It was time to leave for the hospital. Samueline Razafindravao had intended to give birth at her home in southern Madagascar, but after encountering difficulties, decided to go to her local health centre.

Once there, health staff realized she required urgent care they couldn’t provide – she would have to go to a specialist hospital 200 kilometres away. For that, she needed an ambulance, something rarely available in rural Madagascar.

In recent years, three in five deliveries in Madagascar have occurred at home, many unassisted by skilled birth attendants. These circumstances can put mothers at risk of complications and deadly consequences, especially if emergency obstetric care is hard to reach.

For Ms. Razafindravao, the ambulance ride to the hospital felt like a race against time. “The baby was pushing a lot and then suddenly not moving,” she said.

“I thought I was going to die and lose the baby as well.”

A holistic hospital

After Ms. Razafindravao’s ambulance brought her to the Ambovombe Regional Referral Hospital, she underwent surgery and safely delivered a baby girl.

With its happy ending, her story diverges from that of many other women, according to Dr. Sadoscar Hakizimana, UNFPA’s sexual and reproductive health expert in the region; given the shortage of qualified medical staff, he has also put his skills as a surgeon at the service of the hospital.

“Perhaps 60 to 70 per cent of pregnant women who arrive here have already lost their baby because they have sought medical help too late,” he said. “But we have a 100 per cent success rate of healthy births, either natural or via Caesarean section, for those mothers who arrive on time, as we have a range of care options we can offer them.”

The hospital has two ambulances at its disposal, one of which was provided by UNFPA, the United Nations sexual and reproductive health agency, with funding from the Government of Japan. With this support, the hospital has developed into a specialist facility offering a range of services, including emergency obstetric and fistula repair surgeries.

Meanwhile, two midwives are on hand to help with delivering babies and provide advice on family planning; incubators are available for premature babies.

Midwife Jeanne Bernadine Rasoanirina said, “In the last week I have delivered three babies and over the past month I attended over 330 ante-natal and postnatal consultations – so there is definitely a demand for services.”

The result of these changes and others have been life saving: According to Dr. Germaine Retofa, the acting regional director for public health in Androy, maternal and infant mortality rates are down.

“We can offer a more holistic approach to health care, which may include maternal health services alongside nutrition advice and care for malnourished children,” she said.

Free care saving futures

Ms. Razafindravao is just one of millions of women who intended to give birth at home in Madagascar in recent years. For her, it was a financial decision: “I was worried about the expense of going to hospital,” she said.

To address constraints like these, the Androy Regional Referral Hospital offers all its care for free – a significant consideration in a country where more than 80 per cent of the population confronts persistent poverty.

The hospital’s services are complemented by other services provided by the UN agencies UNDP, UNICEF, WFP and WHO, which work together to provide medical supplies, nutritional advice and support, care for children and services for people with disabilities.

Back at the hospital, Ms. Razafindravao and her now four-day-old baby girl were doing well on the maternity ward. As a young mother, she was learning how to breastfeed her baby, who she named Fandresena.

Before long, it would be time to make the long journey back home, but this time not in an ambulance called in an emergency.