MaterCare International in Mission

A History of the Formation of MaterCare International

Motherhood has special significance for every family in every society. But its understanding is also very important for Catholic obstetricians and midwives, who have the great privilege of serving the co-creators of new human life. They, by caring for mothers and their unborn children and ensuring safe delivery of both, fulfill their responsibility to care for the whole family. However, profound changes have occurred in the laws of many countries making abortion widely available on demand. In turn, this has deeply affected the practice of obstetrics and gynecology such that modern maternal health care is overshadowed by an anti-life and eugenic culture.

Abortion and contraception have become the basis of modern maternal healthcare in the developed world, and the policies of Western governments are forcing them on the developing world, resulting in the death of millions of unborn children. Increasingly, Catholic obstetricians are suffering persecution due to removal of their right to conscientious objection to providing the so-called reproductive health services of abortion, contraception, and assisted reproductive technology. They are coerced to refer women for these services either by law or the requirement of government health services and professional associations. Thus, Catholic obstetricians are forced to dichotomize their faith and practice. In addition, the right to be trained as a specialist obstetrician according to one’s conscience is compromised in many countries. Catholic doctors who decide to remain loyal to Magisterial teaching can expect significant negative consequences on their future employment and family income. As a result, fewer young Catholic doctors are choosing to specialize in the care of mothers.

In the developing world, mothers are experiencing unimaginable suffering. Approximately 300,000 mothers die annually because of a scandalous lack of effective care during pregnancy and labor (Ozimek and Kilpatrick 2018, 175–186). At the present time, it is estimated that at least two million mothers are suffering a consequence of birth trauma known as obstetric fistula, which results in permanent incontinence of urine and/or faeces (Ahmed et al. 2007, S1–S3). Unfortunately, little progress has been made in eradicating obstetric fistula, which was virtually eliminated in Europe and USA a century ago (Ahmed, Anasti, and Laski 2016, E80–E82).

Dr. Robert Walley, a Canadian obstetrician and gynecologist whose missionary work began in Africa in 1981, had a particular concern for the problems faced by mothers in the developing world. This concern arose from his firsthand experience of the consequences of mothers having no obstetric care, including obstetric fistula and his first maternal death, and the failure of the International Safe Motherhood initiative to address these problems. After completing specialist training in the United Kingdom, Dr. Walley and his family were forced to leave their homeland when he became unemployed as a result of professional persecution in the British National Health Service due to his conscientious objection to providing abortion (Walley 1976, 1456-1458). The Walleys moved to Canada where, in 1973, Dr. Walley was appointed Professor of Obstetrics and Gynecology at Newfoundland Medical School of Memorial University in Saint John’s.

These challenging experiences were influential in prompting Dr. Walley to lead a group of like-minded Catholic colleagues to form an international organization dedicated to supporting each other and improving maternal healthcare worldwide, based on the ethic that all mothers and babies matter (Walley 1981, 346–360). The idea of a Catholic obstetrical group was first presented at a plenary meeting of the Pontifical Council for Justice and Peace, “Cor unum,” held in the Vatican in 1982. In 1986, an international meeting of Catholic healthcare professionals was convened at a retreat center in Rome. Initially, the organization was called Opus Vitae. Mission documents were written for a concept that would lead to the formation of MaterCare International (MCI) some years later.

MaterCare International was formally established during a meeting of Catholic obstetricians, gynecologists, and midwives at the Life Health Centre in Liverpool, England, from October 11 to 15, 1995. The group had been inspired by the message of St. Pope John Paul II’s Encyclical, Evangelium Vitae, and was dedicated to the care of mothers and babies from the moment of conception (John-Paul II 1995; Walley 1996, 1225). The group’s commitment was further underpinned by an awareness of three significant issues:

Mothers and their unborn children were facing an enormous tragedy with respect to unacceptably high maternal and perinatal morbidity and mortality rates in the developing world, and high rates of elective abortion and child abuse in the developed world.

