By Mark Campbell

With WRATZ, Mlay met with MPs in 2014 to sign a petition demanding CEmONC services at health centers.

If Rose Mlay (BScN’91, MN’98) has her way, Tanzania will achieve a zero mortality rate for mothers during childbirth by the year 2018. The Dalhousie alumna admits it will not be easy. Unfulfilled government promises and a lack of public discussion on the issue have placed the nation among the top six internationally for mortality rates for years, with 24 Tanzanian women and 144 newborns dying each day due to childbirth-related complications.

“It’s a silent tragedy,” Mlay concedes. “By raising awareness, by starting conversations, my hope is that Tanzania can reduce those unnecessary deaths, even eliminate them completely.”

A global call to action

Mlay has been working toward that goal since 2005 as National Coordinator of the White Ribbon Alliance for Safe Motherhood Tanzania (WRATZ). Part of a global initiative that unites people to demand safe childbirth for all women, under Mlay’s leadership, WRATZ has been pushing for increased access to Comprehensive Emergency Obstetric and Newborn Care (CEmONC) nationwide and encouraging women to give birth at health facilities instead of at home.

Transforming advocacy into results

Then Prime Minister of Tanzania with Mlay and colleagues.

Through her advocacy, Mlay inspired the formation of the Tanzania Parliamentary Group for Safe Motherhood that promotes the benefits of midwifery to government and has advocated for a Safe Motherhood Bill. She played a key role in convincing government to end a hiring freeze on health education graduates, effectively addressing shortages in childbirth expertise and services. She persuaded the government to create White Ribbon Day, an annual commemoration of the women and children who have died during childbirth. And through financial support from White Ribbon Alliance Global Secretariat she leads Wajibika Mama Aishi (Be Accountable so Mama Can Live), a WRATZ campaign that calls on government to honour a 2008 commitment to provide CEmONC at 50 per cent of the nation’s 700 health centres. Since the campaign’s launch, the government has expanded care to 113 of Tanzania’s health centres, and achieved a 50 per cent rate in the region of Rukwa, where 65 per cent of women now give birth at health facilities, up from 30 per cent in 2010.

Signing of the Wajibika Mama Aishi commitment.

Despite this progress, mortality rates remain high, due in part to improved reporting on fatalities as more women give birth outside the home and a failure by government to provide sufficient funding for CEmONC. Mlay says WRATZ continues working with parliamentarians, non-government organizations, medical associations and communities so that “everyone will demand better access to life saving services. That is how we will make a change.”

A spark that led to Dalhousie

Rose Mlay (BScN’91, MN’98) at her graduation from Dalhousie.

A nurse-midwife and former lecturer at Muhimbili University of Health Sciences, Mlay knew she wanted to be a nurse from an early age, but it was her mother’s obstetric-related issues that sparked her interest in reproductive health. She studied nursing and midwifery at Muhimbili before gaining admission to Dalhousie, where she earned a BScN through the Tanzania Project and, later, an MN, thanks to financial support from the World Health Organization.

“The environment at Dalhousie was one where everyone was your friend, even the professors,” Mlay observes. “You would address them by their first names, they invited students into their homes for dinner and they conducted lectures like conversations. They encouraged self-confidence and exploration and I still draw on that to this day.”

Inspiring the next generation for change

Mlay talking about the campaign on Capital TV.

Mlay’s dedication to the profession is evident in her work as a mentor to Dalhousie students such as Keisha Jefferies (BScN’13), now a Master of Nursing student who met Mlay through the Canadian Queen Elizabeth II Diamond Jubilee Scholarship and who actually travelled to Tanzania to see first-hand the situation there.

“She gave me incredible insights into the maternal health situation in Tanzania, particularly the political, community and social context involved,” Jefferies says. “It was helpful for my maternal health studies, but it was also inspiring to meet someone who is working to influence change for the better. I can follow her example in taking on issues related to maternal and newborn health.”

Revitalizing the momentum and a new initiative

More than a decade since she became leader of WRATZ, Mlay is showing little signs of slowing down. If anything, she seems more ambitious than ever in advancing awareness and making progress to improve the health of women and newborns. She is campaigning to bring CeMONC to all of Tanzania over the next five years and has met with the nation’s Minister of Health to discuss plans to secure $40 million from the World Bank for the infrastructure to make that happen. She is meeting with members of parliament to encourage them to push for CeMONC for their constituents. And she is working with professional organizations to secure their support for zero tolerance to maternal and newborn deaths.

Yet Mlay is realizing that it is time for a new generation to take the reins of WRATZ and keep it vital for years to come. This would free her to pursue a new initiative, one that has been on her mind for some time: the launch of a community care organization dedicated to serving women in the home post-delivery. She says the idea was inspired by her time working with the Victorian Order of Nurses at Dalhousie.

“There is such overcrowding in hospitals and health centres that women are discharged within six hours of giving birth,” Mlay says. “Because no one is checking on them, there is no one they can turn to when they have issues with breastfeeding or bleeding. We can help them make the transition to the home and prevent health problems from occurring, so my goal is to make that happen.”