In Lesotho, a country that is largely rural and mountainous and with some of the harshest weather in Africa, the rate of women dying during pregnancy and childbirth has doubled in less than 10 years.The majority of women in the mountains deliver at home, and few attend more than one prenatal care visit during pregnancy. Women in the mountains walk for an average of 5 hours to reach a health center, resulting in low numbers of women delivering at health facilities with assistance from medical professionals who can manage complications. 60% of maternal deaths in Lesotho are the result of emergencies that require surgical intervention, such as hemorrhage,infection, or obstructed labor. When such emergencies occur at home, there is almost no chance that the woman will reach lifesaving emergency care in time to prevent severe injury or death.

Partners In Health, in partnership with the Lesotho Ministry of Health and Social Welfare, launched a project at 8 rural health facilities that addresses the challenges posed by rugged terrain and limited resources:

• First, specialized Community Health Workers – many of whom are former traditional birth attendants—are selected by the community and trained, supervised and compensated to educate women in their villages and accompany them to clinic for comprehensive prenatal care, facility-based delivery, and post-natal care.
• Second, clinic resources are upgraded to improve the quality of maternity care,including the equipment, supplies, and medications critical to assuring safe delivery.
• Third, mothers’ waiting houses are built at each facility so that a woman who lives more than a 2 hour walk from the clinic can stay for up to two weeks prior to her due date, ensuring that she is able to deliver at a facility with a skilled attendant.
• Fourth, a fully licensed nurse-midwife is posted to each clinic to run the project and provide comprehensive prenatal,delivery, and postnatal health services.
• Lastly, the women themselves are incentivized to come to the facility to deliver through the provision of peer support and food at the waiting house and a starter pack of basic infant supplies from the clinic.

This initiative to reduce maternal mortality in rural Lesotho is significantly increasing the number of pregnant women coming to PIH-supported health centers.As a result, more women receive comprehensive prenatal care, including vaccinations, screening for HIV, STIs, and TB, nutrition counseling, and monitoring for pre-eclampsia and other complications. The initiative is also increasing the number of women who deliver at a health facility, which decreases delays in accessing lifesaving emergency care, and ensures appropriate care for newborns during the critical first 48 hours of life. Over the long term, the Maternal Mortality Reduction Program will prevent senseless deaths and increase healthy outcomes for mothers and babies in the mountains of Lesotho. 

A training for Maternal Mortality Reduction Project Assistants in Nohana, Lesotho.