GALKAYO, 30 September 2010 (IRIN) - Poor education among women and lack of access to health facilities in many rural areas of war-torn Somalia have increased risks surrounding child birth, according to health officials.

"Home delivery and hospital maternity is not the same; when women deliver at home, some traditional midwives use unclean knives, increasing the risk of death even in cases where the process gets completed successfully," said Habiba Isack Adan Hurmo, a doctor in Galkayo, Mudug Region, central Somalia.

According to the UN Children's Fund (UNICEF), 1,000 women die per 100,000 live births in Somalia, where women have a lifetime risk of dying in childbirth of 1 in 12.

Poor literacy levels and lack of health facilities are the major contributors to high mortality in rural Somali communities, Hurmo said, adding that young pregnant women were at greater risk due to lack of awareness of the need to deliver in hospitals.

Hurmo said: "I have come across rural women who have each had more than eight deliveries at home due to lack of health facilities. In many of the cases the children delivered died. Most pregnant women in rural areas believe in traditional birth delivery, not knowing it may not always be safe. This is made worse when a maternity centre is not located near their homes."

Health officials cite the risks of home-based delivery: excess bleeding, the placenta failing to descend, and disease transmission through handling contaminated blood.

Illiteracy

According to Hurmo, illiteracy in women also considerably increases the risk of death for child-bearing women aged 15 years and above, "especially when living with illiterate men".

According to a September health update by the UN World Health Organization, a major concern in Somalia's south-central regions is the withdrawal, suspension and scaling-down of operations by key humanitarian agencies, as well as their inability to access many areas because of insecurity.

Mohamed Hussein Eid, a Ministry of Health official in charge of Galmudug Region, said the ministry recently established seven new mother-and-child-care centres in the Hobyo, Elgual and Bandiradley areas in a bid to improve health service delivery and check the areas' high maternal mortality.

Eid said mortality risks were high in infancy and early childhood but women faced a greater risk of dying during their reproductive life than men.

He added that the ministry was committed to boosting health facilities in the region and that it would train more traditional birth attendants to reduce the risks of child delivery at home.