MaterCare responded to these needs through new initiatives of service, training, research, and advocacy, aiming to reduce the tragically high rates of maternal mortality, morbidity, and abortion. A board of directors was appointed, by-laws were drawn up and approved, and incorporation and registration as a charity was obtained on January 1, 1998. An office was established in the city of St John’s in the Province of Newfoundland, Labrador, Canada. As a Catholic medical agency, MCI accepted the ideals concisely expressed by the International Federation of Catholic Medical Associations in the “Promise of the Catholic Doctor (FIAMC 1997).” National organizations were established in Ireland, Great Britain, Australia, United States, and in Poland. A memorandum of understanding between MCI and national organizations was composed.

MaterCare International was henceforth established as an international non-government organization (NGO) of Catholic obstetricians and gynecologists (ob-gyns) in response to these challenges and those contained in Evangelium Vitae (John-Paul II 1995):

“Christian obstetricians, gynecologists and obstetric nurses are always called to be servants and guardians of life, for “the Gospel of life is at the heart of Jesus’ message. Lovingly received day after day by the Church, it is to be preached with dauntless fidelity as ‘good news’ to the people of every age and culture (E.V.1).” “But your profession has become still more important and your responsibility still greater in today’s cultural and social context, in which science and the practice of medicine risk losing sight of their inherent ethical dimension, [and] health-care professionals can be strongly tempted at times to become manipulators of life, or even agents of death (E.V.89).”

In 2001, during MCI’s first Rome conference in 2001, Saint Pope John-Paul II commented in a private audience, “It is my fervent hope that, at the beginning of this new millennium, all (Catholic) medical and health care personnel, whether in research or practice, will commit themselves whole-heartedly to the service of human life. I trust that the local Churches will give due attention to the medical profession, promoting the ideal of unambiguous service to the great miracle of life, supporting obstetricians, gynecologists and health workers who respect the right to life by helping to bring them together for mutual support and the exchange of ideas and experiences (John-Paul II 2001).”

MaterCare has clear values as a Catholic professional organization and a vision of what it intends to accomplish with a stated goal and mission. It is open to other specialists from related disciplines, from all countries. Respect for life is the core value of this organization. It recognizes that reverence and respect for human sexuality and the procreation of human life is an essential element of respect for human dignity. Also recognizing the redemptive value of motherhood, MCI acts as a prophetic witness by reflecting on the teaching and practice of contemporary maternal and child healthcare in the light of the gospel and the teaching of the Magisterium.

Despite all the major advances in medical technology in recent years, mothers in the developing world continue to experience immense suffering due to a scandalous lack of effective care during pregnancy and childbirth. Mothers and women in the developed world, while not materially poor, are frequently poor in spirit and their dignity violated. Thus, MCI develops initiatives to provide mothers and women with obstetrical and gynecological care based on life and hope, and the highest medical and ethical standards, respecting the dignity of all women, their children and entire family, and the medical profession.

To appreciate the importance of motherhood in our contemporary world, those in whose professional expertise this responsibility lies must consider many factors. This is what the law, society, and the Church rightly expect of them. MaterCare proposes four complementary approaches. First, Catholic obstetricians must be competent, in knowledge and all the skills associated with caring for mothers and their unborn children. Legal and social aspects are also a fundamental part of the doctor’s responsibility.

Second, they must have the conviction that Catholic teaching on morals, magisterially guided, is not only true, but totally beneficial for doctors and their patients requiring medical assistance within the scope of his or her competency. Third, this involves an appreciation of the nature of society at large and of each particular local community within it. Motherhood is foundational for the flourishing of every society and for every individual community, which is a constituent part of that society. Fourth, the Catholic obstetrician must appreciate that motherhood is so fundamental to human existence that profound compassion is necessary. This involves compassion for all mothers and their families, believers or not, who suffer to beget and bring up their children.

