Unaware that their teenage daughter was pregnant, Maria Deng's parents treated her with traditional remedies at her home in Malakal, Upper Nile State, when she suddenly became ill.
But when Maria's condition had deteriorated a week later, her parents decided to admit herto Malakal Teaching Hospital. After examining Maria, the doctor told them she was four months pregnant.
Being unmarried, the young girl had been afraid to speak about her condition.
The doctor said Maria had anaemia and jaundice, but unfortunately had been admitted too late to be treated. Sadly, the young woman and her unborn child died 24 hours after entering the hospital.
Maria was one of an increasing number of young mothers who fall prey to maternal mortality, a severe health hazard in Southern Sudan.
The 2006 Sudan Household and Health Survey put the nationwide maternal mortality ratio at 1,107 per 100,000 live births. This is almost three times higher than the world average of 400 per 100,000, as estimated by a UN report based on statistics from 2000.
Another problem in Malakal is its high rate of abortions, according to Malakal Teaching Hospital Medical Director Dr. Tut Gony. In 2009, the number performed reached 475 and doubled to 910 in 2010, according to hospital records.
"Abortion is very high in Malakal because there are some women who are unable to keep their babies," said Dr. Gony. "There are various reasons, including conditions of the uterus ... malaria, anaemia, jaundice, and internal bleeding caused by working too hard."
To lower the abortion rate, Malakal Teaching Hospital established an antenatal clinic, which provides free consultation and medication for pregnant women. The facility is supported by the UN Population Fund (UNFPA) through the American Refugee Committee reproductive health service project.
"Now pregnant women in Malakal have started to be aware of the importance of their health as well as their unborn," said Dr. Gony.
One of these women was Nyakach Youl Kour, who came to the antenatal clinic to check on her second pregnancy, which was eight months advanced.
"This is my second time to check my pregnancy up in this clinic," said the 23-year-old woman. "The first time I came here they gave me a mosquito net to make sure I don't get malaria."
Originally planning to deliver the baby at home for financial reasons, Ms. Kour decided to have it in hospital after Dr. Gony said she only needed to pay 20 Sudanese pounds ($8).
If a caesarean was required for delivery, the hospital charged 100 pounds ($40), the doctor added. "The medicine is free because it's provided by UNFPA."
Unfortunately, Malakal Teaching Hospital is facing several challenges in continuing these services, including limited human resources, equipment and facilities.
"We don't have sufficient equipment to diagnose the pregnancy and we only have three doctors, one pregnancy consultant, and 24 midwives," noted Dr. Gony. "Currently, we only have 60 beds to accommodate more than 1,000 delivery cases every year."
Lack of doctors
Malakal is only one of several areas in the region lacking health services for pregnant women. The teaching hospital in the Unity State capital of Bentiu has a maternity ward for 100 patients, but assisted less than 10 deliveries in 2007 due to a lack of doctors and midwives.
To improve its services, the Unity State Ministry of Health has employed 11 doctors and trained 13 midwives over the past three years.
"There were 280 women who delivered in the hospital in 2010," said Bentiu Teaching Hospital Director Dr. Martin Taban. "Out of 280 deliveries, we had two cases where the mother died and three cases of the baby dying."
But Dr. Taban believed the mortality rate was still high in remote areas lacking medical facilities. The state's 13 midwives encourage women to care for themselves but are hard pressed to fully cover its nine counties.
Customary treatment is also challenging, as most pregnant women in remote villages prefer this method to visiting health centres.
"They believe that if older generation could deliver at home without any problem, why can't they?" said Nyachoul Deng, a midwife working at Bentiu Teaching Hospital.
Rates for maternal mortality are lower in North Sudan than in the south, with the highest at over 1,000 deaths per 100,000 live births in Kassala State, said Dr. Shiham Amin, Mother and Child Health Director at Khartoum State Ministry of Health.
High levels of maternal mortality mainly result from lack of skilled health practitioners, birth attendants, and well-equipped facilities, Dr. Amin added. The discrepancy in the rates is also due to the low rate of family planning in Southern Sudan, she said, where most women give birth alone, lacking any assistance.
To decrease maternal mortality rates, the Khartoum State Ministry of Health began a skills training programme for hundreds of rural midwives last October, and aim to raise awareness about the importance of seeking antenatal care.