Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in many developing countries. In the last two decades, Rwanda has achieved a dramatic reduction in the rate of maternal mortality from 1,400 per 100,000 live births in 1990 down to 210 per 100,000 live births in 2014. Despite the progress, every year mothers continue to die from preventable complications practically in rural areas of Rwanda. We work to eliminate preventable maternal deaths by improving the quality of obstetrical care, timely access to care, and quality of family planning and counseling.
In Rwanda, 91% of deliveries take place in health facilities. This provides a very unique opportunity for Rwanda to ensure that all facility deliveries are safe through quick interventions, quick referrals, and ensuring that the standard of care of mothers is of the highest quality.
The leading contributing factors to maternal death are hemorrhage, hypertension during pregnancy and infection. Most of these deaths can be entirely prevented by building well designed and dignified health infrastructures including maternity wards and operating theatres that are well equipped and staffed with trained doctors, nurses and midwives. We identify health facilities that are need of infrastructure improvements or lack necessary medical equipment and work with our partners to construct quality maternity units and provide state-of-the-art medical equipment.
Capacity building and quality improvement
In order to improve the quality of maternal health services delivered we provide routine trainings on obstetrical care and management of emergencies related to pregnancy. We work with health professionals at the level of the district hospital, health centers and at the community level. Our team of mentors identify key areas that could be improved at health facilities and develop quality improvement projects specific to that individual site. Through mentorship and the establishment of learning collaboratives we strengthen the quality of health care delivered to mothers. Additionally, our mentors visit sites to directly observe care and work with the healthcare providers to reinforced key protocols.
Rwanda has made great progress in improving access and use of family planning measures. In 2000, only 4 percent of married women reporting using modern contraceptive methods and today 53 percent do. However, 21 percent of married women report they want to stop or delay childbearing but are not using any method of contraception. To address this unmet need, we provide training and mentorship for nurses at health centers on family planning provision and counseling. Our training and mentorship focuses on contraceptive options including long acting reversible methods and management of side effects.
Community health workers
Our efforts at the district hospitals and health centers are complemented by community health worker programs at the community level. Community health workers create functional referral networks that ensure pregnant women attend antenatal clinics at least 4 times during pregnancy. Additionally, they ensure that any at-risk mother is transported to a district or referral hospital to give birth where there are trained doctors, an operating theater, and a blood bank.