LUANG PRABANG - In 2010, for the first time in more than 20 years, 140 midwives graduated in Laos but specialists say their skills may go untapped because the country's women are not used to visiting health workers.
Only 34 percent of women in Laos seek the advice of medical professionals; even fewer see one when they are pregnant, according to government data from 2009-2010.
At Luang Prabang's regional hospital, some 200km north of the capital Vientiane, Magdalen Muraa, a UN Volunteer with UN Population Fund (UNFPA) is training 20 midwives for graduation in February 2012.
Malaipon, 24, who like many Laotians goes by one name, travelled 1km to the regional hospital for one of her four recommended pre-natal check-ups. "This is my first time at the hospital and I was nervous to come," she said.
On average, the midwifery students see 60 mothers a day and facilitate 100 deliveries a month, Muraa said.
Though the numbers are low for a hospital serving thousands, it is a relative success compared with the often empty wards in outer areas, said Della Sherratt, UNFPA's international skilled birth attendant coordinator, based in Vientiane.
Sherratt arrived in Laos in 2009 to work with the government to train more midwives to help improve the country's abysmal record of infant and maternal deaths.
The historical lack of attention paid to maternal health has contributed to Laos being the third-worst out of 161 countries with reliable health data for a child to fall ill, according to the most recent Health Workers Reach Index by Save the Children, which measures not only the number of health workers, but also their impact.
The rankings take into account a woman's access to emergency care during childbirth and place this peaceful, socialist nation only behind Chad and Somalia, two countries with health infrastructures largely crippled by decades of conflict.
Maternal mortality was 405 deaths per 100,000 live births and infant mortality 70 deaths per 1,000 in 2005, the most recent year for which data is available.
By contrast to Luang Prabang, 14km from the health centre in the northern province, Oudomxay, a group of women and men IRIN interviewed from the village of Moonmeuang said they did not know what a midwife was.
Most delivered their babies by themselves or with the help of their mothers. Many have lost at least one baby, some five. "I have four babies," said Hom, 36, who also goes by one name. "I only went to the hospital because the last one died before it was born."
In this and other hard-to-access mountain villages, women are accustomed to delivering their babies alone. And, like Hom, women typically go to the health centre, in the village's one car, once they encounter severe complications or find their baby is dead. These healthcare centres see on average 10-30 women a week, said Muraa.
According to the 2005 census, 73 percent of Laos's 6.3 million people live in similarly remote areas.
Efforts to promote midwifery to people who do not have a word for it include dressing the students in bright pink uniforms and an eight-week community placement as part of the training. Teachers encourage the students to visit the dozen villages they oversee, door-to-door, hut-to-hut.
"This is not a quick-fix business and we shouldn't pretend it is," Sherratt said of the effort to reduce maternal and infant mortality rates in Laos, adding that the effort required passion.
"If you teach in the right way, you can teach that passion," she said.
But overcoming cultural traditions - for example, grandmotherly advice to give birth at home alone - can be a delicate matter, Muraa said.
"We have to be gentle about how we incorporate healthcare into culture," she said. "But if our midwives just sit at the health centre and wait for mothers to come, it won't work."
Laos has 859 health centres and the government is aiming to place a midwife in every facility by 2015.
[This report does not necessarily reflect the views of the United Nations]