Maternity Needs in Rwanda: Listening to the Women

Introduction: Reducing maternal morbidity and mortality is recognized as a key component of improving the health of the poor globally. Maternal mortality ratio (MMR) estimates reveal large gaps. The MMR is < 1 in Ireland and 900 in sub-Saharan Africa. In our study, we look at specific maternity care needs in a rural community in Rwanda and implement sustainable strategies. Methods: This study was conducted in Nyamasheke District in western Rwanda. Meetings and focus groups were held with members of the Rwandan Ministry of Health, local health leaders, and community health workers (CHW). A village level maternity center, mobile reproductive healthcare teams, and transportation associations were designed. Results: A maternity center staffed by nurses was constructed and provides basic labor and delivery services. All emergencies are referred to the district hospital. A mobile reproductive healthcare team was mobilized and delivers prenatal and postpartum care, family planning services, and VCT/PMTCT. This team consists of a nurse and CHW. The services are delivered at a specified location in each village. A key component of this intervention is creating birth plans with each patient. Finally, a transportation association has been developed in each village. Utilizing a traditional ambulance provided to each village, the association volunteers will transport pregnant women to the new maternity center or local health center. Conclusions: While there are many obstacles to improving maternal health in Africa, involving local leaders and community members in the designing phase is critical to creating a sustainable, culturally acceptable, and successful service intervention.