On South Sudan's nation-building list: Curb horrendous maternal mortality rates

South Sudan faces a daunting to-do list as it prepares to become the world's newest nation in July after last month's historic vote to secede from its longtime enemy to the north. A government must be formed, roads must be built, schools must be started. And somewhere near the top of the list of demands from people in this long-neglected region is better health-care services.

“There are huge expectations for service delivery here,” says Susan Fine, who heads the United States Agency for International Development’s (USAID) programs in Southern Sudan. “People expect to see very rapid change.”

South Sudan has one of world's worst maternal mortality rates. The United Nations humanitarian office in South Sudan's capital, Juba, says that 1 in 7 women who become pregnant “will probably die from pregnancy-related causes.”

“This number could well be grossly underestimated,” says Prinitha Pillay, the medical director for a health clinic run by Doctors Without Borders in South Sudan's Warrap State.

“Addressing [the issue of maternal mortality in Southern Sudan] is a larger and more structural challenge that will need a different approach in order to be tackled,” says Dr. Pillay, noting that merely increasing the number of maternal wards and services for pregnant women, for example, will not prevent women from dying in childbirth in large numbers in South Sudan.

Optimism in the trenches

Mary Abuk Ngor has seen it all. She helps an Italian midwife run the maternity ward at the Doctors Without Border's hospital in a remote area of Warrap State, near Sudan’s North-South border.

On a recent Tuesday, the 10 bed ward in a makeshift plastic tent structure was over capacity and additional patients were being cared for in another tent while three women – all of them new to delivering their babies in a hospital – were in labor.

“This lady told me she’s suffering because according to her Dinka [ethnic group] tradition, the men say ‘we paid a lot of cows for you [as a dowry], so you must provide me with many children,’ ” Ms. Ngor explains as she skillfully inserts an IV into the wrist of the assaulted woman who delivered a stillborn baby yesterday. “That is the problem: The men force the women to keep delivering more babies.”

Ngor has professional and personal experience with this issue. She finished the equivalent of middle school in the South Sudanese system before she was married off to an elderly soldier with 25 other wives. He died soon after the marriage, and Ngor was forced to “marry” one of her brother-in-laws, a common practice in the area.

She remembers her first personal experience with childbirth at age 16, when she spent four days in labor in a mud hut in her village. “I delivered in the end thanks to God,” she recalls. “I thought I might die.”

Despite what she's seen, however, Ngor is optimistic that life will change for the better for women in South Sudan after the region officially becomes independent in July.

“This time is not like before when we were in war,” she says. “Now there is peace, our children are in school, and they will learn to stop this nonsense,” she said as she gestured to the maternity ward full of ailing women.

“Now we have a state governor who is a lady,” she added, saying that when she was a girl, neighbors came to her father trying to convince him to take his daughter out of primary school because she did not belong there.

--- Maggie Fick is a Juba-based journalist who blogs here.