Two months ago we sat down with some of our community health workers to brainstorm ideas for International Women’s Day. What would engage women, what could bring about positive change in their community? Something different to the normal celebrations, perhaps a petition for a midwife? This seemed like a great idea on paper, but would it create false hope in a village where the public health center has been closed for years?

In Madagascar, the chance of dying from pregnancy-related complications remains high; Malagasy women face a 1 in 43 lifetime risk of maternal death. This national statistic masks an even tougher reality in rural settings where health care facilities are few and far between and where travel is difficult (often uncomfortable for pregnant women and can mean forgoing livelihoods). Most women deliver at home, with or without a traditional birth attendant, although many would prefer to deliver in a health center with a skilled midwife or nurse.

Behind each number there is a woman and a baby, a family and a community. To illustrate these numbers, here are a couple of stories from the time when we provided antenatal care in the absence of a government midwife…

A 32-year-old lady from a remote island presents in her tenth pregnancy. Three of her children have died. She is at greater risk of bleeding during the delivery because of the number of babies that she has had. She will probably deliver at home without medication to prevent bleeding after the delivery of her baby; she has little other choice.

Continue reading on Beyond Conservation.