The unbroken pot

Posted: 31 August 2000

Author: Nancy Durrell McKenna

Ghana has ambitious plans to promote safe motherhood and child survival, with a special emphasis on the role of traditional midwives. Nancy Durrell McKenna reports from one Ghanaian village.

"When water pours from the pot and falls on the ground you can replace it; but when the pot breaks, no water can be carried again."

A Ghanaian midwife offers these consoling words to Sitsope a young woman who had just given birth to a stillborn baby. Together they must look to the future and keep the mother strong, so that as the unbroken pot carries water she will continue to bear children.Ghanaian woman© Nancy Durrell McKenna

Sitsope, 19, comes from Pontin Sekoti, a village in the remote Upper East Region of Ghana - 6km from the Burkina Faso border. Her day had began like most days: waking at 5:30 am, sweeping the courtyard and lighting the fire in preparation for cooking. Her husband, Yao, also arose early and prepared to go to work in their nearby fields, where maize and groundnuts are their main crops. Baby Lardi, aged two, lay asleep on a mat in their round mud hut with its thatched roof. During the day Sitsope fetched water from the village well, washed clothes, cooked and chatted quietly with other women under the shade of the Baoba tree.

Late afternoon the first labour pains began and by early evening she decided to walk to the nearby kraal - 2km away - to where Senano, her 76-year-old Traditional Birth Attendant (TBA) lives. Senano's midwifery skills were passed on to her by her mother,who had had a vision from God that she would be a TBA. Despite her lack of formal midwifery training, Senano has a fine understanding of herbs and their various uses during labour and has delivered many healthy babies.

Within an hour of Sitsope's arrival Senano assessed that she should go to the hospital, some 30km away; the baby's head was still quite high in the birth canal and Sitsope was experiencing some distress and weakness - there was nothing that Senano could do. Together they began on bicycle, but the track was so heavily eroded because of the first rains that they abandoned the bicycle and continued on foot, arriving at the main road one and a half hours later. By this time Sitsope was very weak. A passing truck drove them to Bolgatanga Regional Hospital, a 30-minute drive along a dirt road.

Sitsope's baby was delivered stillborn by caesarian section. Sitsope's baby was not named and was not given a formal burial. Traditionally the baby has a naming ceremony on the eighth day and only then is it accepted as a full human being. An early death may signify that it was a ghost child, coming into the world only for a few days before returning to the spirit world.

I met Sitsope, in the early hours of the morning, as they entered the swinging transparent plastic doors of Bolgatanga Hospital. She was supported by Senano. They were exhausted, barefoot and simply dressed. Senano was treated with respect, not always the case as I learned from other TBAs who are made to feel inferior and inadequate. She had done what she could for Sitsope and now the hospital medical staff would take over.

Sitsope's baby was one of four babies delivered stillborn that night. In Sub-Saharan Africa, where a child has a more than 1 in 10 chance of dying before the age of one year and a more than 1 in 5 chance of dying before five years, stories like Sitsope's are not uncommon.

In Bolgatanga District, mothers and children form 70 per cent of the population of 239,000. Morbidity and mortality amongst women and children account for the major proportion of all ill-health and death in Ghana. Maternal mortality at present is 214 /100,000 live births. The national Objective of The Maternal and Child Health Services is to decrease maternal mortality by 75 per cent by the year 2020. Infant mortality rates are 66 / 1000 live births. The goal is to reduce this rate to 50 /1000 live births by the year 2000. These illnesses and deaths are almost all preventable. However until resources and services are made available in these rural areas maternal and infant mortality will continue to be high.

© Nancy Durrell McKenna

Progress is being made by the government with the aid of NGOs. One programme provides Yamaha motorbikes to Community health nurses to travel, on otherwise impassable tracks, to remote communities. They teach health education on nutrition, personal and environmental hygiene, detection of risks (like anaemia) in early pregnancy and of utmost importance they promote family planning.

The TBAs I met, in the Volta and Upper East Region, were dedicated, wizened women who are the important liaison between their communities and the more formal health system. They are eager to receive training and understand that while they cannot prevent death once a complication has arisen, they can contribute to making motherhood safer.

About the author:Nancy Durrell McKenna is a Canadian-born photo-journalist with a special interest in safe motherhood. Her reporting mission to Ghana was made possible by Save the Children-Canada. Visit her website gallery at www.durrell-mckenna.dial.pipex.com/.

Complications arising from unsafe abortions are the primary killer of women in Ghana between the ages of 15 and 44, according to the Minister of Health Eunice Brookman-Amissah. Approximately 1,200 die each year, spurring the Government into action, writes Rosemary Ardayfio.

It has begun to decentralise Ghana's reproductive healthcare services, training community-based midwives to deal with emergencies - arising from unsafe abortions and certain types of miscarriages - that previously could only be treated by doctors.

Brookman-Amissah, believes that extending this training to all midwives could revolutionise healthcare in Ghana and other African countries. But she admits it was an uphill struggle to persuade the overwhelmingly-male medical profession.

In addition, lack of information about the law means that most Ghanaians, including many health workers, mistakenly believe that abortion under any circumstance is illegal. In fact, Ghana relaxed its abortion law in 1985.

Source: Panos Feature Service, London.