The young mother floated in and out of consciousness as she lay in the maternity ward at the Rwaza Health Center. Euphrasie Banyangiriki had just given birth to a healthy baby girl, but now she was bleeding profusely.
“I couldn’t hear anything, and I couldn’t even recognize where I was,” Banyangiriki said, recalling her terror just before she blacked out.
Nurse Françoise Murekatete arrived at Banyangiriki’s bedside soon after delivery. She recognized the severe bleeding as one of the leading complications of birth, postpartum hemorrhage. She examined Banyangiriki, and readily diagnosed the cause of the bleeding—a failure of the uterus to contract after delivery. Murekatete quickly administered the drug oxytocin to stimulate the uterus to contract.
When the bleeding didn’t stop right away, she recalled the instructions of her nurse-mentor Delphine Uwizeyimana, and calmly began compressing the uterus with her hands—an effective way of stimulating a uterine contraction that she had learned in a Jhpiego-led program. Banyangiriki’s bleeding stopped and the 27-year-old soon regained consciousness. Before long, she was cooing and singing to her infant daughter , whom she named Irakoze or “Thankful to God.”
The outcome for Banyangiriki could have been quite different with a less skilled, less confident health care provider at her side. About 300,000 women die every year from complications of pregnancy and childbirth, the majority of whom live in the developing world.
In Rwanda, the ministry of health recognized the healing power of skilled, confident health care providers supported by a resilient health system. The government focused its efforts on building just such a system—one in which nurses, midwives and doctors can manage complications at birth with assurance, expertly resuscitate newborns who can’t breathe, and provide follow-up care after delivery to ensure that mothers and newborns thrive.
That required including lifesaving, evidence-based interventions in basic standards of care and establishing quality assurance policies to maintain those standards. It meant persuading women to come to a health facility to give birth. With its focus on resilience, Rwanda has been on a path of improved care for women and families.
Country health officials, working with Jhpiego through its leadership of the United States Agency for International Development’s flagship Maternal and Child Survival Program, are establishing well-functioning health facilities that support self-reliant providers with hands-on learning, the supplies they need to deliver high-quality services and real-time data for informed decision-making—even in the most uncertain times.
In the 10 districts that Jhpiego has supported since 2015—representing a third of the lush, mountainous country—three key interventions were incorporated into labor and delivery practice.
Despite recent challenges in maternal health outcomes across the country (likely caused by rising malaria rates), the Ministry of Health’s investment in these 10 districts is contributing to saving lives through an educated workforce, dedicated mentors and supportive supervision. An analysis of the impact of these interventions from 2015 to 2017, shows that they contributed to an almost 7 percent annual reduction in maternal deaths in the program area.
The investment has also reaped incredible gains in newborn lives saved. The Ministry of Health’s own data during that same period showed that the proportion of newborn deaths from birth asphyxia dropped by almost half—from 2.4 to 1.3 percent of live births. Birth asphyxia is no longer the country’s leading cause of newborn deaths.
Like Murekatete, the nurses in those districts are empowered decision-makers, using their new skills to contribute to the gains in newborn lives saved.
“Before we received training in the health center,’’ nurse Murekatete said, “when we had complicated cases of mothers during birth … or with a newborn baby, we would immediately transfer the mother to a hospital.
“We felt it did not concern us. But after the training on how to manage complicated cases, we now know how to manage them.”
Banyangiriki is living proof of our commitment to improving the health and futures of Rwanda’s mothers and babies.