Accelerating the Decrease of Maternal Mortality in Benin

By Arlette Toffa, Technical Advisor for the USAID Integrated Health Services Activity, implemented by Management Sciences for Health

Maternal mortality is a serious issue for Benin, a country with one of the highest maternal mortality rates in the world. Since 2008, the Government of Benin has worked tirelessly to reduce this mortality rate by organizing several training sessions for service delivery staff in public health facilities. This training included improving recentered prenatal consultations, understanding how to read a partogram action line during labor, malaria prevention during pregnancy, and the active management of the third phase of labor. Thanks to the work accomplished, maternal mortality decreased from 498 deaths for 100,000 live births in 2006 to 397 deaths in 2017-2018. However, efforts are still needed to achieve the objective of 70 maternal deaths for 100,000 live births by 2030.

The introduction of the intrauterine balloon buffer (IBB) technique is helpful in supporting these efforts. IBB is designed to taking care of bleeding during delivery. It consists of a device that includes a condom and a urinary catheter placed inside the uterus. The condom is then inflated with a saline solution that compresses the blood vessels in the uterus. Even if this action fails, this technique can still help reduce bleeding and save time to prepare another procedure or for emergency transportation of the patient to a hospital.

The USAID Integrated Health Services Activity supported the Direction Départementale de la Santé of Ouémé for its training program for maternity service providers on important procedures for reducing maternal mortality.

Three training sessions took place between June and July 2021 in three health zones, Adjohoun-Bonou-Dangbo (ABD), Akpro-Missérété-Avrankou-Adjarra (3A), and Porto-Novo-Aguégués-Sèmè-Kpodji (PAS). The activity’s interventions focused on facilitating the overview on maternal mortality and immediate post-partum bleeding, with an emphasis on respecting norms and protocols and the quality of care for recentered prenatal consultations. Following the theoretical part, providers mastered the IBB technique by using on-site practice exercises. A pre-training test was performed to assess the knowledge of providers in regard to the training provided (post-partum bleeding, care after a shock, IBB guidance and usage) with performance scores between 27% and 50%. Demos on how to use the IBB were performed by the facilitators with the activity’s support. The participants were then separated into different groups to practice on an anatomical model. A post-training test was done and a significant improvement was observed with a score varying between 85% and 100%. 120 maternity services providers were trained and now master the protocols for emergency obstetrical care, especially for practicing IBB.

Encouraging results followed this training. Between July and October 2021, no maternal deaths have been recorded in the three zones. In comparison, 10 maternal deaths were recorded during the same period in 2019 and 5 were recorded in 2020 in the ABD and 3A zones, 2 of which were due to bleeding during labor in each zone. The next step for the health providers is to make these improvements last over time.

Elsy Bénou, a nurse responsible for the maternity ward in the ABD health zone, thanked all stakeholders for the training provided and the measures to make this work sustainable: “After receiving the IBB training and the reminders on delivery-related bleeding, we are capable of providing quality services to women. For me specifically, I was able to obtain a measuring cup right after this training that enables me to quantify how much blood a patient has lost after post-partum. Additionally, after the training, when we presented the report to our superiors, they asked us during this presentation to acquire all the required material for an IBB so we could have it in our storage room in case it is needed in the different centers.”