“I thought I was going to lose my baby and die on the journey to hospital.”

The chilling words of Samueline Razafindravao, who had to make the harrowing hours-long trip to the nearest specialist hospital in Ambovombe town in the Androy region of southern Madagascar after it became clear she might lose her child if she did not seek urgent medical attention.

Ms. Razafindravao spoke to UN News ahead of World Health Day, marked annually on 7 April.

In a country where many babies are born at home and where a traditional midwife may be paid a chicken to deliver a baby, the decision she had to make was a momentous one.

“I tried to give birth at home because I was worried about the expense of going to hospital,” she said, “but I knew I was having too many difficulties, so I went to the local health centre.”

Health carers there recognised that she needed a more sophisticated level of care and called an ambulance from the Androy Regional Referral Hospital, a journey across a region laced with unyielding roads.

“The baby was pushing a lot and then suddenly was not moving. I thought I was going to die and lose the baby as well.”

Lack of ambulances

It’s a rare lifesaving luxury and an unusual opportunity to be able to call an ambulance in Madagascar. But, then the Androy Regional Referral Hospital is perhaps not a typical hospital in what is one of the poorest regions in one of Africa’s poorest countries.

It has developed into a specialist hospital for a range of services, including maternal health, thanks in part to the support of United Nations agencies working in the country. The United Nations sexual and reproductive health agency, UNFPA, provided one of the two ambulances the hospital has at its disposal.  

The agency also supports a surgeon who carries out Caesarean sections as well as obstetric fistula surgery as well as two midwives who help with delivering babies and family planning. It has also provided incubators for premature babies and birthing kits for mothers.

UNFPA’s Dr. Sadoscar Hakizimana, a surgeon who has delivered dozens of babies by Caesarian section at the hospital, believes that a concentration of maternal health services is the key to saving more lives.

“Many pregnant women, perhaps 60 to 70 per cent, who arrive here have already lost their baby because they have sought medical help too late,” he said, “but we have a 100 per cent success rate of healthy births, either natural or Caesarian, for those mothers who arrive on time, as we have a range of care options we can offer them.”

All the care is free and is complemented by other services provided by different UN agencies. The UN Children’s Fund (UNICEF) is providing nutritional and medical care for children suffering from severe acute malnutrition as well as information sessions on good nutritional practices for parents.

The World Health Organization (WHO) is providing services for people with disabilities and those with mental health challenges.

And UN Development Programme (UNDP) has worked with the hospital to install solar panels to ensure that the equipment essential to keeping people alive is not rendered inoperable by the sometimes erratic power supply from the grid.

Dr. Germaine Retofa helps a new mother to breastfeed.

Dr. Germaine Retofa, the acting Regional Director for Public Health in Androy, has overseen the integration of services at the hospital which has led, amongst other improvements, to a reduction in maternal and infant mortality as well as an increase in childhood vaccination.

“It makes sense to bring all these services together, as we can offer a more holistic approach to health care which may include maternal health services alongside nutrition advice and care for malnourished children,” she said. “It’s also easier to add additional services when we have this structure in place.”

The UN in Madagascar is focusing its resources on what it is calling “convergence zones”, which allows UN humanitarian and development-focused agencies to coordinate long-term interventions. 

Young mothers recover in the maternity ward of the Androy Regional Referral Hospital .

“In these convergence zones, it’s really important to underscore that development and humanitarian actors work in partnership,” said Natasha van Rijn, the Resident Representative for the UNDP in Madagascar.

“If we allow ourselves to look at the situation in Madagascar with all the complexity it deserves, then we have a chance of addressing the needs in all their complex multisectoral dimensions,” she added.

Back at Androy Regional Referral Hospital, Ms. Razafindravao and her now four-day-old baby girl, who was ultimately born by Caesarean section, are doing well on the maternity ward. As a young mother, she is learning how to breastfeed her baby, who she has named Fandresena, and before long, she’ll make the long 200 km journey back home, but this time not in an ambulance called in an emergency.

• Strengthen resilience and adaptation to climate-related hazards and natural disasters
• Integrate climate change measures into national policies, strategies and planning
• Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaption, impact reduction and early warning
• Raise capacity for effective climate change-related planning and management in least developed countries

The UN Framework Convention on Climate Change (UNFCCC) is the primary international, intergovernmental forum for negotiating the global response to climate change.

“You’re speaking about the greatest crime against humanity ever committed,” said renowned historian Sir Hilary Beckles, who also chairs the Caribbean Community’s Reparations Commission, reflecting on the transatlantic trade that enslaved more than 10 million Africans over four centuries.

“One could say it was an institution that was abolished 200 years ago, but let me tell you this,” he explained, “there is no institution in modernity, in the last 500 years or so, that has changed the world as profoundly as the transatlantic slave trade and slavery.”

Remembering slavery in the 21st century

At a special General Assembly event for the International Day of Remembrance of the Victims of Slavery and the Transatlantic Slave Trade, marked annually on 25 March, guest speakers included Sir Beckles and 15-year-old activist Yolanda Renee King of the United States.

“I stand before you today as a proud descendent of enslaved people who resisted slavery and racism,” Ms. King told the world body.

“Like my grandparents, Dr. Martin Luther King Jr. and Coretta Scott King,” she said, “my parents, Martin Luther King III and Arndrea Waters King, have also dedicated their lives to putting an end to racism and all forms of bigotry and discrimination. Like them, I am committed to the fight against racial injustice and to carrying on the legacy of my grandparents.” 

