When instinct told her that her waters would break that month, Esnart Philip mobilised her guardian and other members of Chakhumbira Village for the long walk to meet her bundle of joy at Neno District Hospital.
That, however, was several weeks before she had seen any real labour signs.
Like many pregnant women in rural Neno, such early arrival at the hospital was nothing unusual.
Phillip knew that if she did not arrive at the hospital ahead of her labour pains, she would never make it in time to deliver due to the long distance it takes to reach the hospital and the lack of paved roads in the district.
“Here, you don’t wait for labour pains to start; the labour has to find you at the hospital otherwise you can’t make it,” narrated Phillip, after arriving on foot from her village 35 kilometres away.
For pregnant women in Neno, travelling 35 kilometres or more on rocky and rugged earth roads to reach the only maternity facility in the district has become a routine ordeal.
“We have been here for two weeks now. Lack of food is our major problem. Our relations are not able to visit us regularly due to the long distance they have to cover to bring food here. During the waiting period, the hospital provides food only once a day from Monday to Wednesday. Most times we go to bed on empty stomachs,” Phillip said.
Most women have to wait to check in at the hospital a week or two before their due date as the hospital does not provide food throughout their waiting period.
Annie Antonio, from Nyakoko Village, Traditional Authority Dambe, is a mother to a three-month old child and had to check in at the hospital three months before her due date to beat the long distance between her home and the hospital.
“We walk for over 20 kilometres to Neno District Hospital and there is no other mode of transport apart from walking on foot. When I was about six months pregnant, we left our home to check in at the hospital to avoid any complications,” Antonio said.
According to the mother, whenever a child or anyone falls sick at night, villagers mobilise themselves to take the patient to the hospital.
“One day on our way to the field, we found a woman on the road unconscious but needed help to get her to the hospital, but the road was bad to the extend that even the motorcycle could not move, and people had to push the motorcycle through over 20 kilometres,” she said.
In between where Cecelia Joseph comes from and Neno District Hospital is Ligowe Health Centre, which serves a population of over 15,000 people but the facility was closed to maternal services due to lack of equipment, guardian shelter and surgical theatre forcing people to travel over 13 kilometres to the district hospital.
If Ligowe Health Centre’s maternity wing were in operation, expectant mothers like Joseph would not have been travelling long distances to safely give birth.
Member of Parliament for Neno South Constituency, Mark Katsonga, said funds to finish construction of Ligowe Health Centre’s maternity wing have already been secured and that the work will commence soon.
Senior Chief Dambe acknowledged the challenges women face to access maternal services in the area.
“The problem is that there is shortage of health facilities in the district. For example, Soka area is very far from Dambe Health Centre and Neno District Hospital. This is also the case with Nandaya and, for this reason, people go to the hospital early,” the chief said.
From Soka to Dambe Health Centre, women cover over 35 kilometres to find a health facility which does not accommodate expectant women.
“Another major problem is that of poor roads and it has really affected safe motherhood. The government should consider upgrading roads to make them passable for vehicles, especially ambulances, and open fully equipped health facilities,” Dambe said.
Neno District Hospital Director of Health and Social Services, Grace Momba, said expectant women are mostly admitted at eight months.
“The only time we admit women that early, two or three months before the due date, is when they have a condition that we need to treat or monitor and once they deliver their babies, they are discharged to come back later,” Momba said.
Momba said the women get food like any other patient, but they are supposed to come with supplemental food from home.
To ease pressure on Neno District Hospital and make sure women do not travel long distances to access maternal health care, Momba said they are working on re-opening Ligowe Maternity Wing without the guardian shelter.
Special Adviser to the President on Safe Motherhood and Reproductive Health, Dorothy Ngoma, admitted that women in Malawi continue to face numerous challenges in accessing maternal services.
However, Ngoma said there is strong political will from the president to address the challenges.
“That is why I was appointed special adviser so that safe motherhood issues are top on his agenda. Challenges on the ground are many but not impossible to deal with. We just need more resources for care, especially in rural and difficult-to-reach areas,” she said.
Until things change, expectant mothers in hard-to-reach areas will continue facing challenges in accessing maternal health services.