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The University of Southampton

Pacific Islanders face twenty four hour journeys for emergency maternity care

Published: 1 August 2019
Shore to Ship
Ferry that travels between Samoa and Tokelau (Credit: Dr Iapi Jasperse)

Geographers at the University of Southampton have conducted research for a new United Nations Population Fund (UNFPA) report highlighting the pressing need for quicker and sometimes lifesaving access to emergency obstetric and newborn care in Pacific Island countries.

A team from the University’s WorldPop project has found that while good progress has been made in parts of the region, it can still take pregnant women and infants living in more remote areas 24 hours or more to travel to appropriate emergency centres.

The researchers found that some islands provide good, basic acute care in local units, but that access to comprehensive emergency obstetric and newborn care could mean a long, often arduous journey by combinations of boat, airplane and car.

Dr Natalia Tejedor Garavito of WorldPop says: “The communities we have looked at are in many cases either great distances from main population centres or have very challenging terrain which makes for very long travel times to get to the right medical centre for their needs.

“Quick access to emergency care can be a matter of life or death for mothers and their children and we hope our contribution to this report will help better inform policymakers in the Pacific region – enabling them to target their efforts effectively to improve transport infrastructure and healthcare provision.”

The team produced highly detailed, colour coded maps which illustrate travel times for different islands by combining population and birth figures with data on the location of different types of emergency care centres, geographical terrain and transport infrastructure and services. It is the first time such a large scale study has been conducted to map the region’s maternity care provision.

The results showed that the islands of Tokelau off Samoa are some of the most isolated communities. They have no air access, the only scheduled transport is by boat and emergency sailings to Samoa can take between 24 and 30 hours. A hospital on one of the islands, Nukunonu, offers some limited services, like ultrasound and x-rays, but can’t conduct complicated procedures.

Women on Mataso in the archipelago of Vanuata (some 1000 km from Fiji) face a four hour boat trip, followed by two hours by road to access comprehensive emergency obstetric and newborn care on neighbouring Efate. On Erromango, in the same group of islands, it takes 10 hours by truck to get to an airport for a 15 minute flight to a hospital.

Larger islands, which aren’t seemingly so remote, can present different challenges. Papua New Guinea, north of Australia, has large areas of the country where women are well over two hours away from emergency care. Here the problem is rough terrain – high mountains, deep valleys and very fast flowing rivers – all making transportation to urban centres difficult. Helicopters, boats, boat planes and planes are all essential for transporting patients.    

The UNFPA report The State of the Pacific’s Reproductive, Maternal, Newborn, Child and Adolescent Health Workforce 2019 aims to respond to one of the United Nations’ key Sustainable Development Goals of ‘Good Health and Wellbeing’ by helping to reduce maternal mortality and improve the health of women, children and adolescents. As well as access to emergency centres, it highlights the need to maintain and grow an essential workforce of doctors, nurses and nurse-midwives.

The report was launched in July at the 13th conference of the Pacific Society of Reproductive Health in Papua New Guinea.

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