Mkpani, Nigeria – For Cletus, a security guard from the village of Mkpani in Cross River state, joy that his wife Antonia was pregnant for the fourth time, was tempered with fear after her first antenatal visit: she was expecting triplets.

Eight months later, Antonia gave birth safely at the village Primary Health Center under the care of Sister Clementina, a village midwife. As is often the case with triplets, the two girls and a boy were all healthy but underweight, the largest weighing not quite four pounds and the smallest a little more than two.

Sister Clementina, who was trained under a project supported by the U.S. Agency for International Development (USAID), told Cletus the babies needed to spend time in an incubator at the local hospital, but he was afraid the potential cost would be too big a burden and refused on behalf of the family.

Clementina had heard such refusals in the past, and did her best to prepare Antonia to get through the babies’ critical first weeks of life at home under the circumstances. She counseled them to keep the home warm and clean, wash hands frequently, have the other children handle the babies as little as possible, and apply antiseptic gel to the umbilical cords. She taught Antonia to keep the babies warm with the kangaroo mother care technique, and how to express breast milk.

With three babies, she told her, her own milk supply needed to be augmented with breast milk substitute. When Cletus couldn’t afford that either, Clementina turned to the Mkpani Ward Health Development Committee, which, like her training, was made possible by USAID under the Saving Mothers, Giving Life activity.

Supported by community donations from the private sector, the committee was able to finance the breast milk substitute and a supply of extra-small diapers for the tiny newborns, which Clementina brought with her on her twice-weekly visits for the first six weeks.

As the family settled into a routine, Clementina brought up another important subject. Now with six young children, they must consider family planning.

Once assured the intervention would cause no permanent changes in Antonia, Cletus agreed that she should receive a long acting reversible contraceptive implant, which, unless removed, would prevent another pregnancy for five years.

Saving Mothers, Giving Life is an integrated health systems approach that addresses the three primary delays that put young mothers like Antonia and her babies in danger: the delay in seeking services, the delay in reaching care, and the delay in receiving high-quality care at health facilities.

“We have seen improvements in obstetric and newborn care, and a reduction in women and children dying at childbirth – at a time when a woman and her newborn child are most vulnerable,” said Vathani Amirthanayagam, ” a USAID Health Officer, at the recent closing ceremony for the activity in Abuja.

Since 2015, the multi-country activity, implemented in Nigeria by Pathfinder International, well surpassed its initial targets and helped reduce maternal and newborn mortality by 66 and 47 percent, respectively, in the 108 Cross River communities where it operates with funding from USAID, as well as another 30 private hospitals funded by Merck for Mothers. Project officials will soon present the USAID supported SMGL methodology to Nigeria’s National Council for Health with the aim of duplicating the activity’s success in other states.