An expectant mother waits on a mat outside of a health center in rural Malawi. She is in labor, but will not be given a bed inside the facility until she is almost ready to deliver. Because there is no clean water available at the health center, she must walk a mile to the closest community borehole to fetch water for herself prior to and during delivery.

There are many challenges to giving birth in Malawi. Health services are often not readily available to expectant mothers due to distance and lack of lodging at health facilities, and many women give birth at home with limited access to medical care or safe water sources.

Some expectant mothers wait until the onset of labor to travel long distances to health centers and risk giving birth along the way. Once they arrive, they often have to wait outside of the crowded facility, with no convenient access to clean water, until they are almost ready to deliver their baby.

Many expectant women often have to fetch their own water, while already in labor, walking long distances to unclean and unsafe sources prior to and after delivery. If safe sanitation is not available, they may have to use the restroom in unhygienic latrines with no privacy or outside in the bush.

Postnatal care is just as difficult under these unsanitary conditions, contributing to extremely high rates of infection among new mothers and infants in the days and weeks after birth. The consequences can be devastating and deadly.

These conditions contribute to Malawi’s exceptionally high maternal mortality ratio (MMR) at more than 634 deaths/100,000 live births and infant mortality ratio (IMR) of 44 deaths/1,000 live births (WHO, CIA).

In partnership with Engineer's Without Borders-USA's Engineering Service Corps, an elite team of seasoned engineers, Freshwater Project International embarked on a pilot project to upgrade and optimize water systems at health centers and adjacent maternal waiting shelters in Malawi.