Give Life Without Losing Life: The Casa Materna of Matagalpa and the Struggle to Prevent Maternal Death

Maternal mortality has a face. It is the health indicator with the greatest disparity between the developed and developing worlds, disproportionately affecting poor women with low levels of education, high levels of fertility, and inadequate access to health services. It is the health inequality that most clearly shows how poor health outcomes continue to be directly linked to poverty and socioeconomic disadvantage, while the right to safe pregnancy and motherhood comes with economic privilege. As it occupies such a critical position in community health, maternal mortality has been widely studied and the target of countless health interventions aimed at its reduction throughout the world. There is an extensive body of knowledge about the causes of maternal mortality and effective strategies as to its prevention. As such a well studied and well understood topic, it is particularly disgraceful that maternal mortality continues to take the lives of between 530,000 and 600,000 women every single year, almost all of whom are in developing countries. That is to say that every minute of every day at least one woman dies from pregnancy or childbirth. We have long had the knowledge and the resources to prevent the vast majority of these maternal deaths, yet we are failing to do so in the developing world. It is a shameful injustice that in the twenty-first century we continue to allow women in developing countries to die from complications of pregnancy, labor, and delivery that are both preventable and treatable. As Vicki Camacho of the Pan American Health Organization says, “Women do not die because we cannot treat their complications. They die because societies have to make the decision whether their lives are worth saving.” The Casa Materna of Matagalpa, a non- profit organization in the department of Matagalpa, Nicaragua, has made the decision that yes, women’s lives are worth saving. The Casa Materna is a maternity waiting house for high risk pregnant women from poor rural communities. Founded in 1991, the Casa Materna has been working for seventeen years to reduce the all too high rates of maternal morbidity and mortality in the department, and by extension infant morbidity and mortality as well. The organization employs an interdisciplinary program of medical, educational, family planning, and transport services to make pregnancy and delivery safer for the women that they serve. In this essay I will explore the structural causes of maternal mortality in Nicaragua and how the Casa Materna addresses these causes. I will discuss the organization and activities of the Casa Materna and the challenges it faces in the struggle to break the link between poverty and poor maternal health