In Northern Uganda, a woman has a 1 in 25 lifetime chance of dying during childbirth. The infant mortality rate is ten times higher than anywhere else in the Western hemisphere. It is well documented that most of these deaths are preventable.
In response, Mother Health International (MHI) has developed a birth center and model of care that combines best practices across fields of knowledge to meet the real and immediate needs of families.
Increase in prenatal care
Increase in births with a skilled attendant
Reduction in perinatal mortality
Increase 0-5 survival
Ot Nywal Me Kuc
Ot Nywal Me Kuc (House of Birth and Peace, pronounced “Oat New-Wal Mee Kooch”) is a sustainable, solar powered birth center located in Atiak, Northern Uganda.
Located only 20km to the border of South Sudan, Atiak was one of the areas hardest hit by the 23 year long civil war in Uganda. The closest hospital is located in Gulu, 75km away.
When Mother Health International started working in the region in 2007, Atiak had some of the worst perinatal mortality rates in the region and simultaneously, one of the highest birth rates.
Full Spectrum Care
The MHI birth center was intentionally built as part of the post-war recovery effort. Local midwives envisioned a beautiful, community-owned center where women could come for full-spectrum and respectful care. The design of the center was drawn by midwives and mirrors the local landscape and traditional building style.
Each room is private and there is a large central gathering room filled with hammocks for family and community. In 2020, a postpartum house was built in the same style, to offer more space for families to stay and be cared for.
The Birth Center averages 6 deliveries per day and runs mobile outreach clinics that serve hundreds of antenatal, post-partum and family planning clients each week.
Uganda Birth House Features
The Three Delays
The Mother Health International Birth Center responds to the ‘Three Delays” that contribute to high perinatal mortality rates.
Delay in seeking care: Often women do not trust hospitals, are too busy working in the home caring for other children, or are too concerned about the burden of cost and transport to seek appropriate care.
Delay in getting to care: Once the decision to seek care has been made, transport is often a huge barrier.
Delay in receiving care: Once a mother has reached a health center. It is common for women to experience reaching a health center and find that no doctors or nurses are present to treat them. Many women have stories of delivering babies outside a hospital because it was locked or without staff.
We address the three delays via our Mobile Midwives, Village Ambulance and Emergency Transport initiatives.
Mobile Midwives puts midwives on motorcycles to outreach into rural villages within a 60-mile radius of our birth center.
Traditional Midwives identify pregnant women in their communities and organize them so that each village receives monthly visits. Mobile midwives’ who arrive with assessment tools, medicine and prenatal vitamins as well as phone numbers and phone credit for the labor line to call and receive help when labor begins.
Women are followed throughout their pregnancy and develop in-depth relationships with their midwives. Issues are flagged in advance and appropriate transfer is made before emergencies occur. This personal, ongoing relationship means that women do not hesitate to reach out, thus almost eradicating the delay in seeking care.
Even the most remotely located women get seen from early pregnancy, receive integrated labor support, emergency transport services, and postpartum visits to assess weight, and nutrition, flag health concerns and integrate support into family life.
Before our Mobile Midwives project began, approximately 27% of women in who were birthed at our clinic received more than 2 prenatal visits. As of January 2021, 93% of women who gave birth at our clinic, had received a minimum of 8 prenatal visits.
As a continuation of our Mobile Midwifery Project, Mother Health has 2 Mobile units that serve the population of refugees from South Sudan who now reside in Adjumani.
A collective of 20 Traditional Midwives work to serve the community and receive ongoing support from MHI.
In rural villages like Atiak, many women give birth alongside the road while walking to seek help.
They risk their own lives and the lives of their babies when this happens. Many women must walk miles home after their child is born, risking hemorrhage along the way.
Transport is one of the most important tools we can use to ensure good outcomes.
Village Ambulances are used to pick women up in labor, bring them to our clinic for labor and delivery, and drive them home post-partum, eliminating several risk factors and saving lives.
The village ambulance is integral to fistula prevention, as no mother in our area must wait for days on end without help in the case of true obstructed labor.
Each ambulance transports an average of seven laboring and postpartum women and babies a day, for an average of about 2800 women and 2,800 babies per site, per year.
Imagine an obstetrical emergency in the night, 75KM from a hospital, with no vehicle for transport. This is the reality for women all around the world, and until recently, was our reality in Atiak.
Our ambulance allows us to quickly respond to emergency situations and get patients to higher-level care when needed. Our partnership with Lacor Hospital allows us to seamlessly transfer care.
Make an Impact
In thirteen years of service, MHI has scaled in Atiak sub-county, providing full-spectrum reproductive healthcare to 90% of the women in the region and turning perinatal mortality rates upside down.
While the neonatal mortality rate is 54/1000 births in Northern Uganda, it has consistently been 11/1000 at the MHI birth center in Atiak.
In close to 20,000 deliveries MHI has never lost a mother.