task can be punished. Among poor farming communities, that can mean being fined one goat or a chicken, he said.
On the other hand, there are rewards for men who enforce local rules and national laws protecting a woman’s right to life, while also helping to promote family planning in a culture where men always wanted many children and must learn to equate more births with more poverty. Chief Kwataine said that there was no money for material gifts — he would like to present bicycles, for example — so he keeps alive traditional ceremonial rewards. He gives them beads from his own regalia. “To get a bead worn by the chief in our culture means a life uplifted,” he said.