Improving antenatal care in Savai’i: A journey of hope and transformation

Nurse and midwife Logomai Lualua witnessed firsthand the disparities in healthcare access that expectant mothers experience in Savai'i, and resolved to make a difference.

Woman with pink flower behind her ear and floral black and white dress smiling at photographer, a set up for graduation behind her

As a nurse and midwife working in Savai’i, Samoa’s largest island, a Te Herenga Waka—Victoria University of Wellington Master's student has witnessed firsthand the stark disparities in healthcare access that expectant mothers experience, but is hopeful her research will make a positive difference.

Logomai Lualua is set to graduate with a Master of Health Research and Midwifery, which she completed through Te Kura Tapuhi Hauora—the School of Nursing, Midwifery and Health Practice, in collaboration with the National University of Samoa. Her thesis, Barriers and Facilitators to access of antenatal care by women in Savai’i, was supervised by Associate Professor Robyn Maude, who travelled to Samoa to work with Logomai on the project.

“Robyn’s mentorship was key to my success,” says Logomai. “I also wish to thank my mother Lagaau Savea Ta’ala, who is a dedicated nurse midwife and my motivator and inspiration.”

Logomai says her own experiences on the frontline of maternal healthcare in Savai’i, where resources are very limited, prompted her to strive to improve conditions.

“While Upolu, our main island, enjoys regular access to specialist services and well-resourced facilities, Savai’i often faces a very different reality—resources are limited, and specialist visits are rare and rushed,” she says.

“Expectant mothers travel long distances for care and, too often, wait too long—whether due to a lack of awareness, cultural barriers, or the absence of accessible services. I’ve lost count of the times we’ve had to arrange urgent boat transfers for mothers with life-threatening complications. Each transfer is a race against time, with the safety of both mother and baby hanging in the balance.”

While this has been the accepted status quo for a long time, Logomai knew it didn’t have to be this way.

“The women of Savai’i deserve better. They deserve the same level of care, compassion, and access to services as women in Upolu—and women elsewhere in the world.”

Logomai was able to remain in Savai’i to conduct her Master’s research through Te Herenga Waka as part of the Growing Our Own programme, alongside Jyothi Abraham, Francis Penaia, and Mele Tofaeono. “It was a privilege to study with you.” The programme delivers postgraduate healthcare courses with the aim of building capacity and supporting the nursing and midwifery sector in Samoa.

“I conducted in-depth interviews with women who accessed antenatal care early, late, or not at all. I listened to their stories—accounts of resilience, sacrifice, and hope—while also uncovering the systemic challenges they face,” explains Logomai.

“The findings were both heartbreaking and enlightening. Many women wanted to access care but faced too many obstacles. Some lacked knowledge of the importance of early antenatal visits, while others couldn’t afford the journey to the nearest clinic—or prioritised their families’ needs over their own health. Tragically, fewer than 30 percent of women in Savai’i book antenatal care before 20 weeks’ gestation, the timeline recommended by the World Health Organization.”

Logomai says these stories reinforced to her the urgency of the situation.

“Booking too late for antenatal care often leads to complications that could have been prevented or managed earlier. It’s not uncommon for pregnant mothers to present at hospitals in active labour with severe complications—scenarios that demand emergency transfers between Samoa’s islands, posing significant risks to both mother and baby.”

She says consistent access to specialists, adequate resources, and empowered healthcare providers in Savai’i would make a significant difference, and would result in fewer emergency transfers, reduced risks, and a community where women feel safe and supported during their pregnancies.

“This is why I remain committed to advocating for better access to antenatal care in Savai’i. My research is just one step in a long journey, but I hope it serves as a catalyst for change—a reminder that no woman should face unnecessary obstacles in accessing essential healthcare. Together, we can create a future where every mother feels empowered to seek and receive the care she needs.

“No woman should have to accept limited care as her only option. We can do better. And we will.”

Read Logomai Lualua’s Master’s thesis, Barriers and facilitators to women’s access to antenatal care in Savai’i, including the full list of thank-yous on page 4.


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