Only 65 percent of Senegalese women give birth in the presence of a skilled attendant. Credit: Travis Lupick/IPS

By Doreen Akiyo Yomoah
DAKAR, Sep 24 2014 (IPS)

Diouma Tine is a 50-year-old vegetable seller and a mother of six boys. In her native Senegal, she tells IPS, motherhood isn’t a choice. “If you’re married, then you must have children. If you don’t, then you don’t get to stay in your husband’s house, and no one will respect you.”

Despite this prevailing cultural outlook, becoming a mother here is neither easy, nor safe, with only 65 percent of Senegalese women giving birth in the presence of a skilled attendant.

According to available data, 54 percent of Senegal’s 13.7 million people live in rural areas. Of these, some 3.3 million are women of reproductive age, an estimated 85 percent of who live about 45 minutes from a health facility.

The country has a worryingly high maternal mortality rate (MMR). The last government survey taken in 2005 found that 41 women died per 1,000 live births, giving the country a ranking of 144 out of 181.

“In some regions, like the Kolda and Tamba Regions, you can find up to 1,000 deaths per 100,000 live births [since] some women are denied the ability to make decisions about when to go to hospital, [and] sometimes when roads are bad it’s difficult for them to get to a health centre.” -- Gacko Ndèye Ndiaye, coordinator of the gender cell at the Ministère de la Santé et Action Sociale (Ministry of Health and Social Action)
Between 2005 and 2010, the MMR in Senegal fell from 401 to 392 deaths per 100,000 live births, representing some progress but hinting at the scale of unmet need around the country.

One of the Millennium Development Goals (MDGs) is to achieve universal access to reproductive healthcare by 2015, but it is increasingly clear to health workers and policy makers that Senegal will not reach this target.

This year’s State of the World’s Midwifery Report produced by the United Nations Population Fund (UNFPA) projected that Senegal’s population was set to increase by 59 percent to 21.9 million by 2030.

“To achieve universal access to sexual, reproductive, maternal and newborn care, midwifery services must respond to one million pregnancies per annum by 2030, 53 percent of these in rural settings,” the report stated, adding that the health system must be configured to cover some 66 million antenatal visits, 11.7 million births, and 46.7 million post-partum and postnatal visit from 2012 to 2030.

This past May, on the International Day of the Midwife, former Prime Minister Aminata Touré called attention to a gap of 1,336 midwives in the country, setting in motion a government-sponsored recruitment drive to rapidly increase the number of trained birth attendants.

The midwife shortage is felt most severely in rural areas: the Matam region in eastern Senegal, for instance, has only 14 midwives for a population of nearly 590,000, while Tambacounda, to the south of Matam, has only 38 for a population of about 670,000.

Senegal has both ‘sage-femmes’ (fully trained midwives), and ‘matrones’, direct-entry midwives who deliver the vast majority of babies in Senegal but lack proper education, and often learn their trade on site, sometimes spending less than six months in a clinical training setting before being taking up posts in rural areas.

“There is kind of a crisis in education,” Kaya Skye, executive director of the African Birth Collective, tells IPS.

“Matrones learn how to take blood pressure, but they don’t understand what that means. [With matrones] there is an urgency to get the baby out as soon as possible [and] an overuse of drugs, which is […] another cause of mortality,” she explained.

In fact, Touré stated during a speech on May 12 that 60 percent of maternal deaths in the country could have been avoided with “sufficient personnel, a suitable medical platform, [and] democratic access to women’s health services, notably the disadvantaged in remote areas.”

Gacko Ndèye Ndiaye, coordinator of the gender cell at the Ministère de la Santé et Action Sociale (Ministry of Health and Social Action), and a midwife by trade, tells IPS that numbers alone don’t tell the whole story.

“There are disparities between different areas,” she asserted. “In some regions, like the Kolda and Tamba Regions, you can find up to 1,000 deaths per 100,000 live births [since] some women are denied the ability to make decisions about when to go to hospital, [and] sometimes when roads are bad it’s difficult for them to get to a health centre.”

The National Agency of Statistics and Demography’s 2011 health indicators report found that over 90 percent of urban births are assisted by a trained assistant, but that number falls to just half for rural births.

Skye’s African Birth Collective works to fill these gaps, and recently built the Kassoumai Birth Centre in the Kabar village of the southern Casamance region to meet the needs of mothers and midwives.

According to Skye, “Traditional midwives said they wanted their own place to practice; that they didn’t feel welcome in government clinics. There was nothing in Kabar for women – they were giving birth in the showers behind their houses.”

Although the government does provide training for midwives, building this centre was “about creating infrastructure that is outside of government protocols and facilitating that dialogue where the traditional midwives can say ‘We do it this way’,” Skye says.

A long colonial history and post-colonial education in Senegal has meant that the Western obstetric model has been dominant.

Grassroots efforts, including the work of ENDA Santé, the health division of an international NGO called Environmental Development Action in the Third World, are helping to foster a better balance between Westernised birthing techniques and traditional methods.

