Rebecca Blackwell, Associated Press
GABU, Guinea-Bissau — Fatumata Djau gave birth to her fourth daughter alone, at home, in the dark. She arrived at the hospital at 3 a.m. with the newborn still attached, and the midwife cut the cord in the parking lot.
Hours later, the 32-year-old mother lies listless on her side as sweat beads trickle down her back. She has lost a lot of blood, and the maternity ward is stifling, with no electricity to whirl the rusty ceiling fans to life.
Across the courtyard, first-time mother Aissato Sanha is following doctor's orders — she is spending the final three weeks of a high-risk pregnancy in a bed literally a dash from the delivery room. But she is young, maybe too young, in her teens, and she has high blood pressure.
Both women are up against the same challenge: Guinea-Bissau is one of the deadliest places in the world to give birth.
Despite some progress, childbirth is still a perilous endeavor across sub-Saharan Africa, and Guinea-Bissau stands out for its dire statistics. A woman has a 1 in 19 chance of maternal death in this tiny country, compared to about 1 in 2,100 in the United States.
Experts say women are increasingly heading to medical centers when things go awry. Lives here, though, come down to whether cell phone networks are working, whether tides will allow boats to set sail. How quickly women can get to hospitals on muddy, rutted paths lit only by the moon, and whether their families can buy the right medicine.
Even then, it can sometimes be too late.
Amid the maze of packed beds at the Gabu Regional Hospital, Djau's distraught relatives cluster around her bed in the tiny ward. The room reeks of iodine and bed pans. The howls of labor pain form a chorus with the cries of newborns swaddled in rusty bassinets.
"Give life without dying," reads the poster taped above the chairs where women deliver their babies. It is apt — Guinea-Bissau's maternal mortality rate is the fourth-highest in the world, after Afghanistan, Somalia and Chad. But few can read the sign anyway, because 60 percent of women here are illiterate.
Most women still prefer to have babies in their villages, where they sit in a stew of warm water and banana leaves as matrons coax labor along. However, if anything goes wrong, they are often far from a hospital.
As in many parts of western Africa, Guinea-Bissau's hospitals are few and far between. A journey of just 11 miles can take three hours by foot, or cost up to 10,000 francs ($20) for a car, should one happen to be available.
Entrenched cultural practices can make the fight to save mothers' lives harder. Here, 13-year-old brides have children before their bodies are ready — about 7 percent of girls under 15 are already married, according to UNICEF.
Nearly all women in the Gabu region have undergone female genital mutilation. More than 20 percent had the most extreme form, which involves stitching a woman's vagina shut so that only a small hole remains — a serious health risk during labor and delivery.
Even if a mother gets to a hospital, families must purchase anesthesia drugs before emergency operations can take place. While Djau is hooked up to an IV, a brother is sent out to buy medicine to stop the blood loss.
He comes back with a plastic bag of drugs from the pharmacy, but the midwife tells him he's been given the wrong one. He sets off again, as their sister paces tearfully in the courtyard.
Medics explain that Djau is hemorrhaging badly because she didn't deliver the placenta after giving birth at home. Around 4 p.m., she suddenly begins to convulse in her bed.
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