When delivering babies without water, nothing is possible. There is no hygiene. Water is everything. Everyone uses it - staff, women, everyone.
Madame Madié Diarra is a Midwife from Yélékébougou, a rural community in the south west of Mali. WaterAid have been working in this community since 2007 through one of our partner organisations, the Malian Association for Public Education and Environment Protection, who have built two water points for safe drinking water, and provided families with latrines.
WaterAid is not the only organisation working in this remote community; Marie Stopes International visits the community four times a year, providing women with information about family planning as well as contraceptives. As the quote from Madam Diarra shows, these two seemingly separate services of water and reproductive health are intimately interlinked.
Bringing different strands of work together like this can have an exponential impact.
Women who receive information about family planning are better able to make the right choices for them and their families. If and when they do decide to have children, having clean safe water on site at midwifery stations decreases the chances of birth complications, particularly from infections, meaning more women and babies survive. It's a win-win situation.
In many developing countries, it is women and children, including many school aged girls, who are tasked on a daily basis with collecting unsafe water from sources that are many miles away. Bringing clean drinking water to their communities means that this onerous task is no longer required and that girls can focus on their education.
Education undoubtedly plays a crucial factor. It has been shown time after time that the longer girls stay in school, the fewer children they have and the later in life they have them, which dramatically reduces the risk of birth complications and death.
The provision of adequate sanitation also plays an important role in this regard. As the international development minister Stephen O'Brien acknowledged at a recent Conservative Party Policy Forum event, girls, particularly teenage girls, are much more likely to drop out of school in the absence of adequate and safe sanitation facilities on site. WaterAid believes that it is right to focus on this vulnerable group if we are to bring about better outcomes for mothers in the developing world.
The UK Department for International Development (DFID), alongside the Bill & Melinda Gates Foundation and the United Nations, is this week launching an unprecedented effort at the London Summit on Family Planning to make affordable, lifesaving contraceptives, information, services, and supplies available to an additional 120 million women and girls in the world's poorest countries by 2020. Meeting such a goal in the next eight years is a truly ambitious target that we at WaterAid welcome, and it's not DFID's only ambitious plan.
Just this April, Andrew Mitchell, Secretary of State for International Development, committed to doubling the UK government's efforts on water, sanitation and hygiene to reach 60 million people by 2015.
Just as we are doing in Mali, WaterAid believes the best outcomes are achieved when we take a comprehensive approach to human development, bringing relevant programmes together, to deliver the greatest impact. This is the approach that offers the maximum return on investment, for those who access these services as well as the UK taxpayers that fund them.
A recent statement by the Gender and Development Network also encouraged a more holistic approach to family planning, arguing that "reproductive health is about more than just family planning. DFID's work on... gender, child health, water and sanitation, agriculture and food security, fragility, and nutrition also have a bearing on reproductive health".
As DFID's own research and policies also emphasise, poverty and the lack of access to basic services impact women's ability to make use of family planning services. WaterAid believes that to deliver the best results on family planning, and more broadly on reproductive health outcomes, it is crucial to identify the most neglected and off-track areas of development and act on those that have a bearing on reproductive health.
This understanding that wider determinates of poverty have a big impact on the risks of mothers dying in childbirth is reinforced by evidence, not only from our own programmes but from scientific studies. For example, a 1995 study examining the factors related to maternal deaths in Dar es Salaam, Tanzania, showed that "socio-economic factors were strongly related to the risk of maternal death" including a striking finding that "women with less than 3 years' education had a 3 fold higher risk of dying than women with more than 7 years' schooling". The same study found that those without tap water had a 2.7 fold increased risk of death, while those lacking toilets had a staggering 8.3 fold increased risk of dying during child birth.
Personally, however, I find the words of Madié Diarra, the Malian midwife, to be the strongest argument for the need to look beyond family planning interventions, at the context in which they are delivered:
"Before clean water we had a whole lot of health problems, because to do the work properly we need water. The clinic needs cleaning all the time; before we could not do this. It was difficult to get safe water. There was diarrhoea before. Babies had this. Infections were more likely to occur after birth. So now it is better, the women have clean water."
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