World Prematurity Day: Ensuring every mother is healthy and every baby is born on time in Mali

Have you ever seen a just-born premature baby? Don’t worry, most people haven’t. I can tell you they’re generally no bigger than the size of a tissue box, limbs included. Everything you might already think is small and precious about a full-term baby, is even smaller, more fragile and more frightening to touch in a premature baby. And their risk for infection, disease, disability and complications in development are much higher. The truth is, premature births are largely preventable if we address major risk factors. Yet, each year, an estimated 15 million babies are born preterm around the world, with the lion’s share in Sub-Saharan Africa and Asia.

It was in Mali that I saw an hours-old premature baby in the flesh, on a recent trip in my capacity as communications staff with Save the Children to visit our Born on Time (BOT) program. To be honest, the baby I saw had already died, just five or so hours after his birth. He barely had any hope for survival. The mother hadn’t gone to a health clinic for any check-ups during her pregnancy, she was 16-years-old, and gave birth at home. In Mali, preterm birth is a contributing factor in 32 per cent of newborn deaths.

Standing in that clinic room was one severely unfortunate and saddening event during our trip to gather information, conduct interviews and learn more from the ground teams on the program’s progress. But, it was a fair and truthful account of why our BOT program is so important in Mali. There’s more work to be done to educate every man and woman on the perils of preterm births and how they have the power to prevent them. If risk factors such as poor nutrition are addressed, if women and adolescent girls are empowered, if men and boys are active partners of change, and if women and adolescent girls have access to gender-responsive healthcare, preterm birth can be prevented.

What makes BOT so revolutionary, is that it focuses on why babies are born too soon. The factors to address include: unhealthy lifestyles, maternal infections, poor nutrition and a lack of access to contraception.

I can genuinely say after 9 days in-field and nearly 20 interviews in 6 different villages, BOT has made a significant revolution in maternal health in the villages of southern Mali. So much so, there are chanting circles in the traditional language of “Bambara” that repeat the phrase, “there shall be no preterm births in this village. Not our village.” BOT has become part of standard conversation among the communities and talking about sexual and reproductive health and rights, contraception, family planning and women’s and girls’ rights is no longer taboo; a safe space has emerged to discuss and address the issues that affect the whole community.
Beyond our encounter with that life lost too-soon, we were met by mostly positive and uplifting stories while visiting the villages, midwives, doctors and civilians impacted by BOT in rural and remote areas of Mali. BOT is the first of its kind, a public-private partnership between Johnson and Johnson, the Government of Canada and Save the Children in Mali, World Vision Canada in Ethiopia and Plan International Canada in Bangladesh. The program is designed to be gender-transformative and aims to address the discriminatory social norms and behaviours that can place women and girls more at risk for preterm births and poor maternal and newborn health outcomes. These discriminatory social norms and behaviours also impact the realization of their rights.

I saw these gender transformative aspects firsthand. We spoke to several male and female leaders in various communities. One Male Gender Equality Champion, named Broulaye Diallo, stands out. His job is to meet with newly married couples, or pregnant women and adolescent girls and their partners to educate them on the importance of antenatal care, the importance of good nutrition for expectant mothers and how the male should be engaged as a partner on all matters of maternal and newborn health.

Mali is a patriarchal society where men lead the households and often make unilateral decisions on behalf of the family. Women are often not able or allowed to go to doctor appointments on their own and are limited in their ability to make their own decisions on the use of contraceptive methods to prevent unwanted pregnancies and space pregnancies.

I asked Brouyale what he does when he encounters men that simply don’t agree and don’t change their minds on the issues he’s educating them on, such as, domestic violence, women doing hard labour, prioritizing maternal health:
“There are men who refuse to listen and refuse my information. But if they refuse, I don’t give up. If they refuse, it will mean they’re denying the rights of the woman and the child; they’re denying the child the right to a full-term birth. In the majority of cases, when I keep advocating and educating, they eventually accept and get into a good partnership routine with their wives.”

It was incredible to see how many people and couples Brouyale alone affected. And he’s just one of so many Male Gender Equality Champions working to prevent preterm births in the villages of Mali.

As Brouyale told me, “everything we do to conceive a child, is related to women. If we don’t respect the rights of women, having children is impossible. I want to ensure every woman’s rights are respected.”

On World Prematurity Day, I can’t help but reflect back to my trip and the lifeless baby I saw in that clinic. We can prevent preterm births (and deaths). Together, we can do more to ensure every mother is healthy and every baby is born on time.

By Mai Habib, Senior Communications Specialist at Save the Children Canada