During countless visits to maternity wards without safe water, what I hear time and time again are stories of trepidation – women who fear the very worst outcome for them and their newborn. Vitumbiko, 25, had heard stories about women dying during childbirth at her local health centre. She didn’t tell anyone how worried she was, but was scared as she arrived, already having contractions. Her baby arrived safe and well, but the story isn’t always this positive. Every minute around the world, a newborn baby tragically dies from an infection caused by dirty water and an unclean environment.
Mothers-to-be can walk 20 kilometres on foot to their nearest health centre to give birth, and are often met with a facility without running water. In addition, it can be overcrowded, an ideal environment for bed bugs to fester. With a lack of beds, women suffer the added discomfort of gathering on the floors. And without electricity, nightfall brings darkness. Women are left to make do in what can be extreme discomfort, until it is their time to give birth.
Giving birth at a healthcare facility with no access to water brings a whole new, shocking set of challenges.
Water and sanitation are human rights and essential to the provision of healthcare, and yet 844 million people around the world don’t have clean water close to home. The problem extends beyond individuals and communities in remote or far flung locations, to healthcare facilities that see hundreds of patients every day. A 2015 WHO report found that one in three health centres in the developing world have no clean water.
Last year, the reality of these statistics was brought to life for me when I took part in the Sleepover Challenge at Chinguluwe Health Centre in Ntchisi District, Malawi. The district has a nursing vacancy rate of 86%. Centres that see more than 200 patients each day make do with just one midwife and one doctor working all hours; their job is 24/7. Along with pressing problems around water, sanitation and hygiene, they have several other challenges which make the task at hand – treating patients and providing adequate healthcare – almost entirely impossible.
Healthcare facilities in the district also report problems with electricity, and during my stay I saw this first-hand, when the hospital was subject to a 12-hour blackout. Some facilities have back-up generators, but cannot always afford to turn them on. Midwives deliver babies with the dim light of a head torch, substituting precision for urgency. Antenatal and postnatal wards are far beyond capacity, meaning vulnerable women may have to share beds or rest on chairs or the floor.
It is no wonder that infections march through these wards with terrible results. In Malawi, 574 women out of every 100,000 dies during or immediately after childbirth. In the UK, that number is just 9. An estimated 29 babies out of every 1,000 births will not survive their first month. Worryingly, studies have shown that rates of resistant infections are also rising – meaning that even if mothers and babies make it back to the health centre to be prescribed antibiotics, they still may not survive.
This is not limited to Malawi. Giving birth in an unsafe and dirty healthcare facility prevents mothers from being able to fully experience the joy of bringing a child into the world. Their fear for the future is justified. We cannot expect healthcare facilities without adequate water, sanitation and hygiene to provide health services that will keep patients safe.
We have now a critical moment to help change this deplorable situation. The Executive Board of the World Health Assembly meets in Geneva this week to determine the agenda for their 71st annual meeting in May. Among their important items for consideration is a resolution on the need for every healthcare centre everywhere to have access to these essentials for care: water, sanitation and hygiene.
WaterAid has worked here in Malawi with the support of UK aid from the British people on delivering water, sanitation and hygiene in healthcare facilities. Governments in sub-Saharan Africa and abroad know of its importance; it is time to step up and call for this injustice to be set right on a global scale, with funding to match.
Without clean water, decent toilets and good hygiene, it’s impossible for medical staff to deliver quality care, putting the lives of patients in danger and contributing to the spread of diseases and the rise of resistant infections, as antibiotics may be used to battle infections that good hygiene might have prevented. When staff are unable to keep the environment, their equipment or even their hands clean, vulnerable people are put at unnecessary risk.
As long as there are healthcare facilities without access to water, health professionals cannot ensure safe and quality care, and lives will continue to be cut short as a result.
Mercy Masoo, Country Director at WaterAid Malawi