MaterCare International has clear values as a Catholic professional organization which “Places itself at the service of a new culture of life offering serious and well documented contributions, capable of commanding general respect and interest by reason of merit (E.V.98).” Promoting the dignity of all mothers, especially those in rural areas in developing countries, is realized with essential obstetrical services based on the highest medical and ethical standards with focus on the family as being the chief guardian of life and health. Collecting information on existing programs relating to MCI’s general objectives, evaluating and adapting them where necessary, provides new approaches to current maternal and women’s health problems. MCI’s mission includes supporting, encouraging, and evangelizing Catholic obstetricians and gynecologists, residents in training, and medical students to carry out the work of the Gospel of Life. Constituting a Catholic medical organization, its members act as a professional witness for the Church.

The Development and Application of a Model of Comprehensive Rural Maternity Care for Developing Countries

MaterCare International has assembled a unique, but small, group of specialists with a privileged vocation in the service of mothers and babies. Initially, the group developed a model of essential rural obstetrics in dioceses in Nigeria in the 1980s and 1990s, and in Ghana from 1995 to 2004, culminating in the development, construction, and equipping of a fistula hospital in an archdiocese in Ghana from 1995 to 2006.

In 2004, Matthews and Walley published a description of the implementation and evaluation of a safe motherhood project in the Brong Ahafo region of Ghana (Matthews and Walley 2004-05, 24-33). This project covered six rural maternity centers of eleven in the district and ran from mid-1998 to mid-2004. The overall goals were to improve maternal health by lowering maternal mortality and morbidity rates in the district of Nkoranza and to develop an integrated maternal health service linking the rural areas with the district hospital.

The project included a partograph and emergency skills program for rural midwives, training and monitoring traditional birth attendants (TBAs), a blood bank, and an emergency obstetric transport service. TBAs were included as they were responsible for approximately 65% of women in the district during birth. A total of 4451 births were supervised by trained TBAs.

The results of process evaluation showed that the rural maternal health system was improved by the project activities through a good communication system, better support for rural midwives, better integration of TBAs into the healthcare system, and more community involvement. Outcomes included an increase in the number of referrals of women with risk factors and complications to the district hospital, no cases of prolonged obstructed labor in the group of mothers cared for by rural midwives and trained TBAs, a comprehensive recording and reporting system for women cared for by TBAs, and a well-established emergency obstetric transport service. Integration of TBAs into the healthcare system had positive effects on TBA practice and morale.

The data also suggested that deaths were reduced in the villages covered by the project. However, mothers were still dying after transfer to hospital or health center, and over half of these were mothers not covered by the project. The authors concluded that community education and participation are key components of a safe motherhood project.

MaterCare International representatives have also conducted a needs assessment for maternal health services in Albania, Rwanda, Sierra Leone, and East Timor. A group of doctors and midwives from Poland provided emergency obstetric care after the earthquake in Port au Prince, Haiti, in 2010 and 2011.

From 2005 to 2019, at the request of the late Bishop Locati, MCI developed Project Isiolo in the Apostolic Vicariate of Isiolo (AVI), Kenya, which provides rural mothers with essential obstetric services and brought maternal health services closer to village communities. Unfortunately, Bishop Locati had witnessed firsthand a high burden of maternal deaths in Isiolo, a reflection of Kenya’s maternal mortality ratio remaining unchanged at 488 deaths per 100,000 live births from 1990 to 2013 (UNICEF 2014).

The Isiolo model took into consideration relevant obstetric causes and other contributing factors, such as a lack of adequate facilities and skilled staff and obstructed or delayed communication and transportation.

Initially, the project focused on villages where 80% of deliveries and most deaths occurred. In Isiolo, most rural mothers are delivered by village TBAs who live close to communities and have earned women’s respect and trust. These TBAs have considerable experience but no formal training and their equipment is very poor. MCI trained TBAs already working on site to recognize mothers at increased risk of complications and refer them to the nearest rural maternity clinic staffed by trained midwives. They learned that maternal deaths and birth injuries were not inevitable but could be prevented by timely access to essential antenatal care and skilled normal delivery available at these maternity clinics. Simple transport using newly designed motorcycle ambulances made it possible for midwives to travel to isolated villages to provide antenatal care and education, and to transport mothers in need to the nearest rural maternity clinic. A four-wheel drive ambulance fitted with resuscitation equipment was purchased to transport mothers to the Maternity Hospital in Isiolo. Emergency transport of this kind is essential to resuscitate and transfer mothers with life-threatening obstetric complications to hospital in a safe and timely manner.