The African Birth Collective and ENDA Santé have translated the educational manual ‘A Book for Midwives’ into French, giving birth attendants in Francophone West Africa access to crucial information, such as the case for non-supine positions, and inverted resuscitation methods.

For women like Tine, the pride that comes from being a mother will always outweigh the dangers and complications of pregnancy and childbirth.

But if the government of Senegal scales up its efforts to improve health services, it can remove the fear factor altogether, and make a strong contribution towards global efforts to ensure the health and safety of every mother.

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Kanya D’Almeida

The Dangote cement factory, set to be one of the largest on the continent, is now in Galene, Poute and Dangane, villages close to Thies, Senegal’s third-biggest city. Credit: Doreen Akiyo Yomoah/IPS

By Doreen Akiyo Yomoah
DAKAR, Jun 22 2014 (IPS)

While the cement factories in Senegal are at war, ostensibly over the environmental impact one company will have on this West African nation, experts have cautioned that as the government plans to radically develop and industrialise the country, striking a balance between environmental protection and development will be key.

“I don’t think we can want one thing, and also want its opposite. We need cement to help industry in Senegal. At the same token, it will have adverse effects on the environment and we have to try and minimise them,” Dr. Thomas Ibrahima, a researcher at the Senegalese Institute of Agricultural Research (ISRA), told IPS.

Sococim, the Senegalese subsidiary of Vicat, a French cement manufacturing company, is at loggerheads with the government of Senegal."Even ministers admit to not being able to follow all [the recommendations] in the environmental impact studies." -- Djim Nanasta, Environmental Development Action in the Third World

The French company began suing the state in November 2013, at Common Court of Justice and Arbitration (CCJA), a regional arbitration court in Abidjan, Côte d’Ivoire, for allowing Dangote Cement, a Nigerian cement conglomerate, to set up shop in Senegal.

Dangote reportedly paid the descendants of Cheikh Amadou Bamba, a renowned Senegalese religious leader, a 12.6-million-dollar settlement to develop the factory on forest lands they inhabit. The factory, set to be one of the largest on the continent, is close to Thies, the country’s third-biggest city. The villages of Galene, Poute and Dangane are in close proximity to the site.

IPS was not allowed entry near the site, and was banned from entering the village of Galene. However, some villagers in Poute have expressed relief that the factory has come to the area.

Aboulaye Fall, a Dangote employee and Poute resident, told IPS: “Dangote is ready to help Poute. The company is going to provide electricity and roads for easier travel. The company is decreasing youth unemployment, and most of us are very happy to have the factory here in Poute.”

But Djim Nanasta, programme officer at Environmental Development Action in the Third World (ENDA), an international environmental and energy NGO based in Dakar, told IPS that due to cultural pressures, “people may have objections about the setting up of the factory, but they may not feel that they can openly express their complaints.”

According to Nanasta, when conflict arose between Sococim and Dangote, the youth in Poute formed a coalition in support of Dangote. However, he pointed out that one of the concerns of a cement factory, is that “they emit a lot of dust. This affects the population by causing respiratory problems.”

Boubacar Camara, the CEO of Sococim, said in an earlier interview: “This is the first time in the history of Senegal that we have seen a plant built in violation of all the rules.” Camara claimed that the requirements — acquiring permits, and conducting environmental impact studies, which are necessary steps for opening a cement factory in this West African nation — had been flouted by Dangote.

Abdoulaye Ndaw, a senior legal officer and the chief of knowledge and information management at CCJA, told IPS that the case was still pending with the court, and no ruling has been made on whether Dangote has violated any laws.

According to Ndaw: “Vicat, which made heavy investments to control the entire national cement [industry], does not want to see their business plunge into instability with the entry of a new cement [competitor].”

Cement manufacturing is not the only industrialisation taking place here. President Macky Sall went to Paris in February to solicit donations to fund Emerging Plan Senegal (PSE), the government’s plan to radically develop and industrialise the country.

PSE focuses heavily on industrialisation, and while cement manufacturing is hard on the environment, this type of activity will increase. Senegal already exports phosphate. Chemical Industries of Senegal, the country’s largest phosphate developer, is expected to begin providing two million tonnes of phosphate per annum, which will place a significant toll on the environment.

The president has also expressed a desire to make mining, which is notoriously destructive to the environment, one of the pillars of Senegal’s development, saying: “We’re committed to putting all the conditions in place to attract companies.”

However, Francis James, country director of the United Nations Development Programme, has said that two-thirds of Senegal’s soil, or 34 percent of the country’s surface, is affected by environmental degradation, and the country is losing 50,000 hectares of land per year.

Moustapha Ndiaye, an environmentalist at the Ministry of Environment and Sustainable Development, told IPS that in the face of industrialisation: “There are many laws that exist to protect the environment. It’s absolutely necessary for companies to respect them.”

But Nanasta cautioned that although cement companies may comply with environmental regulations in order to be given the go-ahead to commence operations, there is hardly any follow-up. “Even ministers admit to not being able to  follow all [the recommendations] in the environmental impact studies,” Nanasta said.