They die from bleeding, infection, high blood pressure, prolonged labor and botched abortions  problems that can be treated or prevented with basic obstetrical care. But in Tanzania, which has neither the worst nor best medical care in Africa, but is similar to many poor countries, everything is in short supply: doctors, nurses, drugs, equipment, ambulances and paved roads. By the time many women get to the 120-bed hospital here, it is too late to save them.

Image Ute Klatt directs the orphanage in Berega, where children get extra care from teenagers who are their extended relatives. Credit... Béatrice de Géa for The New York Times

Their babies may be saved, but their survival hangs in the balance. Often, the father or other remaining relatives cannot take care of newborns. Without breast milk, infants here are in real trouble. Formula and baby food are not widely available, and cow’s milk is a poor substitute. Malnutrition and infection are constant threats. An orphanage can provide basic needs, but to thrive, babies need dedicated caregivers, and their extended families may live in distant villages.

The orphanage here, started in 1965 by United German Mission Aid, an evangelical Christian mission, began recruiting relatives to move in about five years ago. Ute Klatt, a German missionary and nurse who has been director of the orphanage for 10 years, said she learned about the practice from another orphanage in Tanzania. Now many of the children at the orphanage are cared for by a teenage girl from the extended family  a binti, in Swahili  often a sister, cousin or aunt, who lives with them and learns how to take care of them.

The young women come to love the children, and will look after them when they leave the orphanage, Ms. Klatt said. In addition, the bintis, some of whom have never been to school, gain some education. Ms. Klatt provides schoolbooks, she said, and the young women study and teach one another in the evenings. Many arrive illiterate and leave knowing how to read. She also teaches them the basics about health, and they learn sewing and batik, and share the cooking in an outdoor kitchen.

“Before we had this system, the families weren’t visiting, and it was hard to reintegrate the children,” Ms. Klatt said. “There were attachment disorders.”

With the bintis, Ms. Klatt said, life becomes less institutional and the children grow up more normally, as they might at home.