The AVI MaterCare Maternity Hospital has thirty beds and provides full antenatal, intrapartum, and postnatal care, including diagnostic ultrasound and specialist management of life-threatening obstetric complications with Caesarean section and blood transfusion. It also provides training for medical and nursing staff in essential obstetrics. Postnatal care includes access to natural family planning services offering modern fertility awareness methods (FAMs).

Maternity waiting huts (manyattas), built in a traditional village style, were erected at village maternity clinics and planned for the AVI MaterCare Maternity Hospital to enable high-risk mothers from remote locations to safely await delivery. Mothers unable to care for themselves are allowed a relative to stay and provide care. The development of Project Isiolo required other services such as a fully equipped kitchen and laundry, rainwater collection and storage, and alternative energy sources (including solar power and innovative biogas from the hospital sewage and community waste).

At present, MCI is planning new obstetric projects in Rwanda and Uganda.

Other Activities

When required, MCI provides human and financial resources to prepare tailored programs in developing countries for obstetricians, midwives, residents, and medical and nursing students, in subjects such as bioethics, FAMs, the diagnosis and ethical treatment of infertility (including NaProTechnology), essential obstetrics, and obstetric fistula care. MCI’s members consider it their duty to inform the public, especially in developed countries, about the poor state of maternal health in developing countries and what can and should be done to improve it.

Numerous educational and training programs have been organized and implemented by MCI. In Kenya, regular activities of this kind were offered for TBAs to improve their knowledge and ability to provide care during normal pregnancy and delivery, with special attention to the early recognition and referral of high-risk pregnancies using a pictorial antenatal form (Pictograph). Other resources provided in developing countries include the CALM course (critical activities in labour management) for doctors and midwives, training in the Billings ovulation method, an introductory course in NaProTechnology (Nairobi, Kenya, in 2013 and 2014), and a training DVD on the surgical and nursing management of obstetric fistula, which has been widely disseminated.

MaterCare has offered regular conferences for Catholic ob-gyns in Rome, Italy (2001, 2002, 2004, 2006, 2008 2011, 2013, 2015, 2017, 2019, 2020); in Zagreb, Croatia, and Warsaw, Poland (both in 2007); and in Rzeszów, Poland (2019). During the first MCI conference in Rome, Saint Pope John Paul II invited participants to a private audience. The late Holy Father stated that MCI fulfilled the need for an international group of Catholic obstetricians and gynecologists which provides life and hope and challenges the status of the culture of death that is the basis of modern obstetrics.

In the late 1990s and early 2000s, three studies were prepared and performed in Ghana to evaluate a simple, effective, safe, inexpensive medication to prevent or treat post-partum hemorrhage, the commonest cause of maternal mortality in the developing world (Walley et al. 2000, 1111–1115; Parsons et al. 2006, 20–26; Parsons et al. 2007, 711–718).

Together with co-workers, Dr. Walley prepared and published the Charter of Maternal Rights (MaterCare 2012). We underline that at the global level, maternal health remains the most neglected area of healthcare despite it being discussed extensively for many years by a plethora of stakeholder government representatives and professional associations. MCI believes that effective implementation of the Charter of Maternal Rights will, by enabling mothers to receive the full range of authentic maternal rights, serve to improve the health and lives of mothers and babies and enhance their dignity.

MaterCare International has provided its expertise to healthcare decision-makers to set appropriate priorities to protect all human life, to affirm the dignity of parenthood (and motherhood in particular), and to uphold the teachings of the Catholic Church in all matters. MCI has worked with policy makers, the public, and media to develop programs to ensure that sound medical practices and healthy behavior and lifestyles are promoted to the general population, especially the young, with a view to the primary prevention of infertility and other adverse outcomes from the misuse of human sexuality and fertility.

