Giving birth is deadly

"The women invariably don't come to us until they are seriously ill," says Elisabeth Nyalok, who works with MSF in southern Sudan.

MSF has about half a dozen antenatal, post-natal and obstetrics projects in the region - which has one of the highest rates of maternal mortality in the world.

The countryside is vast and barren. Only where there is a tributary of the Nile does anything grow on the dry soil. The occasional lorry or car belonging to an aid organisation makes its way along the region's sparse sandy tracks. Other than that, there is next to no traffic. Many of the towns and villages are not even accessible by car and can only be reached on foot.

MSF staff member giving health care information to people waiting in the clinic in Kalma Camp, the biggest IDP camp in the world. It is becoming more difficult and complicated to operate. Especially for smaller organisations, it is almost impossible due to government bureaucracy, expensive logistics, insecurity, limited impact one can make considering the scale and complexity of the humanitarian drama in Darfur.

In these places, we see women collecting water from wells, markets with little or no produce to sell, other than salt and rice, and cows grazing in and around the market. And, everywhere, round, mud huts with pointed straw roofs. In villages like Pieri, there are just a handful of them, but a town such as Leer has thousands. And wherever you look, there are children running around, laughing and playing. Family is a big thing in southern Sudan - but hardly anywhere else in the world has such a high rate of infant and maternal mortalities.

Angelina Matai is one of the lucky ones to have survived. When her contractions started, the young woman went to her mother's house to give birth. Seven days later, she was still in labour when her unborn child suddenly stopped moving. Her family summoned a traditional healer, who attempted to pull the stillborn baby out of Angelina. But she cried out in such pain that her relatives eventually decided to take her to the MSF healthcare centre in Pieri. It took them a day to trek their on foot.

"I really thought the mother would die too," recalls midwife Hellen Galla. "But after six weeks in the clinic, she was fit enough to be discharged. She was lucky - very lucky indeed."

Nurse feeding malnourished child with breast milk through a tube and with help of syringe through the child's mouth. With her finger, she tries to stimulate the child to swallow.

In southern Sudan, where Angelina comes from, one in 50 pregnancies is fatal for the mother. This means that there are 230 times as many maternal mortalities there compared to Germany.

In the region, tradition has it that women give birth to their offspring in their mother's home. They only seek help in the event of complications, first and foremost turning to a traditional healer or an untrained midwife in the village.

For more than 20 years, there was no schooling or training anywhere in southern Sudan, and the area was plagued by war until three years ago. A public health system has only just been initiated and, until recently, antenatal and post-natal care were non-existent. Many of the pregnant women who come to MSF are already suffering from serious complications, and one in seven requires a Caesarean section.

"Many women wait until the very last minute to come to us because they have other children to look after too," explains Elisabeth Nyalok, who works in the hospital in Leer. "They are often worried that if they go to the healthcare centre, the doctor will want to keep them there, and there will then be no one to stay at home with their children. In this case, we talk to them and explain that, if they die, their children will be left all alone, so it is better that they look after their health and live."

Women in southern Sudan run an increased risk of suffering from childbirth-related complications due to the frequency with which they give birth and, to some extent, also the advanced age at which they are still having children.

"People are very proud of their children here," says Hellen Galla. "They are a symbol of a person's prosperity and it is not unusual for a couple to have eight or more children. Many of the children die at an early age due to malnutrition, malaria or other illnesses. So the women have more children and are sometimes still becoming pregnant and giving birth in their late 40s."

MSF has been providing antenatal care in southern Sudan for approximately two years now. In view of the number of pregnancies in the region, only a fraction of the pregnant women are taking advantage of the medical aid on offer, but the number is steadily rising.

In 2006, the MSF teams looked after 2,500 women, but this figure rose to 6,800 last year. And the MSF workers hope that word about their services will continue to get around, as it did in the case of Angelina's village.

When Angelina returned to her village in full health six weeks after she had left, the people thought it was nothing short of a miracle. Her family and neighbours were convinced that, with a stillborn child in her, Angelina would surely die too. So the good news spread quickly in the village. And now other women from the same area have started to come to Pieri - not just to give birth, but also for some antenatal care or for some post-natal care a few days after giving birth.