Our World is a new series featuring images and perspectives from the field. See how IntraHealth is working with local partners to increase access to maternal, newborn and child health services in Mali.
Giving birth in Mali is especially risky: pregnancy- and delivery-related mortality remains the primary cause of death among women of reproductive age. Women here face a 1 in 15 lifetime risk of maternal death.
A large country with vast rural areas, Mali bears a chronic shortage of well-trained midwives available to serve in its remote territories. 75% of skilled birth attendants are based in the capital city of Bamako, while most of the population lives along vast territories to the North, bordering the Sahara.
Less than 50% of pregnant women in Mali receive skilled care at birth.
Establishing training institutions closer to rural areas can improve deployment and retention of health workers in those areas. Far from Bamako, on the edge of the desert, IntraHealth works with a private-sector nursing school, Ecole des Infirmiers de Gao.
With more than 350 students, the school plays a vital role in training health workers to serve diverse populations in the surrounding regions of Gao, Kidal and Tombouctou.
Through the USAID-funded Capacity Project, IntraHealth supported the school by revising its curricula using the IntraHealth-developed Learning for Performance approach, which connects learning to specific job responsibilities and competencies students will need.
Learning for Performance shortens the required training time by focusing students’ learning on what is most essential for the job—in this case, what students need to safely attend mothers in labor. Authorizing and supporting various cadres of health workers to perform lifesaving interventions also has an impact on maternal health outcomes in Mali.
Health officials required rigorous proof that a group of auxiliary midwives, called matrones, who deliver the majority of babies, could safely administer uterotonic drugs to moms immediately following birth—key to preventing postpartum hemorrhage, the leading cause of maternal death.
Until 2009, matrones weren’t authorized in the practice, called Active Management of the Third Stage of Labor (AMTSL), only doctors and nurse-midwives. A pilot study led by IntraHealth and the Capacity Project, in partnership with the Ministry of Health and the Prevention of Postpartum Hemorrhage Initiative addressed this issue by demonstrating the efficiency and the safety of matrones using AMTSL.
Matrones’ scores in recognizing and handling delivery complications were virtually identical to those of skilled birth attendants, and data from the final assessment showed that almost all deliveries in the study’s health facilities had occurred using AMTSL. Matrones attended many of these births, and the postpartum hemorrhage rate decreased from 1.9% (93 cases) in the baseline survey to 0.13% during the final assessment (11 cases).
Now, with revised medical curricula and new national standards, hundreds of thousands of women who rely on matrones services in childbirth can receive the lifesaving, pre-emptive protocol. Learn more about this work, click Mali under Where We Work and Resources.
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