Lack of water, toilets, and hygiene leads to maternal health crisis
For many, the birth of a child is one of life’s most remarkable moments. But for the over 16 million women every year who give birth in hospitals and clinics without adequate water, toilets and soap, it is a completely different experience.
The world is experiencing a maternal health crisis, but those of us living in countries where clean water, decent toilets and good hygiene are often taken for granted may not be aware of it. The crisis is taking place in developing nations all over the world, where access to water, toilets and hygiene present many challenges despite being a basic human right. Currently, almost one in two people worldwide are using healthcare facilities with nowhere to safely wash their hands, and 765 million people are using healthcare facilities with no toilets at all.
Under these circumstances, it doesn’t matter how much training healthcare workers have, how many hours they work, or how much they care about their patients. It is near impossible for them to protect their own health and provide safe maternity care without the basics they need, including clean water and soap. Without them, pregnancy and childbirth become deadly. Infections associated with unclean births currently account for over a quarter of newborn deaths and 11% of maternal mortality each year – together accounting for more than 1 million deaths annually.
Unsurprisingly, it is the communities with poor access to water, toilets and hygiene overall where healthcare facilities are hit the hardest. Take the northern Mozambique district of Cuamba for example, where demand for water is higher than the water available in the area, putting added pressure on the healthcare facilities. There are 16 healthcare facilities in Cuamba’s rural areas, and 13 of them have no clean, piped water, making healthcare services unsafe for both patients and staff.
Without clean water to sterilise equipment, to wash bedding and to keep people clean, health workers, mums-to-be and babies are at risk of getting sick and in tragic cases, dying.
Matilde Romao, mother and patient, has lived in nearby Napacala her whole life. She gave birth to her baby at her local health centre in May last year.
I bring my new baby here every month for his vaccinations. But I have had three children that have died. We’ve now given a name to my son which means ‘leave the baby with us this time’. If I could change anything about the health centre, I would change the toilets. They are not good. They are dirty. We were washing our hands often because of coronavirus but nowadays we don’t wash regularly because we [don’t] have a lot of water, even at home. Water is a real problem here. We have only one small well for many, many people. We want to change our life. I would like to have more babies. I would like to have better conditions in hospital in the future.”
Similarly, to the north in Zomba, Malawi, expectant mother Mary Makowa, 31, is also painfully aware of the dangers of lack of access to clean water:
My third born died when he was one year and three months old due to diarrhoea. That time, we did not have a borehole in this village. The water source we were depending on… [was] contaminated. I believe if we had this borehole back then, I would not have lost my son.”
Tragically, the threat of diarrheal diseases extends far beyond the maternity ward to all corners of a healthcare facility and throughout the community. Half a million people die each year from diarrhoea and acute respiratory infections that could have been prevented with good hand hygiene. Timely hand hygiene prevents up to 50% of avoidable infections acquired during healthcare delivery, including those affecting the health workforce.
In Mwogo Health Centre in Rwanda, midwife Devota Byukusenge, often sees female patients with diarrhoea, genital infections and skin diseases, attributing it to the dirty water they have to collect from swamps.
For a midwife with no water in maternity services you can imagine what we go through. Everything is at risk, be it the mother, the newborn; everyone is at risk of getting infected because of the lack of water.”
Women comprise 70% of the health workers globally and are therefore disproportionately affected by lack of water, toilet and hygiene services in healthcare facilities and are exposed to infections.
The United Nations Sustainable Development Goals (SDGs), which set out a blueprint for a better world by 2030, focus on maternal health in SDG 6: Ensure healthy lives and promote well-being for all at all ages. This goal, and the world’s ability to reach, is inextricably linked to SDG 6: Ensure availability and sustainable management of water and sanitation for all.
WaterAid Australia is working to build healthy communities by increasing access to water, toilets and hygiene in healthcare facilities. This is done through an integrated approach, knowing that improved health and improved water, toilets and hygiene have to go hand in hand. Influencing work also ensures greater funding and action within the health sector is targeted at clean water, toilets and hygiene.
Bernice Sarpong, WaterAid Australia’s Technical Lead for Health comments:
Healthcare facilities without basic water, sanitation and hygiene services threaten the safety and quality of care for patients, staff, and the wider community. They also compromise the standard of care for new mothers and babies and raise their risk of infection. It’s simply unacceptable that every two seconds, a woman gives birth in a health facility without access to clean water, sanitary facilities, or good hygiene. This equates to an astounding 16.6 million women being exposed to this unnecessary risk to their lives each year. By championing clean water, decent toilets and good hygiene in all healthcare facilities around the world we can help stop the spread of deadly diseases and give women and future generations a better chance of a healthy life.”