Around 60% of mothers in Laos give birth without any trained attendant. That rate is closer to 80% in remote areas. Unsurprisingly, Laos has the highest rates of infant and maternal mortality rates in Southeast Asia.
Why? One factor is a desperate lack of midwives.
From the late 1990s to 2010 – more than 20 years – no midwives were trained. In 2010, Laos had just 100 formally trained midwives for a population of 6.5 million.
The Lao government has begun taking action to improve Maternal and Child Health and, specifically, increase the number of midwives. With the UNFPA, the government developed the Skilled Birth Attendance Development Plan to address acute staff shortages.
At a “Month of Midwives” event in June 2012, Lao Vice-Minister of Health, Som Ock Kingsada, declared:
Every community needs to have its own professional midwife to work with community leaders, families, individual women and adolescent girls to improve knowledge of safe pregnancy, childbirth and care of mothers and babies after birth.
While government intentions appear good and progress is being seen, the UNFPA finds that staff shortages remain acute – particularly in rural areas. This is certainly the case in southern Salavan Province, where my organization CleanBirth.org provides local nurses and village volunteers with Clean Birth Kits (birthing supplies) and training to reduce birth-related infections.
Where we work the clinics are simple wood structures, often empty of patients and supplies. Rain prevents mothers from accessing even these simple clinics, during part of the year.
Most births occur at home or outside; some religions dictate that women deliver without a birth helper (mother, sister, friend) present.
Given the preponderance of home birth and lack of trained attendants, CleanBirth.org works to increase knowledge about hygienic birth and the need for birth helpers. We train both local nurses and Village Volunteers, women from each village, to distribute Clean Birth Kits and educate mothers. This summer midwives from the Yale University School of Nursing will expand our training to include the WHO’s Infant Care and Resuscitation protocol.
By building the capacity of local nurses and Village Volunteers, we hope to improve outcomes … as we await the time when each mother in Laos has a midwife at her birth.
Kristyn Zalota is the founder of CleanBirth.org, a non-profit working to improve maternal and infant health in Laos. Kristyn holds MA from Yale, is a doula and Lamaze educator. She lives in New Haven, CT with her husband and two children.