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Story from the Front Lines, Part 1 : Maternal Mortality—One Woman a Minute

Mariam’s Story: When Care Comes Not a Minute Too Soon

By the time her mother and sister brought her through the doors of Sekou Toure Hospital, 25-year-old Mariam Madoshi was semiconscious and bleeding heavily.

Mariam attempted to abort her baby at home using an herbal method common in Tanzania, cassava. She thought she had succeeded in terminating the pregnancy, but later she began having severe stomach pains—which went on for two days—and started bleeding. At the time, her mother and sister did not even know that she had been two months pregnant.

They knew something was wrong when the bleeding didn’t stop and Mariam became increasingly pale. They decided to take her to the hospital, and they traveled for more than three miles in an oxcart to board the bus that took them to Sekou Toure Hospital, in the city of Mwanza.

Fortunately, at Sekou Toure, Mariam received emergency postabortion care services that stopped the bleeding and brought her back from the brink of death. “Mariam was lucky to be taken to this hospital—unlike most of the girls in our village who do not get immediate help and die at home or en route to the hospital,” said her mother. “I thank the doctors for saving her life.”

As Mariam’s mother notes, her story may be the exception to the rule in Tanzania, where an estimated 30% of all maternal deaths are due to complications from unsafe abortion. Recognizing the dire need for better postabortion care, Tanzania’s government called on EngenderHealth to help expand these services nationwide.

EngenderHealth pioneered a comprehensive package of postabortion care services and is working to improve these services and their availability in even the most remote areas of Tanzania. Throughout Mwanza and Shinyanga, where there is particular need for more accessible postabortion care, EngenderHealth trains health staff to safely provide a range of services, including emergency treatment of complications from abortion and miscarriage; family planning counseling and provision; and referrals to other needed health care services. Health care providers also receive clinical training in infection prevention practices.

In rural Tanzania, since most villages are far from the regional district hospitals, a key priority is ensuring that clinical services to treat abortion complications are also available at community clinics. “The aim is to make these services available at local health centers, so women like Mariam do not need to come to regional hospitals,” said Sekou Toure nurse Rehema Wence. “By doing so, we can save the lives of many more women.”

Mariam remains grateful for the services she received at Sekou Toure, as well as for the family planning counseling and information Nurse Rehema offered afterward so that Mariam could make an informed choice about whether she wanted to use contraception. “I won’t forget the staff here—I’m sure that I would be dead if not for their care,” she said.