UN News caught up with Ms. King and Sir Beckles to ask them what the International Day of Remembrance meant to them.

UN News: The transatlantic trade in enslaved Africans was abolished centuries ago. Why is it still important for the world to remember it?

Sir Hilary Beckles: When we say centuries ago, yes, maybe just under 200 years, but slavery and the slave trading enterprises were the greatest commercial enterprises in the world at that time and had an impact on the structure of the world economy, politics, race relations and cultural relations and how civilizations have interacted with each other. The impact was so profound and deep seated and sustained over several generations.

Yolanda Renee King: It’s so important for there to be some sort of acknowledgment. It is a day of reflection. I think that we have to acknowledge our history, our mistakes and the pain. We haven’t reached the full potential of our world because of the transatlantic trade in enslaved people.

The Memory of Slavery exhibit at UNESCO’s Slave Route Project in Paris. (file)

UN News: What legacies of the transatlantic trade in enslaved Africans are still with us today?

Yolanda Renee King: There are still remnants of that racism, of that discrimination. We must acknowledge the origin in order to solve the problem and to solve the issues. Clearly there’s a lot of discrimination and racism everywhere. While we have, each century, made strides, I think there are still issues very much present.

In order to solve the issue, we have to first acknowledge it.

Especially now more than ever, we’re seeing a big push back. We’re seeing a rise of racism and not just racism, but discrimination against all marginalised groups in general.

Sir Hilary Beckles: The consequences have been very significant. We see the evidence of those legacies everywhere, not only in the places where it was practiced, like in the entire Americas, but in Africa and to some extent in Asia.

We see it not only in the obvious issues of race relations and the development of racism as a philosophy for social organization, where most societies where it has touched are now structured in such a way that people of African descent are considered the most marginalised people, and the descendants of the enslaved people still continue to suffer racism.

If you look at countries with the greatest incidence of chronic diseases, Black people have the highest proportions of diabetic adult patients in the world.

The island where I’m from, Barbados, is considered the home of chattel slavery where the slave code in 1616 became the slave code for all of America in which African people were defined as non-human chattel property. Now, Barbados has the world’s highest incidence of diabetes and the highest percentage of amputations. 

It cannot be a coincidence that the small island that was the first island to have an African majority and an enslaved population is now linked to the greatest amputations of patients with diabetes in the world.

The Island of Gorée off the coast of Senegal is a UNESCO heritage site and a symbol of the suffering, pain and death of the transatlantic slave trade.

UN News: How should those legacies be addressed?

Yolanda Renee King: If you want to have a world with discrimination and prejudice and all this and you want hardship for the future, then go ahead and just leave things the way they are today.

But, if you want change, if you want to really do something, I think the best way to do that is really holding our leaders accountable and bringing these issues up to them. They’re the ones that are going to determine not only your future, but your child’s future, your family’s future and those after you, the future for them.

Sir Hilary Beckles, Vice-Chancellor of the University of the West Indies and Chair of the Caribbean Community (CARICOM) Reparations Commission, addresses the General Assembly.

Sir Hilary Beckles: We are still dealing with clearing up the fundamental issues of colonisation, massive illiteracy, extreme malnutrition and chronic disease, and addressing these matters required tremendous amount of capital investment. So, when we speak of justice, basically what we are saying to the colonisers and the enslavers who have left us legacy behind: “This is your legacy, and reparatory justice says you must come back to the site of the crime and facilitate the clean up operation.”

Thirty or forty years ago, reparatory justice was a concept that attracted very little support. By redefining the concept of reparations, we said they are about repairing the damage done to a people, communities and nations. These issues must be repaired if these countries have a chance of having development.

We have found that African governments now equipped with the historical knowledge are able to say “we want to have a conversation around reparations; we want to talk about it.” That was one of the major seismic achievements. When the African Union met at the end of last year and declared that 2025 is going to be the year of African reparations, that was a huge historic achievement.

UN News: Ms. King, your grandfather’s iconic I Have a Dream speech in Washington in 1963 continues to inspire generations to forge ahead in the struggle for rights. His dreams were for a day when people would be judged on their character, not their skin colour. Has his dream been realized in 2024, and have you ever felt judged by the colour of your skin?

Yolanda Renee King: I don’t think we’ve reached that dream yet. I think that there has been some progress. I think that there have been some strides since the speech was made. But, we shouldn’t be where we are now. I think we should be more ahead. And if he and my grandmother were still alive, I think that we as a society would be much farther along than we are now.

As someone who is a Black person, I think that unfortunately we’ve all faced some sort of discrimination and judgment. Unfortunately, yes, there have been times when I’ve been judged based on my race. I think that we need to find a way to move on, and we need to begin to strategise.

I think a lot of people, rather than talking about the dream and glorifying it and celebrating it and putting a tweet acknowledging it on [Martin Luther King] MLK Day, we actually need to start taking some action in order to move forward as a society, in order to improve and in order to be in the world in which he described in that speech.

#RememberSlavery, #FightRacism: Why now?

UNFPA Executive Director Natalia Kanem speaks at the opening of the Ibo Landing exhibit in New York.

The UN hosted a series of special events to highlight the Week of Solidarity with the Peoples Struggling against Racism and Racial Discrimination, from 21 to 27 March, and to mark the final months of the International Decade for People of African Descent.

To find out more and access key documents, conventions and information, visit the UN outreach programme on the transatlantic slave trade and slavery and #RememberSlavery.