Khim Mar Tun almost died when Cyclone Nargis devastated her village in May. "Our whole village was swept away," the 28-year-old told IRIN. "Of the eight people in my family, four died. All of them were washed away."
Six months pregnant and barely able to stay afloat, she spent nearly four hours in the water that swept away her home before being rescued.
Three months after the cyclone struck, leaving nearly 140,000 people either dead or missing and 2.4 million badly affected, she is about to give birth. "I'm lucky, I guess," she said. "I've already been to the camp clinic and will give birth either here or at the hospital in Labutta," she said, referring to the largest town in the area, 3km away, at the southern tip of the Ayeyarwady Delta.
In the aftermath of Nargis, now described as the country's worst natural disaster, the risk factors for pregnant women have increased. According to the World Health Organization (WHO), the country has a maternal mortality rate (MMR) of 383 deaths per 100,000 live births.
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"It's entirely possible that those rates [MMR] would go up. One would expect them to," Dan Baker, country representative for the UN Population Fund (UNFPA), told IRIN in Yangon, the former capital.
Pregnant women are among those in the greatest danger during humanitarian emergencies, with poor nutrition and a lack of access to safe delivery options often having fatal consequences, he explained.
In the Ayeyarwady Delta, where women typically give birth at home with the help of midwives or in rural health centres, the widespread destruction of homes and disruption of transport and medical services would exacerbate matters.
Tens of thousands of pregnant women have been put at risk by the storm's disruption of health services, Baker noted.
Damaged health facilities
Based on fertility estimates, UNFPA estimates that at any given time there are 35,000 pregnant women in the delta, and each month, 4,400 women will give birth; of whom 440 will experience complications, and 220 will require Caesarean sections.
|A young woman and her newborn baby at a displaced persons camp outside cyclone-affected Labutta|
However, many community health centres were wrecked by the category four storm, and scores of midwives killed.
According to the Post-Nargis Joint Assessment (PONJA), a report prepared by representatives of the Myanmar government, the Association of Southeast Asian Nations (ASEAN) and the UN, released in July, Nargis damaged almost 75 percent of health facilities in the affected townships, with much of the damage occurring in places such as Labutta at the extreme end of the delta.
Almost all the destroyed facilities were primary health centres, including station hospitals, rural health centres and sub-centres and the impact on maternal healthcare is significant.
"Hospitals account for a small number of births in the country," Baker said.
Three months after the cyclone, there are no exact figures on the number of pregnant women who have died giving birth, but key assumptions can be made.
"If a woman has no shelter and has to give birth without any health attendants, by herself or with an untrained person, she is much, much more likely to die," Baker said, stressing the importance of getting health services back up and running as soon as possible.
|Myanmar's maternal mortality rate is one of the highest in the region|
Progress on the ground
UNFPA, with the Myanmar Medical Association, has hired additional doctors to work at area clinics, and dispatched a wide range of supplies to the affected area, ranging from rubber gloves for midwives to hospital equipment delivered to the Myanmar Ministry of Health for distribution.
To date, tens of thousands of clean delivery kits have been distributed through various partners - international and local NGOs, community-based organisations, mobile clinics and individuals.
In addition, the agency has opened maternity waiting homes in places such as Bogale and Labutta, where women who live far away can stay while awaiting delivery.
Women can receive prenatal care and delivery referrals at the centres, which also serve as a base for mobile clinics providing general and maternal health services to more remote areas.