August 10, 2018
"You'll be meeting your baby soon!"
A midwife kindly touches a pregnant woman's lower back and talks to her in a gentle voice. The expectant mother lays down on a clean bed, and sometimes stands and leans on the midwife and assumes a comfortable position while waiting for the big event to come.
A mother looks into the eyes of her healthy boy who was just born.
At this health center in Tambacounda Region in the southeast, about 500 kilometers from Dakar, the capital of Senegal, a healthy boy is born.
"I was able to feel at ease and give birth because I had a midwife by my side the whole time," the mother says.
The midwife has been supporting the pregnant woman since she found out she was pregnant.
The settings where babies are born are changing in Senegal. Health facilities that in the past were feared and avoided by expectant mothers because of unsanitary environments and medical care not achieving standard quality are becoming places where they can give birth with peace of mind under appropriate medical care. Today there are more and more pregnant women who give birth in health facilities and neonatal infant mortality is dropping.
Along with Senegal's Ministry of Health and Social Action, JICA is spreading this "safe childbirth that gently responds to mother and child."
Pregnant women wait to be examined under a blazing sun.
"A long line of pregnant women waited hours for their turn in front of a health center's consultation room under a blazing sun. The temperature was forty degrees Celsius. The room where they were supposed to give birth was still dirty, flies were flying around and it stunk."
This is what JICA Expert Miho Goto observed at a health center she visited in Tambacounda Region for a survey about 10 years ago. Pregnant women in labor pains went neglected and sometimes babies were accidentally born in halls without any birth attendants, she says.
In Senegal, because of the mistaken belief among health care providers that "childbirth should be wrapped up quickly," harmful medical interventions, such as pushing the baby out of the mother's womb, used to increase the risk to mothers. One midwife said with regret that she once jeered at a pregnant mother out of irritation at the shortage of human resources and medical equipment.
Aiming for gentle, safe birth for mother and child, JICA has been carrying out the Project for Reinforcement for Maternal and New Born Care in Senegal since 2009. Based on the Tambacounda Region survey, JICA created an original model for caring for mothers, newborns and childbirth along with Senegal's Ministry of Health and Social Action. In partnership with regional health centers, JICA is supporting health facilities improvement and training human resources for health.
A midwife, right, takes care of a mother and her baby after childbirth.
The essential concept of this model is "humanized maternity care," the basis of the care of pregnant women by midwives in Japan. It's based on the following concept: When mother and child are both in a healthy state, delivery should be done in a way that supports the birth of a life by respecting humans' original powers — of a mother to give birth and of a baby to be born — based on evidence based medicine (EBM) under a clean and safe environment.
In Japan, giving birth without difficulty in a safe environment is taken for granted, but every day in the world, including developing countries, 830 mothers lose their lives for preventable causes related to pregnancy and childbirth*. This "humanized maternity care" is being re-evaluated and considered, along with the creation of obstetric care facilities, as an initiative to reduce maternal and neonatal mortality rates in developing countries.
Classes are being held in various villages to share correct knowledge about childbirth. A Bajenu Gox wearing a pink T-shirt takes on the role of a pregnant woman and demonstrates labor positions, while a midwife gives an explanation.
The model for caring for mothers, newborns and childbirth introduced in Senegal beginning in 2009 is being carried out in all 14 regions and about 100 health facilities today. Women in each village with childbirth experience, called "Bajenu Gox" and known as "the mothers of the community," are the ones working to spread knowledge related to safe childbirth based on this model.
"It's important to get periodic checkups while pregnant," said a Bajenu Gox teaching a class. "You'll feel at ease at health facilities because competent midwives will assist you in your childbirth."
Bajenu Gox, along with local midwives, hold classes in various villages to give women correct knowledge related to childbirth. They counsel women on pregnancy and birth and accompany them to examinations at health facilities.
JICA Expert Miho Goto, right, teaches the method known as " Kangaroo Mother Care," in which immediately after birth, a mother holds her baby to her breast, in a health facility in Senegal.
"It's possible for us to protect the lives of mothers and babies that should never have been in danger in the first place. There are things Japan could learn from this initiative of government, health facilities and communities coming together as one, getting residents involved and improving their community health care," said Ms. Goto.
Senegal is including this model in mother-child health policy and aims to introduce it into all health facilities. JICA is supporting this effort.
JICA's "humanized maternity care" initiatives have their origin in "the Maternal and Child Health Improvement Project in Northeast Brazil," carried out for five years beginning in 1996. Before the start of the project, overmedication and inappropriate medical interventions stemming from an excessive dependence on medical care were increasing in Brazil, which had no midwives. In addition, women received inhuman treatment based on inferior medical services, and maternal and neonatal mortality rates were high.
Obstetrics staff members stay with a woman in labor and kindly give her a massage. JICA projects have changed the attitudes of health care providers toward childbirth in Brazil. (Photo: Sakae Kikuchi)
Through this project centered on the spread of "humanized maternity care," the attitudes of Brazilian health care providers toward childbirth have changed. Unnecessary and inappropriate medical interventions dropped, humane, warm care began to be offered, and big improvements came to the maternal and child health services, including Maternity Waiting Homes run by obstetric nurses.
A baby just born in a medical facility in the state of Ceara in Brazil. Humanized maternity care that protects the safety and dignity of the mother and baby is a blessed experience for everyone in the family. (Photo: Sakae Kikuchi)
About 20 years have since passed. To make it common to protect the safety and dignity of mothers and babies in birth settings, JICA continues to carry out humanized maternity care initiatives in eight countries including Senegal, Mozambique and Cambodia.