In 2005, MCI was invited by the Government of the Republic of Georgia to give advice on the effects of a high abortion rate and the quality of obstetric practice on the demography of Georgia and, in 2006, served as a witness at a hearing on a pro-life constitutional amendment at the Polish Sejm (Parliament). Representatives of MCI, most often Dr. Robert Walley, participated in an NGO Conference at the United Nations (2006) and co-sponsored briefings on Aid for Women’s Health in the European Parliament (2006).

From 2007 to 2020, representatives of MCI actively participated in the Forum for Catholic Inspired NGOs, organized by the Secretary of State of the Holy See, and served as a witness at a hearing of the United States House of Representatives Foreign Affairs Sub-committee on Africa and Global Health (2008). MCI was also briefed by the Prime Minister of Canada’s senior policy advisors regarding maternal healthcare needs for rural mothers in developing countries care (2010 and 2014). Dr. Robert Walley, representing MCI, worked as a speaker at the side event organized by the Office of the Permanent Observer Mission of the Holy See to the UN on Best Practices for Maternal Health Care in Africa during the UN Commission on the Status of Women (2016). Dr. Walley was appointed a Consultor to the Pontifical Council of Health by Pope John Paul II in 1985 and has been reappointed twice, most recently in 1996. On December 9, 2012, he was awarded Pro Ecclesia et Pontifice by Pope Benedict XVI, the highest award given to a lay Catholic.

MaterCare International cooperates closely with FIAMC and has official recognition as its obstetric arm. As mentioned above, FIAMC’s Promise of the Catholic Doctor, approved by the Holy See, was accepted by MCI. MCI also cooperates with CICIAMS (World Federation of Catholic Nurses) and other pro-life professional organizations, for example, the American Association of Prolife Ob-Gyns (AAPLOG). MaterCare’s Economic and Social Council status is recognized by the United Nations. As mentioned earlier, MaterCare informs the public about the poor condition of maternal health in developing countries and what could and should be done to improve it.

The Future

What is the future role of a professional organization of obstetricians and gynecologists following the teachings of the Catholic Church? Not surprisingly, there are many roles to fulfill: providing a professional voice defending the Catholic position on matters of faith in the practice of ob-gyn; defending with vigor the right to practice according to conscience; continuing to develop maternal healthcare projects for at-risk communities in Africa; revitalizing existing national MaterCare organizations; encouraging the development of new national organizations and recruiting young colleagues; promoting wider usage of modern FAMs of family planning and morally acceptable treatments for infertility such as NaProTechnology; reaching out more effectively to undergraduates and young specialists in training before they become disheartened by the prevailing culture of the ob-gyn profession, and helping to steer them through their challenges; continuing Rome-style conferences every 1–2 years which could be replicated nationally; providing information to colleagues concerning the Church’s moral teaching; supporting medical students and residents in training, especially to attend MCI’s conferences; and publishing position papers and professional statements on current ethical issues.

The 2021 MCI Rome conference has been postponed to 2022 because of the COVID-19 pandemic. Linacre Quarterly readers are welcome to attend MaterCare’s next meeting at Istituto Santa Maria Bambina in Rome in September, 2022 (date to be confirmed).

Closing Remarks

St Luke tells us of the incident of the woman who raised her voice in the crowd and said to Jesus: “Blessed is the womb that bore you and the breasts that nursed you.” In reply Jesus said, “Blessed, rather, are those who hear the word of God and keep it” (Luke 11: 27–28). Dr. Walley believed that Jesus’ answer was not one of disapproval of what the woman had said about His Mother, as He understood more than anyone that Mary was the complete Mother who gave Him total and unconditional love and shared intimately in His life and in His death. Jesus was, however, issuing a call to action to His Church to follow His Mother’s complete love and service which is so necessary in these difficult times. Let us also answer the 2001 call of St John Paul II to the medical profession, and ob-gyns in particular, to “commit whole-heartedly to the service of human life…promoting the ideal of unambiguous service to the miracle of life!” Would you be prepared to join an organization which challenges the culture of death by providing life and hope?