MaterCare: preferential option or mothers.

Bringing a Catholic presences maternal health care.

Dr. Robert Walley, professor of obstetrics and gynecology at Memorial University in St. John's, Newfoundland, is medical director of MaterCare International (MCI). Established in 1996, MaterCare is an association of Catholic health care professionals who are guided by the principles outlined in Evangelium Vitae in providing health care for expectant mothers and their babies. Established as a NonGovernment Organization (NGO), MaterCare is seeking to reach out to like-minded health professionals. It has established a popular internet website (www.matercare.org), and it publishes a quarterly newsletter updating supporters on new projects and events.

Pope John Paul II's 1995 encyclical Evangelium Vitae (The Gospel of Life) presented a clear challenge to all those concerned with promoting a culture of life as a counterbalance to the burgeoning abortion-contraception mentality.

The encyclical generated tremendous debate among church groups and pro-life associations for its defence of life and family and its denunciation of the emergent "culture of death." The encyclical became a rallying point for pro-life supporters, but it also provided special inspiration for the Newfoundland obstetrician who has long been concerned with bringing a stronger Catholic presence to the highly politicized maternal health care field.

MaterCare operates under an international board of directors, which has representatives in Canada, Ireland, Britain, Switzerland, and various African nations. Its chief aim, according to Dr. Walley, is to turn around the "abortion asteroid" in favour of a more compassionate, Catholic-centred approach to maternal health care.

Health care for African mothers

Professor Kay Matthews of Memorial University (Newfoundland) School of Nursing is a Canadian member of MCI's board of directors. She said the organization is a natural extension of successful maternal health care projects in Nigeria in collaboration with Dr. Ann Ward of the Medical Missionaries of Mary and with the Sovereign Military Order of the Knights of Malta.

"Having completed that project and finding it to be a useful model, Dr. Walley, in collaboration with Dr. John Wilson, a Catholic obstetrician-gynecologist in Ghana, and in partnership with the Ghanaian Conference of Catholic Bishops, started a similar project in Ghana," Prof. Matthews said.

From there, MCI began reaching out to other African nations and to other areas of political and civil unrest.

Dr. Walley's long commitment to pro-life ideals led in 1985 to his being appointed to the Vatican's Pontifical Council for Health Care Providers. He is convinced that, in the rush to address infant mortality and the health risks associated with pregnancy, many international development agencies and medical professional groups focus exclusively on abortion and contraception.

"If one considers maternal mortality, morbidity, and abortion rates throughout the world, the obvious conclusion is that the world cares very little for motherhood," Dr. Walley said in an interview. "My contention is that there is a sharp distinction between women's health care and maternal health care. I think this point has to be made loudly and clearly. Unfortunately, we as a church have been caught in an eternal ethical wave on reproductive issues and are forgetting that, at the end of the day, we have to do something for each mother."

Dr. Walley also said that, since his early days as an obstetrician, the medical establishment has often pursued maternal health care policies and practices opposed to Church teaching on the sanctity of life. "At MaterCare International, we felt that the solutions to maternal health care problems were more services and, in particular, emergency obstetrical services," Dr. Walley added. "... I felt that there should be an international organization that could provide help for mothers in accordance with what the Church was teaching."

Grisly statistics

MaterCare points to grisly statistics that underscore the urgent need for greater international cooperation in the area of maternal health care and childbirth. Third World countries are especially susceptible, with up to 600,000 women dying each year due to complications arising from pregnancy and giving birth.

Most of these deaths are the result of bleeding and obstructed labour. Thousands of teenage mothers, whose pelvises are often too small to accommodate a healthy delivery, are particularly vulnerable to injury and hemorrhage. Other problems stem from cultural practices, such as genital mutilation.

In addition to deaths related to childbirth, Dr. Walley says, thousands of Third World women suffer from a condition known as obstetric fistulae. This affliction, affecting mothers in the 14 to 20 age range, involves tears to the rectum and vaginal area due to unrelieved obstructed labour. Even if the newborn survives such a traumatic entry into the world, the mother suffers urinary and bowel damage, leading to incontinence, decreased hygiene, and eventual rejection by the local community.

MaterCare officials estimate that, for every single childbirth death, as many as 30 Third World women suffer the degenerative effects of obstetric fistulae. This is especially tragic in view of the fact that the condition can be prevented with the most basic obstetric care.

One of MaterCare's pioneer efforts is the West African Health and Obstetric Fistula Project. Centred in Ghana, the project consists of prevention, curative care, training, research and advocacy programs aimed at identifying and preventing maternal health care problems. The project trains birth attendants in African villages and arranges for obstetrical emergency patients to be transported to district hospitals.

A second phase of the project, timed to coincide with the millennium year, involves ongoing training of specialists in fistula treatment and rehabilitation. A key component of the project is the establishment of a 30-bed clinic near Accra, Ghana.

