Hesperian Health Guides

Hesperian Health Guides

Working for Change

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HealthWiki > Where Women Have No Doctor > Chapter 6: Pregnancy and Childbirth > Working for Change


Throughout the world, millions of women die needlessly from problems during pregnancy and childbirth. Many of these deaths happen because a woman or her family wait too long to get help for emergencies.

Here is the story of a group of women who worked in their community to understand and solve some of these problems.

During the last rainy season, my friend Ekwefi was pregnant. When it was time for her to give birth, her husband had gone away on a trip. Several wise women were there to help her. But the labor was too long and Ekwefi started bleeding. I said that we needed to take her to the health center. No one could decide what to do. Her husband was gone and he was the one who should decide. Soon after we realized that Ekwefi and the baby would not survive, they both died in front of us.


This made me very sad. Ekwefi was my friend, and we could not help her. I started talking with other women in my village. We had to do something about this problem. Ekwefi was not the first woman to die while she was giving birth. Many other women lost their babies during birth. Some women said this is how things are in our small village and we should accept it. But we said no, we can do something to solve this problem.

We decided to have a meeting to learn more about the problem of women and babies dying during birth. During our meeting we decided to talk to the families with this problem. Six women in our group agreed to visit families where a woman had died from a difficult birth during the past two years, or where a woman was still recovering from one.

a woman speaking to a man who stands in a doorway with two small children

We learned several important things. Everyone agreed that the biggest problem was that women wait a very long time before they call a doctor or go to the health center. Sometimes a woman cannot ask for help without her husband's permission. Many times, like with my friend Ekwefi, the husband is not in the village when the woman needs to ask his permission to get help. The neighbors are afraid to give help, because they do not want the husband to be angry or offended. We also learned that most husbands do not know about the many risks women face during labor.

four women sitting and talking under a tree


We decided to walk the 7 miles to the health center to talk to the midwife. We told her what we had learned and asked her to help us find ways to solve this problem. The midwife was very happy to help us. She talked to the head of our village and asked for a meeting with the elders. During the meeting, the midwife talked to the elders about the health risks of a long labor. She also told them what we had learned about women dying while giving birth in our village. The elders all agreed that this was a very serious problem for the whole village. They asked the midwife how this problem could be solved. The midwife told the elders that this was not just a problem in our village but in many villages in Nigeria. She suggested that the village pick 12 men and 12 women to go to a five-day training on reproductive health and family planning. These villagers would become reproductive health workers, and would work to teach and motivate the rest of the village.

two women helping a pregnant woman get to a truck


After the training, the men who had gone realized that they had to be actively involved in solving this serious problem. They decided to work hard to teach the other men in the village about the risks of labor and how to help women in labor. They also decided to have a transportation committee to help women get to the health center when they needed it.

We all worked very hard to solve this health problem in our village. In the beginning, many people said that women often die giving birth and there was nothing we could do about it. But we did not get discouraged. By working together with the women, the midwife, the elders, and the men of the community, we came up with a solution that works in our village. And the answer to our problem wasn't more money or a new technology. The answer was in our time and effort. All of us from our village encourage you to work together to improve the life and health of your community.

To learn more about thinking about and solving health problems, read Chapter 2.

How to help save more childbearing women's lives
a man speaking
I am going to help my wife have a safe and healthy pregnancy and birth.

Most deaths and injuries from pregnancy and birth could be prevented through better nutrition, child spacing (with family planning), access to safe abortion, good care during pregnancy and birth, good transportation, and good blood services. Here are some ways to help:

  • Learn the danger signs during pregnancy, birth, and after birth.
  • Plan how to get help before it is needed.
  • Try to organize your community so that emergency transportation, money, and blood donations will be ready when difficult births happen.
  • Work with local leaders to build small houses near a hospital where women from remote areas can stay until it is time to give birth.


How health workers can help save women's and children's lives:

  • Offer family planning services to prevent unsafe abortions and to help women avoid having births too close together.
  • Offer STI treatment and prevention to all women and girls old enough to have children.
  • Promote condom use, and other ways to have safer sex.
  • Provide testing and treatment for HIV, including medicines and other support to prevent HIV spreading to a baby during pregnancy, birth, or breastfeeding.
  • Make tetanus vaccines available to all women.
  • Learn how to detect problems during pregnancy, birth, and after birth.
  • Refer women with problems in a pregnancy (now or in the past) to a health center that has emergency transportation.
  • Teach birth attendants and midwives how to prevent infection and how to watch for and treat danger signs during pregnancy and birth.
  • Encourage all women to breastfeed for at least 2 years.
  • Have a medicine box that includes:
    • oxytocin, ergometrine, misoprostol, and local plants to prevent and control severe bleeding after the birth.
    • antibiotics to treat infection.
    • equipment to do injections in the muscle (IM) and the vein (IV).
    • medicines to treat eclampsia.
    • gloves or clean plastic bags.
    • new razor blades.
    • enema bag or can for rectal fluids.


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