Aina attends a prenatal consultation with midwife Bakoly Rasoamanontany at Itaosy District Hospital of Reference. © UNFPA Madagascar/Hantanirina Andremanisa
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.
Free transport available
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."
A life at risk
Sonia, too, learned that free transport was available. It saved her baby's life.
She went into labour the same day that the lockdown came into effect.
"Normally, we would have taken a taxi," Sonia's aunt explained. "Now, with the various restrictions and hygiene measures [in place], it has become difficult even to ask for the services of relatives."
Instead, they phoned the doctor and learned about the transport service. Within 20 minutes, the vehicle arrived to take her to Befelatanana Hospital.
There, an ultrasound showed that Sonia's baby was in a dangerous position; an emergency Caesarean section was required. The maternity ward, equipped with UNFPA-provided emergency delivery kits, was able to provide this critical procedure.
Just two hour after Sonia's phone call to her doctor, her baby, Yanaël, took his first breath. Mother and son were both in good health.
Bringing home a special delivery
In the maternity ward with Sonia were 10 other new mothers. Many of them had arrived at the hospital on foot, some walking for as long as two hours.
After learning of the free transport, they all planned to use the service to bring their new babies home.
"We will return home with the same transport, and I can tell you, frankly, this service is a blessing," said Sonia.
The free transport for pregnant women is available 24 hours a day, and is expected to serve around 5,000 women during Madagascar's anticipated month-long lockdown.