09/26/2012 09:49 am ET Updated Nov 26, 2012

We Need to Stand Up for African Mothers


Can you imagine delivering a baby in the middle of the night with no light except the glow of a mobile phone? Without any water or electricity? Without even a bed or sheets for that matter? Esther Madudu, a 32-year-old Ugandan midwife, can. She encounters challenges like these almost every day.

In North America, expectant and delivering mothers take for granted that they will have a bed with clean sheets, drugs to ease the pain and a fully equipped operating theatre in case something goes wrong during delivery.

In Africa though, these are all impossible luxuries. Most women give birth at home, often alone, on a sheet on the ground, far from any health facility. If you're lucky, you will have someone to help you, often a traditional birth attendant who may have basic skills, but she won't have advanced training to deal with complicated labor if something goes wrong. In which case, you have to hope there's a bicycle, or able-bodied men to carry you, or a motorbike that works and has gas -- to transport you to the nearest health facility, which may be 40 miles away or more.

Sub-Saharan Africa has one of the highest maternal mortality rates in the developing world. In 2010 alone, nearly 177,000 African women died in pregnancy and childbirth. And the worst thing about all of this is that these deaths could have been prevented if only basic obstetric care were readily accessible.

Maternal, newborn and child health is one of the key priorities at the African Medical & Research Foundation (AMREF). And together with the other 25+ NGOs in the Frontline Health Workers Coalition, we're actively working together to urge greater and more strategic US investment in frontline health workers in the developing world as the most cost-effective way to save lives.

At AMREF, we recognize that frontline health workers, particularly midwives, can bring about a huge transformation in maternal health. That's why AMREF has initiated our Stand Up for African Mothers global campaign. Our goal is to train 15,000 midwives by 2015. One skilled midwife can provide care for 500 mothers each year and deliver 100 babies. These newly trained midwives will ultimately help over seven million African women each year.

This week when the global health world is focusing on the Millennium Development Goals, I joined a panel about how frontline healthcare workers are saving lives. As I reflected upon the hundreds of dedicated individuals that AMREF has the privilege of working with, Esther Madudu's story stands out...

Esther received training by AMREF in advanced midwifery skills, specifically in handling difficult deliveries. She is employed by the Government of Uganda and has worked in the Atiriri Health Center, deep in a remote rural area, for three years and in the Katine district itself for seven years. Her duties include examining mothers, counseling HIV+ mothers, preventing mother-to-child transmission of HIV, nutritional education, family planning and post-natal care - all of this coupled with delivering 45 to 50 babies a month at any time of the day or night.

This workload, shared by only one other midwife, means that Esther works nearly non-stop, is on call 24/7 -- and in her own words, hardly has time to eat. Esther remarks almost nonchalantly, "I have to do this because without me, some children will not even get a chance to live."

By her own estimation, she has saved more than a thousand babies and mothers and her dream is "to save more lives - in the thousands, by the time I'm 35."

Why does Esther work so tirelessly? What motivates her to care so deeply for these women she doesn't even know? Perhaps the fact that her own birth was premature. As Esther recounts it, she weighed only a few pounds at birth and the midwife present insisted on 'not throwing her away' as was often the fate of other premature babies in her village. Instead, Esther believes she's alive today because "someone made a sacrifice."

Now Esther carries forward that sacrifice for the many, many women she cares for in Uganda. And she is not the only one - at AMREF, we know many amazing midwives like Esther. On behalf of all of these dedicated women, we've decided to honor them by nominating Esther for the 2015 Nobel Peace Prize. If you believe that childbirth should be a time of joy for every woman, join us by signing the petition for Esther at

It is with the absolute devotion of people like Esther, the support of partners like Johnson & Johnson whose programs include upgrading nurses' skills in Kenya, as well as drawing attention to the essential role of frontline health workers during this 'MDG' week here in New York, that we will continue to make a difference in the lives of African women and children.

With Esther's nomination we celebrate the dedication of all African midwives and underscore the importance of their critical role in creating lasting health change in Africa. While we have made much progress in the Millennium Development Goals 4 and 5, to reduce child mortality and improve maternal health, we're not quite there yet.

Our best weapon would be to clone Esther Madudu...fifteen thousand times over.

Follow AMREF on twitter at @AMREFUSA