Voices from the Capacity Project

Health worker Berthé Aissata Touré is dedicated to helping women deliver their babies safely, but in a large country like Mali with vast rural areas, birth complications are especially risky. “When we had cases of hemorrhage we referred them to the district referral center,” Touré explains. “Often the trip is very long and there is too much time to lose blood on the way. Even once you get there it can take a while to have blood available. Many women were lost.”

Touré is among a group of auxiliary midwives called matrones who attend the majority of births in Mali. Pregnancy- and delivery-related mortality remains the primary cause of death among women of reproductive age. Although postpartum hemorrhage—the leading cause of maternal mortality—cannot be predicted, it can be avoided with appropriate measures. The World Health Organization recommends using a technique known as active management of the third stage of labor (AMTSL) to prevent excessive blood loss after delivery. AMTSL also helps decrease other complications that can occur, including retained placenta. Matrones, however, were not authorized to administer uterotonic drugs, a critical component of AMTSL, and thus couldn’t be trained in the lifesaving practice.