Ensuring critical maternal health services after cyclone Freddy wreaks havoc in Malawi

NSANJE, Malawi – Ruth Zuze was nervous. Her local disaster management committee, in the Makanga village, was broadcasting alerts about a ferocious cyclone barrelling towards Malawi’s southern coast.

Ms. Zuze, 30, was nine months pregnant and had been preparing to leave for the district hospital: Her first child had been delivered by Caesarean section due to medical complications, so doctors had advised she be monitored in the final days of her pregnancy. 

But just as she was about to leave home, Tropical Cyclone Freddy made landfall, pounding the village with torrential rain and fierce gales for hours. With all roads submerged, Ms. Zuze’s route to hospital was cut off.  

Cyclone Freddy is reportedly the longest-lasting tropical storm on record and has caused severe flooding and mudslides, with the worst damage in Madagascar, Malawi and Mozambique. Hundreds have died, many health centres are still submerged and entire villages have been left stranded as roads and bridges – often the only way for thousands of people to reach essential services – were washed away.

When pregnancy turns life-threatening

Ms. Zuze’s contractions started a few days later. Risking everything, her husband carried her to the nearest health centre, more than 40 kilometres and a boat ride away.

 “I was losing a lot of blood, and the pain was getting worse every minute,” she said. “The health centre was our only hope, as the road to the district hospital was still impassable.” 

The couple eventually made it, only to discover the facility wasn’t equipped to perform the Caesarean section she needed. “They told us we had to go to the main district hospital for the delivery. Staff tried to call the hospital for an ambulance, but all the roads were flooded.”

With her contractions getting closer together, the medical team alerted the Ngabu health centre in the neighbouring district of Chikwawa, where some roads were still passable. UNFPA supports the centre and had helped secure fuel, batteries and new tyres to repair four ambulances in the district – one of which was dispatched to rush Ms. Zuze straight to the operating theatre, where she gave birth to a baby boy. 

“I am grateful to the staff who worked tirelessly to help me deliver safely,” Ms. Zuze told UNFPA. “I had lost hope, I didn’t have any other alternative but to wait and pray.”

Diseases compound dangerous lack of access

Some 30 kilometres away in the village of Mkolimbo, 22-year-old Fanny Gambuleni was also going into labour. “When we arrived at the local health centre, they said there was no access to the main hospital as the roads had been washed away.”

Ms. Gambuleni explained that here too, the Ngabu health centre sent an ambulance. “Although it was difficult to move through the flooded road, we made it and I was immediately sent to the operating theatre.”

She gave birth to a healthy baby girl, but many of the estimated 3,500 other pregnant women in the district haven’t been able to access maternal health services. Meanwhile more than 30,000 women of childbearing age are struggling to meet their sexual and reproductive health needs, including contraception, menstrual hygiene products and treatments for sexually transmitted infections. 

Malawi was also battling its deadliest cholera outbreak ever recorded before the cyclone hit, with malaria and other infectious diseases also threatening the health of hundreds of people in an already highly vulnerable situation. 

UNFPA ensuring continued critical maternal health services

Today's multiplying climate crises are a growing threat in particular to women and girls and people from marginalized communities. A recent report warns that almost half of the world’s population live in regions that are highly vulnerable to climate disasters, among them the people of Malawi, who have contributed very little to the causes behind these catastrophes. 

More than 560,000 people have been displaced in Malawi by Tropical Cyclone Freddy, and some 130,000 people affected in the Nsanje district alone. UNFPA is distributing thousands of dignity kits to women and girls in the most affected districts of Blantyre, Chikwawa, Nsanje and Mulanje. The kits include a 20-litre water pail, washing cloths, soap, underwear, a toothbrush and toothpaste and menstrual pads. 

“Since the cyclone, we haven’t had any electricity so UNFPA stepped in to help procure fuel for generators,” said UNFPA’s Olive Makuwira from a clinic in Nsanje. “This helped ensure that Caesarean sections can continue in the absence of the normal power supply.” 

UNFPA is working with district health offices to ensure continuity of maternal health services, provide transport to reach pregnant and breastfeeding women in displacement camps and set up integrated maternal and neonatal outreach clinics. The clinics allow greater access to sexual and reproductive health services, helping to reduce deaths and complications for pregnant women and newborns, which spike during crises as critical support structures are much less available to those in dire need of them.