What if your doctor couldn't even wash her hands before examining you?
During countless visits to maternity wards without safe water, what I hear time and again are stories of trepidation - women who fear the very worst for themselves and their newborns.
Vitumbiko, 25, had heard stories about women dying during childbirth at her local clinic in Malawi.
She didn't tell anyone how worried she was when the contractions started.
Mothers-to-be like her sometimes have to walk 20km to their nearest health centre to give birth. Seven in 10 women in the country report at least one problem in accessing healthcare and, for more than half, it's distance, according to the latest demographic and health survey.
When women finally do arrive, they can find maternity wards overcrowded - an ideal environment for bedbugs. With a lack of beds, women suffer the added indignity of having to lie on the floors.
And without electricity, nightfall brings darkness.
Women are left to make do in what can be extreme discomfort until they give birth.
Giving birth at a healthcare facility without access to water brings a whole new, shocking set of challenges.
More than two billion people still lacked access to safe drinking water as of 2015, a 2017 World Health Organisation (WHO) report shows. The same can be said for almost four out of 10 health facilities in low- and middle-income countries, 2015 WHO statistics reveal.
Last year, the reality of these statistics was brought to life for me. Along with a handful of other female executives, I spent the night at the Chinguluwe Health Centre in Ntchisi District about two hours' drive north of the capital Lilongwe. We wanted to see the challenges that mothers like Vitumbiko face every day.
Almost 90% of nursing posts in the district are unfilled, government officials say. Meanwhile, health centres that see more than 200 patients each day make do with just one midwife and one doctor. Their jobs are 24/7.
Meanwhile, health facilities grapple with intermittent electricity cuts and, during my stay, I saw this first-hand when the hospital was subjected to a 12-hour blackout.
Some facilities have back-up generators, but cannot always afford to turn them on.
Midwives deliver babies with the dim light of a head torch, substituting precision for urgency.
A 2014 survey of more than 1 000 health facilities that had access to water showed that only half had adequate hygiene standards and even fewer reported decent sanitation, the 2015 WHO report shows.
It is no wonder that infections march through these wards with terrible results.
Without clean water, decent toilets and good hygiene, it's impossible for medical staff to deliver quality care, putting the lives of patients in danger and contributing to the spread of diseases and the rise of drug-resistant infections as more antibiotics are needed to battle infections that good hygiene might have prevented. When staff are unable to keep the environment, their equipment or even their hands clean, vulnerable people are put at unnecessary risk.
Vitumbiko had a right to be worried.
In Malawi, 634 women die during or after birth for every 100 000 babies born alive, 2015 Unicef statistics reveal.
For every 1 000 live births, 63 babies won't make it to their fifth birthday, the demographic health survey shows. Unicef figures show that almost 10% of these deaths are because of diarrhoeal disease, which is in part caused by poor water and sanitation.
Giving birth in an unsafe and dirty healthcare facility prevents mothers from being able to experience fully the joy of bringing a child into the world.
Their fear for the future is justified. We cannot expect healthcare facilities without adequate water, sanitation and hygiene to provide health services that will keep patients safe.
This week, the executive board of the WHO meets in Geneva to set the agenda for their annual meeting in May and to decide whether they put basic access to water for health facilities on the agenda.
If they do, they could adopt a resolution that says every clinic and hospital should have adequate water, sanitation and hygiene. It - and funding to match it - would be long overdue.
Vitumbiko's baby arrived safely and well. Now the world has a chance to help to ensure other mothers can say the same.
Mercy Masoo is the country director at WaterAid Malawi. Follow her on Twitter @wateraidmalawi.
Read the original article on Bhekisisa.
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