LÍAS PIÑA, Dominican Republic – While Lucía García’s husband is away planting peanuts, she feeds the children in their simple, clay-floored house. At 19 years old, she is already pregnant with her third child. The family struggles to get by on an income of less than three dollars per day.
And they are not alone. Some 83 per cent of the residents in Elías Piña Proivince were impoverished as of 2013, according to the UN Development Programme. Maternal mortality rates in the province are also extremely concerning, with the public health ministry estimating some 114 women die per 100,000 live births. And now, the COVID-19 pandemic is taking a toll as well, deepening poverty and disrupting health services.
Yet despite these challenges, Ms. García says she feels more prepared for childbirth, and better supported, than she did before.
She, like most of the 350 pregnant women in the area, once had to travel by foot along mountainous roads before reaching the nearest primary care unit. “To go to the hospital, I would walk out and have to sit down to rest because I got dizzy,” she explained.
But today, health services are much easier to access. She can simply catch a free ride on one of the new motorcycle ambulances made available through the Champion Mothers programme.
Safe and healthy motherhood
The Champion Mothers programme was launched amid the COVID-19 pandemic by UNFPA, the public health ministry, the national health service, local health authorities and community organizations.
“This project seeks to prevent and reduce maternal mortality. What we are executing here in six primary care units of Comendador and the Rosa Duarte provincial hospital is the strengthening of sexual and reproductive health services,” explained Dulce Chahín, a reproductive health officer with UNFPA. Comendador is the capital of Elías Piña and the site of the provincial hospital.
These services are sorely needed, said Dr. Marina Cordero, who works at the primary care unit of Rinconcito, 10 km from Comendador. In the last few months of 2020, three pregnant women died because they were unable to access emergency care in time, she said.
Access to services is not the only problem. The area also faces inadequate medical equipment and a shortage of health providers.
The Champion Mothers initiative is working to address all of these issues. In addition to providing a fleet of six motorcycle ambulances, the programme has also trained more than 100 health personnel and technicians, and it has equipped 10 primary care centres in Comendador municipality with new medical equipment.
Primary care units have also been equipped with mobile phones and tablets with unlimited data, enabling health workers to monitor the health of pregnant women, provide advice and seek expert care when questions or complications arise.
To address rising financial insecurity caused by the pandemic, Champion Mothers is also delivering food packages to pregnant women to ensure they receive adequate nutrition, and it is providing 350 kits post-natal kits containing diapers, sanitary pads, hand sanitizers and face masks.
Confronting teen pregnancy
The project is also taking aim at another concern: persistently high rates of teen pregnancy, which can disrupt girls’ educations and increase their vulnerability to poverty and violence.
The project is supporting services for survivors of violence, and it is expanding access to family planning counselling and commodities. Significant quantities of male and female condoms are now dispensed at each of the province’s 17 primary care units as well as local hospitals. Seventeen “key houses” have also been established; these are locations where community leaders, who have been trained in family planning counselling and providing nonjudgmental sexual and reproductive health information, can provide condoms and other family planning services.
Such services will not only help prevent unintended pregnancies. “We are going to reduce sexually transmitted diseases,” said Elsa Fortuna, manager of Elías Piña's Health Area 3.
A brighter path forward
As for Lucía García, she was able to visit the primary health unit Pinzón for one of her last prenatal care appointments. There, Dr. Esterlina Barrientos measured her belly and assured her the pregnancy was going well.
Dr. Barrientos has also benefitted from the programme. She recently attended the two training workshops – one on family planning and one on obstetric care.
“As a resident, I am happy to know that projects like this give a hand to the community,” she said.