Email
PrintMaking motherhood safer
Childbirth can be a life-threatening experience in remote Laos. East Asia Program Coordinator Lee FitzRoy explains how Oxfam Australia is training local women to be midwives.
Chanpheng, aged 22, of Dongxa village, in Thateng District, southern Laos, has completed midwifery training with Oxfam Australia's support. Here she speaks with Boutda who is nine months pregnant with her third child. Photo: Jerry Galea/OxfamAUS.
Women in the Ta Oy minority group in southern Laos traditionally give birth on a small platform in the forest. Sometimes the birth may go well and mother and baby both emerge healthy; other times women may experience difficulties, suffer serious illness or even death.
The maternal health mortality rate in Laos is the second highest in Asia, 656 deaths per 100,000 live births. In rural areas, where there are few skilled medical staff, the rate is estimated to be even higher, up to 900 per 100,000 live births.1
In remote villages like Lapung, in the Tay Oy district, we are supporting local women to be trained as midwives. In the training, the women learn how to help the mother before, during and after childbirth, provide advice on good nutrition and hygiene and recognise problems during the earlier stages of pregnancy.
Women from the community say they have now started to give birth in the village because they can access clean water via the new wells and gravity fed water systems that Oxfam Australia has provided. They also say that they trust the midwife to help them give birth and trust some of the western medicine available to them from the midwife or village health volunteers.
Miss Soy is one of two women from Lapung who completed the midwifery training and works as a midwife in the village.
“Over the past year, I have helped four women give birth to healthy babies. No babies or women have died,” Miss Soy said. She explained that a fifth woman had difficulties during labour, but she
and members of the woman’s family transported her to the district health centre — about two hours walk away — where the baby was born safely.
While villagers aren’t charged a set fee when Miss Soy assists during childbirth, there is a general expectation that families will make a small contribution towards her services and any western medicines used. Many villagers in Lapung do not have cash money and sometimes give Miss Soy rice or other food they have grown or collected.
But despite greatly appreciating and valuing the work that the midwives do, many villagers live in extreme poverty and are unable to pay them, even with food. The villagers often have difficulties growing and finding enough food for their own needs and sometimes experience rice shortages for four to six months a year. Ironically, Miss Soy and her mother were among a community focus group discussion held recently in Lapung with villagers who describe themselves as being the poorest in the community.
Families in Lapung are also used to women previously giving birth in the forest without incurring any costs; so having the support and assistance ofa village midwife, access to western medicine, and paying for these services, are totally new experiences for them.
There is also the difficult question as to the relative value of women and children and whether scarce resources can be prioritised to pay for the support of a midwife during childbirth. In some ways, the issue of non-payment may be exacerbated when the birth goes smoothly and when both mother and baby are well.
The midwife program is an important strategy to help improve women and children’s health and provide opportunities for midwives to increase their income. However, we acknowledge that challenges exist and we will continue to have discussions with key community leaders and work in partnership with villagers to find ways to compensate midwives for their time and skills.
- World Health Organization, A strategic assessment of reproductive health in the Lao People's Democratic Republic, 2000. www.who.int/reproductive-health/publications/