Aina, 24, is in the last month of her pregnancy. This alone would be reason for some anxiety. “As it’s [my] first time, I’m worried,” Aina told UNFPA. But with the country’s partial lockdown, in response to the COVID-19 pandemic, Aina faces an unexpected challenge: the suspension of public transportation. Her local hospital, Itaosy District Hospital of Reference, is a two-hour walk away.
Even under normal conditions, a minority of pregnant women in Madagascar give birth with the help of skilled health personnel – around 44 per cent, according to the most recent data. Lack of skilled care is one contributor to the country’s high maternal death rate, which is 353 deaths per 100,000 live births (by comparison, the global average is 216 deaths per 100,000 live births).
Under the pandemic, the number of deliveries taking place in health facilities, under the care of health personnel able to manage deadly complications, could decline even further.
Hospital attendance at Itaosy has fallen. Usually, the hospital manages 10 to 15 deliveries and holds 20 to 30 prenatal consultations a day. On one recent day, just two women visited the obstetrical care service for prenatal consultations.
To help improve women’s access to life-saving maternal health services, the Ministry of Public Health and UNFPA have stepped in to provide free transportation for pregnant women visiting hospitals in Antananarivo and Toamasina.
Aina discovered the news on social media, and was immediately relieved. She has since been able to visit the hospital for prenatal care.
“Everything is okay. Mother and baby are fine,” reassured midwife Bakoly Rasoamanontany at a recent visit.
“Without that free transport, I would have walked for two hours in the sun with my big belly. It could have been quite risky,” Aina said.
“It helps us a lot, especially in this period of confinement, when no public transport is available. I can say that I was lucky.”
