Awatif, South Darfur, Sudan
Awatif, six months pregnant, is frightened of giving birth after the sun goes down. The Serif camp she has called home for the past four years has no night midwife available because of security concerns.
"I'm afraid," she said, swathed in a shawl of sunset orange, reds and purples. "I want a midwife to be by me in case something happens."
Awatif, 27, was married at the age of ten, and this is her second pregnancy in this camp for internally displaced persons outside of Nyala, the capital of South Darfur. The camp midwife helped her give birth to the youngest of her four sons, and she is hoping for a girl this time.
The first time her village was attacked in Darfur's civil war, she said, "They took all of our cows. The second time, they attacked the people and burned all our houses." After that she fled here with her family.
In Awatif's village, the nearest health care centre was a three-hour walk away. Awatif relied for her first three pregnancies on a traditional birth attendant, who in Darfur customarily ties the hands of the expectant mother above her head and then pulls on the rope to elongate the woman's body through each contraction. It is a difficult and painful process, especially if the woman's labour continues for hours on end.
In the camp, a nighttime complication will mean Awatif will have to get from the camp to the hospital in Nyala. But donkey carts are the only available transport. "It's dangerous, and you have to pay a lot of money," she said.
Maternal mortality is high in Sudan: 509 women die for every 100,000 live births - a ratio that puts Sudan 130th on a World Health Organization ranking of the 181 countries with populations of 1 million or more. A woman's lifetime risks here are so great that one in every 30 Sudanese women will die of pregnancy-related complications: only 71 percent of pregnant women receive antenatal care, only 57 percent of deliveries have a skilled birth attendant present, and only 13 percent of women receive postpartum care in the first six weeks following delivery.
Most people do not know how to identify complications, and men – who make the decisions about when a woman can seek health care – often do not recognize the importance of referring their wives to emergency care, or they are too poor to seek it. UNFPA, the United Nations Population Fund, teaches women and men in the camps about the importance of seeking such care, and also supports pooled community transportation funding for emergency night referrals.
A green tent houses the camp's maternal health care clinic. Straw mats cover the floor and the smell of disinfectant wafts through the hot air. A simple sheet separates the 'operating theater' from the consultation room, manned by midwife Amina Mohammed. She provides ante- and post-natal care to IDP women, but wives must be accompanied by their husbands to receive contraception.
"I'm very proud of what we've done here," she said. "I'd like to do even more – we'd like to support every pregnant woman in the area."