The majority of the world's mothers take it for granted that, when the time comes to deliver their babies, getting to a safe place for delivery won't be a major problem. Unfortunately however that's not the case in Africa. It may not be too hard in cities, but in rural areas most households don't have access to transport, and the journey may be difficult, particularly in mountainous areas or in poor weather conditions.
Ethiopia has become the first African country to have a national network of ambulances - about one for every 50,000 people - and they provide a free service for all women needing to get to a health facility for delivery, as well as covering other health emergencies. These have to be 4x4 vehicles to cope with Ethiopia's tough terrain. Setting up this service has been a key policy development for Ethiopia's Minister of Health, Dr. Kesetebirhan Admasu. He believes that helping women to get to facilities is a key part of an effective, modern health service. It might even be considered as a basic human right. However good health facilities might be, if people can't get there no health impact is possible. Providing transport can both increase the proportion of deliveries happening in facilities, and avert bad outcomes for women with complications.
The risk of a woman dying in connection with a pregnancy is more than a hundred-fold higher in many African countries than in typical European countries. Many factors contribute to this, but not being able to access care promptly is one major concern. A new study has evaluated the effect of the ambulance programme in Ethiopia. As the ambulances were deployed, and started to be used effectively in many Districts, maternal death rates fell - to half the previous levels. While that means there's still room for improvement, it's making a major impact on the problem of maternal deaths.
Of course ambulances are no use on their own - major developments in road infrastructure and in mobile phone networks over recent years in Ethiopia have contributed to the possibility of ambulances being able to operate effectively, and be called when needed. Similarly a robust legislative framework had to be put into place to make sure that the new ambulances are used appropriately and effectively.
On average the ambulances in the study travelled about 7,000 km per woman's life saved - surely a very worthwhile investment, considering the devastating consequences on a family of losing their mother. The evaluation suggests that a substantial proportion of the 180,000 or so pregnancy-related deaths in Africa each year could be prevented by an annual expenditure of around one billion US dollars. Wouldn't that be a worthwhile investment in the future of African children and their families?
The recently concluded Millennium Development Goal 5 called for a 75% reduction in maternal deaths from 1990 levels by 2015. Most countries in Africa did not achieve this goal, for various reasons. Yet the Ethiopian experience suggests that two-thirds of the 75% reduction could have been achieved by simply getting women to health facilities safely and promptly. Now the global community has embarked on Sustainable Development Goals - which aim for further reductions in maternal mortality, without being specific as to how that might be achieved. Can't the world mobilise resources for actually getting women to delivery facilities as a starting point?