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Beatrice and Aziza: A friendship formed through the journey of antenatal care (ANC) in South Sudan

7th March 2024

To celebrate this year's International Women's Day, we shadowed Beatrice and Aziza in Juba, South Sudan. Beatrice, a mother of five who welcomed a new addition to her family in December, found support from Aziza, a dedicated Community Health Worker- known as Boma Health Workers (BHW)- in South Sudan, supporting ANC accessibility for women.

Beatrice with Noel Francis aged one and a half months old at their home.

Under the hot South Sudanese sun, Beatrice invites us into her home. She lives with her husband, five children, her brother and sister-in-law in Luri Payam, Juba County. Guava and mango trees surround us, infusing the air with a fragrant sweetness. Beatrice is sat with two-and-a-half-month-old Noel Francis, born on December 7, 2023.

During Beatrice’s latest pregnancy, the support of a BHW and a midwife marked a stark contrast to her previous experiences. Her pregnancy journey with Noel Francis sheds light on a critical gap in ANC services for expectant mothers in South Sudan. When it comes to sexual and reproductive health, women grapple with a disproportionate burden of morbidity and mortality. According to a report by the United Nations released in 2023, a woman dies during pregnancy or childbirth every two minutes.


The importance of ANC

The World Health Organisation advocates for a minimum of four ANC visits during pregnancy. These crucial appointments serve not only to prevent mortality but also to safeguard the well-being of both the mother and the baby.

The appointments, overseen by a midwife or doctor, involve health checks that identify potential issues early on and offer vital reassurance to the mother.

However, in South Sudan, the widespread adoption of this public health intervention has been limited, with only an estimated 40% of pregnant women receiving the recommended four visits. This is due to several reasons. Most of South Sudan’s population lives in rural areas. This often means the nearest health facility is hours, if not days away. Transportation is often not available, and if it is, families cannot afford it. Roads are often flooded during the rainy season, and poor road networks make journeys strenuous and, at times, impossible. In addition, women are often focussing on their domestic chores, urged by their husbands not to attend appointments so they would not miss them. In many communities, the benefits of ANC are not yet recognised, and pregnancies are perceived as low risk for the mother.

In more rural and remote locations, women still have to ask for permission from their husbands to go for ANC. This is where the gender and social inclusion and mainstreaming plays a key role in gender roles from the male perspective and their importance to maternal child health.

Beatrice’s and Aziza’s journey

Beatrice’s journey into motherhood started at the age of 19. Her experience involved undercurrents of fear. Despite the unwavering support of family and a husband advocating for her to attend ANC sessions, Beatrice lacked a guiding hand armed with knowledge and reassurance.

Enter Aziza, a Boma Health Worker. In the picture below, we can see Beatrice absorbing health education on the nutritional nuances of pregnancy, sharing this experience with other pregnant women. Aziza is delving into the significance of a balanced diet during pregnancy and the potential risks associated with low haemoglobin levels, both for the baby and the mother.

2-Health education with BHW (1)

Beatrice is seven months pregnant and attending a community session with Aziza who is providing awareness on the benefits of nutrition.

Initiated in 2017 by the Ministry of Health and Health Pooled Fund Programme, the Boma Health Initiative represents a national-scale community health programme designed to strengthen the healthcare system and implement comprehensive health promotion and disease prevention activities at the grassroots Boma level.

Positioned strategically in terms of geography and social connectivity, the Boma Health Workers play a pivotal role in delivering promotional maternal healthcare services, complemented by household visits to support the woman on their journey.

The services provided, including nutritional support, have equipped Beatrice with knowledge that extends beyond childbirth, fostering good health, immunisation, and disease prevention.

15 going home (1)

Beatrice leaving the Gurei PHCC health facility after being checked in the ANC wing by the midwife, accompanied by Aziza.

The photo showcases Beatrice after the safe delivery of her baby. Her journey has highlighted the crucial importance of ANC and the early identification of potential complications.

During her time with Aziza, Beatrice learned about potential complications such as excessive bleeding after delivery and changes in the umbilical cords colour. Recognising the significance of these warning signs became imperative for her to proactively safeguard her and her baby’s health.

Reflecting on her experience, Beatrice recognises how being pregnant with Noel Francis contrasts from her previous pregnancies. For example, the discovery of a varicose vein prompted a diagnosis that led to a recommendation for delivery in a hospital setting, where any potential complications could be promptly managed. During her previous pregnancies, there were no community health workers like the BHWs in the community to create awareness of maternal health and messages on healthy pregnancy and childbirth.

Sadly, a lack of awareness often deters many women from seeking ANC services. For Beatrice, the support and education from Aziza prompted her to undergo essential check-ups, a vital step that might have been overlooked without Aziza’s support.


Aziza and Beatrice together, one month after giving birth to Noel Francis.

Since the joyous moment of giving birth, Aziza and Beatrice have forged a lasting friendship. Aziza, initially anticipating a baby girl, was pleasantly surprised when a little boy arrived. Witnessing the safe delivery of healthy babies is the driving force behind Aziza’s dedication to Boma health work.

The connection with Beatrice provided Aziza with a companion with whom she could share every aspect of her pregnancy journey. This camaraderie, absent in past pregnancies, highlighted the invaluable support that such relationships bring.

Beatrice feels extremely grateful to Aziza and acknowledges the pivotal role Aziza played in making her pregnancy experience a positive and supported one.

When looking ahead, Beatrice sees a future full of possibilities. She would like to have another child in three years, with a goal of eventually starting her business. Her plan for now is to spend as much time as possible with her Noel Francis.

Story by Nicole Greene, Communications Manager, supported by Grace Otto Lajul, Community Health Manager, Crown Agents

About HPF

Both Keji and Aziza are part of the health care workers under the Health Pooled Fund (HPF) Programme, led by Crown Agents in collaboration with Montrose and IPA. HPF provides hundreds of thousands of citizens, especially women and children, with quality healthcare, delivering services across 80% of South Sudan. The programme is funded by the Foreign, Commonwealth and Development Office (FCDO), the United States Agency for International Development (USAID), the European Union, Canada and the Swedish International Development Cooperation Agency (SIDA).

About the Boma Health Worker (BHW) Initiative

Initiated in 2017 by the Ministry of Health and HPF, the Boma Health Initiative represents a national-scale community health programme designed to strengthen the healthcare system and implement comprehensive health promotion and disease prevention activities at the grassroots Boma level.

Since 2019 to December 2023, the BHWs have provided maternal health sessions which includes ANC awareness to 2,783,627 participants.