Midwife in South Sudan Champions Innovative Program to Reduce Bleeding after Birth


The world’s youngest country, South Sudan gained independence from Sudan in 2011 after the world’s longest civil war. These years of unrest left the country’s health care system with inadequate infrastructure, personnel and funding, causing adverse health consequences—particularly for women and children.

Mary Rose Dalaka sees this reality every day. A midwife working in the country with the highest maternal mortality ratio in the world (2,054 per 100,000 live births)—where 1 in 7 women are at risk of dying from pregnancy-related causes—she is championing the implementation of an innovative program to reduce bleeding after birth. Through training and follow up of healthcare workers on prevention of postpartum hemorrhage (PPH), safe birthing practices, and newborn care, she is saving mothers and infants from needless deaths.

Midwife Mary Rose Dalaka talks to a group of mothers with their babies at the Primary Health Care Centre in Lanyi, in Mundri East County South Sudan. Kate Holt/JhpiegoMidwife Mary Rose Dalaka talks to a group of mothers with their babies at the Primary Health Care Centre in Lanyi, in Mundri East County South Sudan.
Photocredit: Kate Holt/Jhpiego

Her efforts are part of a larger scope of work being implemented by USAID’s flagship Maternal and Child Health Integrated Program (MCHIP) to prevent excessive bleeding after birth, a leading cause of pregnancy-related deaths worldwide. The program for community distribution of misoprostol in Mundri East, a county in Central Equatoria State in South Sudan, is part of a package of high impact interventions—implemented by MCHIP, Jhpiego and the Mundri Relief and Development Association (MRDA) in collaboration with the Ministry of Health—to help reduce maternal deaths.

As a key player in implementing MCHIP’s efforts, Dalaka—MRDA’s Maternal and Neonatal Child Health Officer—has mobilized community stakeholders and recruited health workers from the villages. She has trained these home health promoters to counsel women on the use of misoprostol after birth to prevent PPH, and to encourage facility births.

This International Day of the Midwife, we remember that no woman should have to lose her life giving life. Yet each year, nearly 300,000 women die and many more suffer from largely preventable complications related to pregnancy or childbirth. Moreover, when we lose a mother, her children face an enormous risk of dying, too. 

“Such information enables the communities and pregnant women to know the danger signs before and after delivery, and it causes them to seek the help of home health promoters,” Dalaka says. This is particularly critical in a country like South Sudan, where the vast majority of women (90%) do not give birth with a skilled birth attendant. While the country moves forward in training sufficient numbers of competent midwives, ensuring high impact interventions (such as distribution of misoprostol) are provided at the community level is vital amid the country’s ongoing health crisis.

Dalaka’s determination has been integral to the success of MCHIP’s intervention in the targeted communities. “I support this program because I do not want to see any woman lose her life or suffer during or after delivery,” she says. “I want them to get all these services.”

Thankfully, worldwide, midwives like Dalaka are saving mothers and infants from needless death and disability every day. Their impact is felt intimately within families and on the larger community level. The world needs midwives like Dalaka now more than ever to expand access to high-quality services, bringing us closer to our goal of better health outcomes for all.

Written by: Sheena Currie, MCHIP Senior Maternal Health Adviser, Tatiana Elghossain, MCHIP Communications