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In Mali, maternal and newborn health is severely threatened . Maternal and newborn mortality rates are among the highest in the world: 970/100,000 and 54/1,000 respectively (UNICEF, 2008; UNICEF, 2009). The immediate postpartum period is the most dangerous for both mothers and neonates. For women, postpartum hemorrhage is the greatest threat (Khan et al., 2006). For neonates, the vast majority of deaths occur in the first 48 hours of life and 1/3 of these are intrapartum-related (birth asphyxia) (Lawn et al., 2009). In order to reduce these deaths, an effective provider must be available where most women and their newborns receive care. In Mali, this is increasingly in rural maternities where women and newborns are cared for by assistant midwives, or matrones.
Unfortunately, Mali’s health system is overwhelmed. The global health workforce crisis is particularly acute in sub-Saharan Africa. Compounding the crisis is maldistribution of health workers, with rural settings having a significantly lower share of the available workers (Liese & Dussault, 2004; Dormael et al., 2008). The devastating shortage and severe maldistribution of adequately trained and supported health care workers makes it almost impossible for countries to meet the Millennium Development Goals. In Mali, as in other developing countries, few providers want to live in the rural areas where the majority of the population lives. In Mali, this leaves matrones, who are the primary maternal health provider in rural areas, with enormous responsibility and challenges.
On average, Malian matrones have less than 8 years of formal education and have been at their posts for 11 years. Matrones’ initial training from the Malian Ministry of Health is not standardized and only lasts an average of 11 months. Once at their rural posts, matrones receive little support. Most matrones have no reference materials at all. They work with little supervision, irregular salaries, and little or no peer support. 1 in 4 matrones report they have never had any continuing education at all.
Large aid agencies offer trainings targeting a few, highly trained providers but they rarely include matrones. In a setting where 1 in 15 women die because of childbearing complications and 1 in 20 newborns do not survive their first month of life, it is imperative that matrones get adequate continuing education.
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