September 13

Erin Barringer / Erastus Maina

A C-Section Should Not Be a Privilege: Expanding Access to Life-Saving Maternal Care

Mothers often experience a mix of excitement and apprehension as they prepare for the birth of their child. Months of planning culminates in an experience that remains unpredictable. When complications arise, often the safest way to protect the mother’s and baby’s lives is an emergency C-section.

C-sections are major surgeries and there are risks involved – and in the U.S., there is growing awareness that they are even riskier for black mothers. Fortunately, though, it is very rare that a mother in the U.S. will not be able to access a C-section in an emergency situation. Sadly, this is not the case for women everywhere.

Many women in low- and middle-income countries cannot access life-saving C-sections when they desperately need them. Even if they have the surgery, post-op complications and infections are much higher in developing countries than elsewhere in the world.


Local Partnerships for Local Problems

Across sub-Saharan Africa, only 7.3 percent of babies are born by C-section. And the rates become more shocking when you look at individual countries – the caesarean rate in Nigeria is 2 percent, in Liberia it is 3.5 percent and Zimbabwe it is 6 percent. Now take a look at the maternal mortality rates (MMR) of these countries: for every 100,000 live births, 814 women die in Nigeria, 725 die in Liberia, and 443 die in Zimbabwe. (For comparison, the U.S. has the highest MMR in the developed world at 26.4). It is clear, C-sections are essential to saving mothers’ lives.

Improving access to safe C-sections in low- and middle-income countries is not easy. A hospital could have the most qualified surgeon ready to provide a C-section, but without an anesthesia provider, running water, medical oxygen, sterilized equipment or lighting, the surgery can’t go ahead. The entire surgical system, the people, supplies and infrastructure, must come together to deliver safe C-sections.

Safe Surgery 2020, a partnership funded by GE Foundation, brings together innovations, global expertise and local experience to make surgical care safe and accessible for all. The initiative develops the technical and soft skills of surgical teams working in remote parts of Ethiopia and Tanzania, while overcoming infrastructure barriers by identifying and scaling innovations.

By adopting a unique approach to partnering with ministries of health and local organizations, such as universities, professional associations and NGOs, Safe Surgery 2020 strengthens surgical systems in both the short and long term. From supporting national policy development and implementation around surgical care to providing significant coaching and technical support to local partners, the initiative empowers local actors to continue building surgical capacity independently long into the future.

The combination of a holistic program and local leadership has dramatically improved access to C-sections, and surgical care more broadly, in Ethiopia and Tanzania.


Delivering Safe Maternal Care

Up until 2016, when a mother living in Mehoni, a remote town in northern Ethiopia, faced complications in childbirth, she was referred to a hospital over 25 kilometers away. The journey to this hospital was difficult for women in labor, leading to many women and their babies dying before ever reaching the operating room.

Rahel Berhe grew up in Mehoni and witnessed mothers in her community dying in childbirth her whole life. After getting married and having one child naturally, Berhe became so concerned about complications with childbirth that she decided to hold off on having another baby.

Seven years later, Berhe’s desire for another child overtook her fears.

She had a normal pregnancy and didn’t seek any prenatal care. She woke early to her water breaking and walked to the health centre to see the local midwife. Her labor pains were increasing and when the midwife checked the baby’s position, Berhe was informed that her worst fears were coming true. Her baby was in a position that would make a natural birth impossible, and both her and her baby’s lives were in danger.

Luckily for Berhe, over the past two years, Mehoni’s surgical team has been working with Safe Surgery 2020 and the Ethiopian Ministry of Health to improve the quality of care provided within the town. The surgical team now collaborates to solve the challenges that previously prevented them from conducting surgery, and they use the WHO’s Safe Surgery Checklist to ensure patient safety.

Mache Tsadik, the Integrated Emergency Surgical Officer at Mehoni hospital, was on hand to explain what a C-section involves to Berhe. She was scared, and her family concerned, but she trusted Tsadik and decided to give consent for the surgery.

In thirty minutes, Berhe went from a life-threatening situation to holding her healthy baby girl. And all of this happened just minutes from her home, with her family close by.


Basic Surgeries: A Basic Right

In two years, the Mehoni hospital has gone from not being able to provide C-sections to providing at least 15 safe C-sections every month. Not one woman who has had a C-section has died over the past year. The Mehoni hospital is just one example of how emergency and basic surgeries, such as C-sections, can be successfully integrated into community healthcare in developing countries.

Every woman should be able to access safe emergency care if labor becomes complicated; this should not be a privilege reserved to those living in developed countries. To improve maternal health and prevent mothers from dying needlessly, we need many more organizations to come together and work collaboratively to strengthen surgical systems. By tackling this issue, we have the opportunity to unlock the incredible power of surgery for all.


Erin Barringer is a Partner at Dalberg Advisors and Director of Safe Surgery 2020.

Erastus Maina is Program Manager of Safe Surgery 2020 based in Kenya.


Image credit: Jhpiego/Safe Surgery 2020




Health Care
global development