Resource allocation 

Dr. Walley points to a tragic juxtaposition of resource allocation in the maternal health care world. He said that while up to $5 billion has been spent on reproductive health care projects (read abortion and contraception), only a pittance goes to the provision of emergency obstetric care. The MCI medical director agrees that obstetric fistula remains "a forgotten disease," one that has failed to receive the same international attention as AIDS, land mines, reproductive health, and other issues that capture the imaginations of United Nations bureaucrats.

"To die in childbirth is a tragedy that can lead to the deaths of young children and the family itself," Walley said. "It is an international disgrace that so many poor mothers, especially in Africa, should have to endure this ultimate indignity, incontinence, when treatment is available. It is a sad fact that obstetric fistula is not of political importance as is AIDS or land mine injuries."

In addition to establishing MaterCare as a bulwark for motherhood and the family, Dr. Walley has been busy generating operating capital. In 1998. the Canadian International Development Agency (CIDA) granted $375,000 to assist MaterCare's programs in Ghana. MCI however, must raise some $3 million over three years to fully fund its work in West Africa. A number of church groups, including the Catholic Women's League of Canada, and the Newfoundland State Council of the Knights of Columbus have supported MCI, but the fund-raising efforts continue.

Kosovo refugees

In addition to the ongoing health care projects in Africa, MaterCare has turned its attention to other immediate concerns. Dr. Walley has noted the emergency facing Kosovo refugees temporarily resettled in foreign countries during the recent "ethnic cleansing" campaigns in the former Yugoslavia. Although most of the ethnic Albanians are now being returned to their native land, many among them are pregnant women facing problem pregnancies. Dr. Walley recently visited northern Albania with Dr. Gian Gigli of the International Federation of Catholic Medical Associations to study the needs facing maternal health care workers in the area.

He said most relief agencies working in Kosovo deal with the immediate problems of infectious disease, trauma, and general practice. Often overlooked, however, is the fact that normal life goes on and that complications occur to pregnant women requiring specialist help. "There are no specialist services for mothers in the area," Dr. Walley reported. "Even though hostilities are now over, our services will be necessary in the Albanian camps, but also in Kosovo itself as part of long-term reconstruction."

MCI is hoping to work with an Austrian military field hospital near Shkodra (100 kilometers from the Albanian capital of Tirana) to assist returning refugees. The organization will arrange teams of volunteer obstetricians from the United States, Canada, Ireland, England, and Italy to provide specialist care for two-week periods.

Dr. Walley said the longer-term aim of the Kosovo plan is to reduce maternal and perinatal mortality and improve the quality of life for refugee mothers. MCI officials estimate that between 10,000 and 15,000 Albanian women will be in need of immediate assistance.

"Maternal deaths occur because of the unavailability of emergency care," said Dr. Walley in explaining the Kosovo relief effort. "Maternal deaths in rich countries are reduced to a minimum simply because mothers have access to specialist obstetrical services. Refugee mothers deserve the same." MCI officials estimate that the Kosovo effort will cost in the area of $850,000 and it is now seeking assistance from concerned pro-life supporters and church groups to support the project.

Catholic initiative

Prof. Kay Matthews of the MCI board of directors described Dr. Walley's efforts as "an excellent initiative for the Catholic community to take to its heart." She said a key component of MCI's success involves primary prevention programs in the rural areas, and working with local people to improve local conditions. "It is the local people, village leaders, nurses, midwives and doctors who do the work," Prof. Matthews said. "Our major role is to facilitate their efforts, and to support and advise. My experience has been that the people know very well what needs to be done, but they do not have the resources."

Dr. Eamon O'Dwyer, professor emeritus of obstetrics at the National University of Galway, Ireland, expressed hope that MaterCare's health care efforts will continue gaining attention worldwide. Dr. O'Dwyer, director of MaterCare's Irish affiliate, said there should be little difficulty convincing the medical and nursing professions of the organization's overall effectiveness. "The only problem I envisage is the generation of sufficient funds, especially in the early years, to enable MaterCare to fulfil its mission," Dr. O'Dwyer said. "We have an obligation to do what we can to make for safe pregnancy and childbirth in parts of the world less privileged than our own."

Dr. Walley summed up his motivation in establishing MCI in an address to the U.S. National Conference of Catholic Bishops in March, 1999. "Abortion currently dominates international health care policy," he said. "It is a policy which arises from poverty of thought and more seriously the poverty resulting from the lack of love. So-called unwanted pregnancy is now considered a disease to be treated with either surgery or with new medical treatments or abortifacients. Society has accepted an easy solution for the problem of so-called unwanted pregnancy, but it has been bought at the price of millions of babies' lives and at the expense of a once noble profession."

To win back some of that tarnished honour, Dr. Walley has called for a "preferential option for mothers." He believes this is the only response for Catholic health care professionals and others concerned with preserving the sanctity of human life. The coming millennium, he suggests, is an ideal time to reiterate such an appeal.

Michael Mastromatteo is a freelance writer in Toronto.