PARMaCM: Providing Maternity Waiting Homes in Namibia
PARMaCM, the Programme to Accelerate the Reduction of Maternal and Child Mortality in Namibia, is providing,
amongst other things, Maternity Waiting Homes in Ohangwena Region (almost complete), and Omusati,
Zambezi and Kunene Regions (scheduled for completion in 2015). The design and construction schedule of the
Maternity Waiting Homes was agreed with the Namibian Government, following broad consultation with Namibian
stakeholders. Without suitable prenatal accommodation options, women from rural areas, in particular, all too often
elect not to come to maternity wards to give birth, or only do so once complications have set in.
MATERNITY WAITING HOMES IN NAMIBIA: HOPE FOR THE FUTURE
Although Namibia is on track to reach most of the targets set for other Millennium Development Goals (MDGs), on
MDG 4 (Reduce Child Mortality) and MDG 5 (Improve Maternal Health), Namibia is behind target:
2010 – 2014
MDG 2015 target
Infant mortality rate
39 deaths per 1 000 births (incl. 20 neonatal deaths)
19
Maternal mortality rate
358 deaths per 100 000 births
56
Major contributing factors include inadequate antenatal care; no health care at births, especially for first-time
mothers; and late arrivals at maternity facilities, often only after complications have set in.
At Maternity Waiting Homes, expecting mothers will receive antenatal care; monitoring in a safe environment, and
timely transfer to the maternity ward; and information on post-natal care and immunization.
PARMaCM
Programme for Accelerating the Reduction
of Maternal and Child Mortality in Namibia
Ministry of Health
and Social Services
EUROPEAN UNION
World Health Organization: PO Box 3444, Windhoek, Namibia, Tel. +264 61 255 121, Fax. +264 61 204 6202, [email protected]
PARMaCM is a European Union funded project
implemented by the World Health Organization in Namibia
Maternity Waiting Homes in Namibia:
Hope for the Future
Opuwo lay slumbering at last, its vibrant and chaotic main street
deserted, even the most raucous of the many drinking venues
fallen silent. Now, deep in Namibia’s stark and arid north-west,
the quiet of the mountain desert descended, blanketing the
town in the plain below.
When Muhapikwa awoke, the moon had set, and the night was
as black as the markings on her father’s favourite cow. The fluid
running down her legs and the sharp pain knifing through her
belly told her that the time had come. Now, in the early hours of
the morning, in a makeshift shelter in a field on the outskirts of
Opuwo, she knew that she must get to the hospital, somehow,
so that she and her baby would be safe.
Muhapikwa’s mother, Veriapeke, stirred beside her, awoken by
her moaning. She was a Himba – a people born in the crucible
of a troubled past, their women still clothed in naked dignity,
their men as proud as the horns of their cattle. She had been
constantly by Muhapikwa’s side for the last months, as her
mother had been by hers, coaching her daughter towards the
ultimate validation of womanhood: the dawning of new life.
When malaria had taken Muhapikwa’s husband just as suspicion
grew to certainty that she carried new life within her, she had
fallen into hopeless despair. But Veriapeke told her: “Your name
is Muhapikwa, the Survivor, the one who never goes under in a
struggle. You must continue with the journey and never give up.
Your child will be your life.” As her belly started to swell, hope
replaced the pain that Muhapikwa felt at losing her husband.
“the thought of a safe place
to stay when the time came
was sweet, like cool water
in the heat of the day”
While waiting at the hospital, she had heard talk of a building
that was to be built there – a temporary home where women
could come and stay while their time was drawing closer, where
they would be safe, and cared for. At once she was excited: it
was not easy staying out in the open, even for the short time she
needed to be in Opuwo for a check-up, but they had no choice.
So the thought of a safe place to stay when the time came was
sweet, like cool water in the heat of the day whispering his
passion in her ear.
When it was Muhapikwa’s turn to be seen by the doctor, she
asked about the waiting home. It was going to have enough
space so that someone supporting the women – like her mother
– would be able to stay with them. And they would get all the
care they needed before the birth, and help on how to look after
the child, like when to come back to the hospital for the child to
get important injections. And the best was that as soon as the
baby was starting to come, the women would be taken across to
the maternity ward of the hospital, where there was everything
needed for a safe birth.
