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RENEE MONTAGNE, Host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

The United Nations has pledged to cut poverty in half in less than a decade. One of the most urgent problems facing Africa is how to ensure the survival of future generations. That means saving the lives of both mothers and their babies.

One out of every six children in Africa dies before the age of 5. For women, the chance of dying in childbirth is three times higher in Africa than in industrial nations.

In her series, Portraits of Poverty, NPR's Charlayne Hunter-Gault traveled to Zambia and its neighbor Mozambique. Those are two African countries trying to cope with the challenges of childbirth.

(SOUNDBITE OF CROWD NOISE)

Unidentified Man: (Foreign language spoken)

CHARLAYNE HUNTER: In this small, dark house in a poor black compound not far from Zambia's capital, Lusaka, the Gugonga(ph) family is grieving.

EDWARD LUSALO GUGANGO: (Foreign language spoken)

HUNTER: Edward Lusalo(ph) Gugonga, the 83-year-old elder of the house, tells of losing two women in the family within days of each other. One from a botched abortion - the other, whose ultimately fatal labor began at the funeral for the first.

Countless numbers of women in Zambia and around the continent have died from botched abortions. And many more, like Estelle Gugonga, die from what doctors call the three delays: the delay to seek medical care, the delay to get to the point where they can get medical care, and a lack of appropriate treatment once there.

JAMES GUGONGA: (Foreign language spoken)

HUNTER: Estelle's husband James tells of the family's ordeal from all three delays. His wife failed to heed the advice of nurses to return for monitoring after the first visit to the clinic revealed a possible breech birth - the legs of the baby coming before the head.

GUGONGA: (Foreign language spoken)

HUNTER: The second delay occurred once Estelle's pains became almost unbearable. Securing transport in the poor area where the Gugongas lived proved as difficult as the journey of a few miles over dirt roads full of potholes. But eventually, they reach the neighborhood clinic.

WISDOM GUGONGA: She was admitted for about six to seven hours.

HUNTER: Estelle's brother-in-law, Wisdom, describes the third delay at the clinic, where there was no doctor or midwife. After the long wait, the staff on duty told her to go to University Teaching Hospital several miles away, which specializes in difficult pregnancies. Only, as Wisdom recalls...

GUGONGA: There was no ambulance.

HUNTER: As they struck out on foot, Estelle - barely able to walk - they flagged down a friend in a passing car who only took them as far as the taxi rank on the outskirts of town. Then another 15-minute torturous ride to the hospital.

GUGONGA: Within a few minutes, (unintelligible), the mother passed way, the baby was always dead.

GUGONGA: Yeah, I know. I think they are kind of uncomfortable.

HUNTER: At the hospital where 29-year-old Estelle died, Dr. Mulindi Mwanahamuntu headed a study on maternal mortality. He says her case is fairly typical.

MULINDI MWANAHAMUNTU: Problems begin from rural areas. Okay. So that some women - those that manage to eventually get to institutions like ours - they are in such bad shape that we can't save them.

HUNTER: Dr. Mulindi says medical care is crippled by a lack of resources.

MWANAHAMUNTU: The front line, you know, fighters to try to bring down this maternal mortality are midwives. And when they do produce midwives, midwives still leave the country generally because we, our government cannot pay enough money to midwives. The brain drain is the biggest issue.

(SOUNDBITE OF CROWD CHATTER)

HUNTER: Zambia has a young population, with women bearing an average of almost six children. It also has one of the highest rates of maternal mortality on a continent that has its share of losses.

(SOUNDBITE OF CROWD CHATTER)

HUNTER: At a special maternity mortality conference on the outskirts of Lusaka - organized by the government and its international partners, UNICEF, WHO and UNAIDS - government officials acknowledge such mistakes and are now drafting what they call a roadmap - defining the problem and trying to come up with solutions.

Zambian doctors, like Gricelia Mkumba report back their mostly bleak findings from a country-wide study of maternal mortality, including few theaters for delivery, inadequate supplies and equipment, low numbers of supervised deliveries, and a lack of emergency medical obstetrical care or EMOC.

GRICELIA MKUMBA: All those patients, those - the ones that we visited did not have any EMOC facilities.

Man: (Unintelligible).

HUNTER: Conferees, like UNICEF Country Director Lotta Sylwander, agreed - however, saying that even with limited resources, governments like Zambia can bring down the rate of maternal and infant mortality.

LOTTA SYLWANDER: Skilled birth attendants can be trained in a year to actually do quite a lot. Giving that one-year training to quite a number of unemployed people - which there are plenty of in this country - I'm sure could do a lot.

(SOUNDBITE OF CROWD CHATTER)

HUNTER: One need go no further than neighboring Mozambique to a district clinic in Marracuene - about an hour's drive outside the capital, Maputo - into the rural countryside.

There, we meet with a group of traditional healers who were trained in some of the basics of midwifery after Mozambique's devastating 15-year civil war. They had memories of the war years delivering babies with little or no training, and often with disastrous consequences.

ANITA MOSHAVA: (Foreign language spoken)

HUNTER: Anita Moshava, one of the traditional healers, recalled they only had traditional tools at their disposal - one, the back of the snail, which was sharp enough to cut the umbilical cord.

MOSHAVA: (Foreign language spoken)

HUNTER: Sometimes, she explained, that led to infections and death.

MOSHAVA: (Foreign language spoken)

HUNTER: She says traditional healers no longer use snail backs, but sterilize scissors from a kit prepared for them by the government's medical professionals.

Mozambique has launched a campaign to get more expectant mothers to come to the hospitals for classes like this one, and also to make provisions for concerned pregnant women from the rural areas to come to district hospitals like this one at Manica, and stay there until their babies are born.

(SOUNDBITE OF CROWD NOISE)

HUNTER: At another district health center in Marracuene, Pawel Gamma(ph), the chief medical officer, says HIV/AIDS is putting a huge strain on limited resources and endangering their gains on infant mortality.

PAWEL GAMMA: (Foreign language spoken)

HUNTER: Gamma says there are not enough vitamins and medicines for the growing number of HIV/AIDS cases, and not enough hospital space to accommodate the sickest - most of whom are women.

Built in 1952, the hospital was designed to accommodate 58 patients. But the wards now are overloaded and so is the staff of one doctor and seven health professionals who struggle as they see close to 400 patients a day.

Lorenzo Moyo(ph), of the British-based NGO ActionAid, says African governments and the international community need to be prepared for a battle that may jeopardize the U.N.'s millennium development goal of reducing infant and maternal mortality by half by 2015.

LORENZO MOYO: It's not one thing or two things, or one or two years. It'll be possible to (unintelligible). It's a long process.

(SOUNDBITE OF BABY CRYING)

HUNTER: A long process, but Africa's future depends on being able to save its mothers and sustain the cry of this newborn baby girl as the new battle cry across the continent.

Charlayne Hunter-Gault, NPR News, Manica, Mozambique.

MONTAGNE: Our series continues at npr.org, where you'll find photos, more stories, and an essay by Charlayne.

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