«  A family brought together by tragedy »

“My mother died on May 14, 2015, during childbirth”, says Mawoupeno Awala sadly. Her father, Yao Awala, now a widower, preferred not to talk to us, but did not miss a word his firstborn was saying.

We are welcomed by Yao and Mawoupeno in the courtyard of their house, an adobe structure with no glass or doors in the openings. All around us, sitting on stones or playing, are Mawoupeno’s six siblings. There are goatlings and animals running around and, between 2 trees, we can see a makeshift drying rack.

Yao is a farmer and lives with his family in Hahotoé, a place that was only recently connected to the electrical grid, despite the proximity to the capital (located 45 km away from Lomé) and despite being one of the main phosphate exploration sites – which is considered to be Togo’s oil.

Mawoupeno explains the conditions under which her mother died. “When my mother began to feel the first contractions we went to the unauthorised health centre”. The midwife in charge (head midwife) was not in the centre and, therefore, the first stage of health care was provided by an intern and a friend of the midwife.

“The head midwife eventually arrived”, Mawoupeno goes on. “Some time later, the midwife came out of the delivery room and I asked her if the baby had been born, if my mother had given birth. She said yes”.

But the situation became complicated – “The baby did not cry” – and at some point, Mawoupeno and her father saw the midwife leave the delivery room, “she came out with a bucket full of blood”. When Mawoupeno’s father confirmed that it was his wife’s blood, he wanted to take her to the Vogan hospital, but the midwife refused to let him, saying that she was able to handle the situation.

While her father and grandmother were preparing to take her mother to the hospital and Mawoupeno was waiting impatiently near the delivery room, the midwife finally left the room and told her “I’m tired, I’m exhausted. I do not know what else I can do”, Mawoupeno tells us, looking disheartened.

“If I could go back in time, I would have taken my mother to an authorised centre, where health workers have been trained to treat and save women and children”, Mawoupeno admits. When we ask why they didn’t, she replies: “Our grandmother told us to take our mother to this unauthorised centre, because she knew someone there”.

The maternal mortality rate in sub-Saharan Africa is the highest in the world. In Togo, just over half of all births (59%) are assisted by trained staff, but bleeding – along with infections, eclampsia, and other complications – is still one of the main direct causes of maternal deaths.

Although the risk of a woman dying from complications during pregnancy or childbirth has decreased significantly in the last decade, it remains very high: 1/46 in Togo and 1/15 in Chad, whereas it is 1/6100 in France.

There has been a substantial reduction in the number of maternal deaths in Togo since the implementation of maternal and child health programs, for which the French Muskoka Fund has contributed since 2011. The maternal mortality rate fell from 470 to 400 deaths per 100,000 live births between 1998 and 2013.

The challenges for the coming years are set out in a monitoring strategy (continuous follow-up) that emphasizes prevention and training of health professionals, but there will be another formidable obstacle: the strong demographic growth, which consequently involves a greater need for human resources in the health sector.

There are risks associated to health facilities that are not authorised by national health authorities and where care is delivered by staff who did not get adequate training, and these risks are sadly known in the home of the Awala family, which now has to adapt to a new life without the matriarch.

Sooner or later, Mawoupeno will have to fill the void left by her mother, as her father, who is about to turn 50, “is not in good health”. “Our mother was everything to us, she took care of everything for us to eat and to go to school” Mawoupeno says. “Now, as she is no longer here, it’s really hard for us”, she finishes.

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