But then the doctor told her that this home was for the future; it
would not be built in time for her confinement. And the shadow
returned: her husband was dead, and she was alone.
Still, the journey to new life was dangerous, uncertain; the
never-mentioned spectre of other women – like Veriapeke’s
own sister – dying in childbirth that would not end, their babies
lost and families ruined, hung over their conversations and
infected their silence.
The doctor said that there were no signs of problems, but
Muhapikwa was only nineteen, and this was her first pregnancy:
she should come again in two months, for another check-up.
Muhapikwa explained that she could not do this – it took days to
get to Opuwo from their village. Then it was very important for
her to get to the hospital in time for the birth.
But now the new ways were better: in the hospital, mothers and
babies would be safer. They had heard the stories from others,
they had seen the healthy babies and mothers, and four months
ago, they had come all the way from their village to the Opuwo
hospital for a check-up, camping in the same field.
So ten days earlier, when Muhapikwa’s belly was heavy with life,
she and Veriapeke had again set out on the journey to Opuwo,
this time to stay until the baby came. With meagre rations of
water and food, they left their village, far beyond stony, burnt
plains and mountain ranges that gouged the sky; they took the
track that led through riverbeds and up steep slopes, walking all
day and resting up overnight in one of the tiny shelters put up
by other travellers before them.
The next day, they reached the gravel road that led to Opuwo.
When they heard a car approaching, they would waive their
arms pleading for a lift, but like all the others, it would roar past
them, scattering stones in their path and choking them in clouds
of dust.
At last a donkey cart stopped for them, and Muhapikwa could
slump into deep sleep, her head rocking in her mother’s lap.
Late in the afternoon, the disjointed outskirts of Opuwo came
into view. If Muhapikwa’s family had had relatives or friends
in one of the townships, they would have gone to them, and
set up camp in their yard. But Opuwo was a forbidding and
alien environment for them, where everyone was a stranger
and no one would offer so much as a drink of water without
expecting payment in return, so they were dropped off
alongside an open field.
Here other families were also encamped, waiting as long as
it took for an elder to recover in hospital, or die, or for alien
bureaucratic machinery to confer, or deny, a document their
parents would never have needed. They occupied the remains
of an abandoned shelter – no more than a skeleton of sticks
– and strung a threadbare blanket over it for protection for the
night; by the end of the next day, with the addition of cloth and
plastic gleaned from the dump, it was home-from-home.
“she should go away and
only come back after
another week, or when
the labour pains began”
On the third day, Muhapikwa prepared to go and see the doctor
at the hospital, as she had been told. Before setting out, she
smeared her body and face with some of the traditional Himba
mixture of sweet-scented resin, ochre and butterfat she had
brought with her, so that she would look her best in public. It took
them more than an hour to walk to the hospital, Muhapikwa’s
distended belly now making each step a challenge. When at
last it was her turn to be seen, she hoped that she would be
told to go straight to the new maternity ward and stay there
until her baby was born. But the doctor smiled and told her that
everything looked good, she should go away and only come
back after another week, or when the labour pains began.
And now, in this simple shelter, Muhapikwa lay groaning as the
waves of pain swept over her. Veriapeke told her to gather her
things together and get up – they must go to the hospital at
once. She managed to sit up and crawl out of the shelter, but
she knew that she would not be able to walk all the way to the
hospital. Her mother had told her that at first, there would be
many minutes between contractions, but something was wrong
– right from the start, they were coming much closer together,
and with each one, she was struck down, moaning in pain.
The commotion had awoken the others sheltering in the field;
urgent messages were passed, till someone with a cell phone
was found. Could a taxi be called? No, but he knew a man with
a pick-up truck, who might come. The call was made, and after
shouted explanations and promises of rich reward, good news:
he would come to fetch Muhapikwa. Twenty minutes later, he
arrived; Muhapikwa, now delirious, was loaded onto the back
of the pick-up, with Veriapeke beside her, and they raced off.
As they approached the hospital, on the uncertain divide
between life and death, they passed the site where soon, the
maternal waiting home was to be built.