03/05/2013 02:41 pm ET Updated May 05, 2013

Birthing Shelters

In 2011, I traveled to Namibia to meet with the first lady, Mrs. Pohamba. In our meeting at the State House in Windhoek, I learned about women, who in their last month of pregnancy, were sleeping under a tree, near the District Hospital in Outapi. In this community in northern Namibia, near the Angolan border, these heavily pregnant women needed to be near a hospital to deliver their baby safely. They did not want to take the risk of trekking for long distances while in labor.

I visited this site in Outapi, and others while in Namibia. The conditions under which they were living were untenable, particularly for women who are nine months pregnant. They have no shelter, no kitchen, no toilets, no bathing facilities, and no water. When it rains, they cannot make a fire and do not eat. They face the compounding stresses of fending off animals and criminals. These physical and psychological stresses create a great deal of suffering just before the intensely physical demands of childbirth and subsequent care of a newborn.

Birthing Shelters: A Community-Owned Solution

The Outapi community came to Mrs. Pohamba and asked her to help these pregnant women. The community had raised a portion of the money to build a shelter for the soon-to-be mothers but they were struggling to raise the full amount. Birthing shelters, as these structures are known, are successful around the world. The first lady and the community were asking for our help to raise funds to build this much needed and necessary refuge.

I really believe in the birthing shelter program and it is a perfect example of a type of program that makes incredible sense to support; it is self-sustaining and community-owned. A birthing shelter is a dormitory located near a hospital to provide shelter to pregnant women one month before they are due to deliver. UNICEF recommends these shelters as a critical component in reducing maternal and newborn deaths. For many women and newborns, being near a hospital with emergency obstetrical care can mean the difference between life and death for one or both of them. The women are poor and live in rural areas far from the hospital. They can get neither private nor public transport to take them to the hospital when in labor.

My research has shown that these shelters (also known as Birth Waiting Homes in other countries) have been proven to reduce maternal and infant mortality rates because they relieve women from the need to travel to the delivery hospital when they are in labor. Based on current demand of 60 pregnant women a month and assuming the life of the building is 40 years, one building will provide shelter for more than 28,000 women. Community and hospital support as well as modest fees by residents make the shelter self-sustaining. While women are in the shelter for those two to four weeks before delivery, the local hospital provides free health education classes on childcare, breastfeeding, HIV/AIDS, and nutrition. These women are close to the hospital for prenatal appointments and delivery and best of all, they have a wonderful sense of companionship with 60 other women who are pregnant at the same time!

Birthing Shelters in Action: Educating and Caring for Pregnant Women

I visited the Eenhana birthing shelter located in the region of Ohengwena, situated in Northern Namibia. Ninety percent of its population lives in rural areas, with a very low population density. Due to its proximity to neighboring Angola, the Northern region of Namibia experiences a high influx of persons seeking health care, especially pregnant women looking to deliver their babies in Namibia.

When I first walked into this birthing shelter with its open courtyard and mature trees, I could feel how safe and comfortable these women were. It was a marked difference from the anxiety and concern of the women who were sleeping under the trees. The shelter has six semi-private bedrooms with nine beds (with a malaria net above each), a health education room, an outside cooking area, and a washing area with plumbed toilets, showers and sinks to wash clothes and linens. Health education classes in nutrition, sex education, childcare, breastfeeding, HIV/AIDS, etc., are provided weekly to the women by the affiliated hospital located within 500 meters, a two-minute walk from the shelter. The sense of camaraderie among the women was clearly evident. When I asked them about their favorite part of the shelter, the overwhelming answer was "sleeping on a bed is very nice."

I met with many members of the Eenhana community, all of whom recognized the urgent need of these pregnant women. The shelter's initial funding came from the local community and then supplemented by NGOs. The town council donated the land and the shelter is currently managed and maintained by the town council as well. Each women is asked to contribute N$1 (about $0.15) per day toward maintenance of the shelter, however, women are not turned away if they cannot pay. Most women stay about one month and the shelter is continually overcrowded with women sleeping on extra floor mattresses provided by the shelter to cope with the excess demand.

First Ladies: Advocates for Communities With the Most Need

As the first lady, the citizens of the country become her new family and she is now the mother of millions. Oftentimes, she is the last resort for citizens who come to her when all else has failed. First ladies receive countless letters and requests everyday from their citizens asking for help. In the words of Mrs. Pohamba, "First ladies are not elected or appointed in terms of any legislative provisions; however, the role of any passionate, loving and caring first lady is no longer negotiable. Improving and changing the lives of people is our concern and priority."

For more information about our organization and how you can help these pregnant women, please visit