“If she wasn’t bleeding, she would have suffered like I did and delivered at home,” said Fasika’s* mother Menesch at a Lie and Wait center for expectant mothers in rural Ethiopia.
Menesch was inside the room with her expecting daughter Fasika while nursing her three-month-old daughter on a chair. It was Menesch’s eighth child who, like all the rest, she delivered at home with no trained labor assistant.
Fasika was a mere 15 years old with baby fat still surrounding her cheeks and a shy smile that often looked down at her largely pregnant belly. Meeting Fasika and her mother on the last day of my trip was the defining moment of my two weeks of reporting on maternal and newborn health in Ethiopia.
I went to Ethiopia as a reporting fellow with the International Reporting Project with the goal of gaining a better understanding of the country’s comprehensive health care system established to save the lives of mothers and babies who are at serious risk of dying during and after childbirth.
We met with health extension workers, doctors, midwives, expectant mothers, new mothers and NGOs in both rural and urban settings to get a clear understanding of how Ethiopia, one of the poorest countries in the world, achieved Millennium Development Goal 4—reducing child mortality rates for children under five by two-thirds—well ahead of the 2015 deadline.
We saw the remarkable progress that has been made and the lives that have been saved thanks to the government’s commitment to improving access and quality of maternal and child health.
Yet, there in the dark, mud walls of the Lie and Wait center we heard the story that painted the real picture of the work that remains to be done in saving the lives of Ethiopia’s mothers and newborns, particularly within the birthing process and the first 28 days of life which are the most dangerous days to be alive for a baby.
Although progress has been made for both mothers and children under age five (since 2000, the maternal death rate has decreased from 1 in 24 to 1 in 67 and child mortality rates have been declining 6.1 percent annually), neonatal mortality rates have not seen as much progress and still contribute to 42 percent of all child under five deaths. (Source: Save the Children – Ethiopia).
There are still 118,000 newborn deaths every single year in Ethiopia.
One of the main causes of such high rates of maternal and newborn mortality is the fact that 80 percent of Ethiopian women give birth at home with no trained labor assistant.
To combat maternal, child and newborn deaths the Ethiopian government has trained and deployed an army of over 38,000 Health Extension Workers (HEW) who have been critical to Ethiopia’s amazing success story at reducing child under five deaths as well as maternal deaths. These women are selected, trained and paid by the government to live within and cover a rural Health Post that serves up to 5,000 people within the community. The HEW program launched in 2003 and has saved many lives.
We visited one Health Post in the village of Mosebo to get a better understanding of the services they provide. The Health Post is part of the Ethiopian government’s three-tier health care system to reach its 90 million people, of which 85 percent are located in remote, rural areas. There are currently 16,000 Health Posts like Mosebo in Ethiopia yet the country needs many more as some people walk as much as two hours or more on foot through difficult, mountainous terrain to reach a Health Post.
The more I traveled through Ethiopia, the more evident it became that many people have never even met a health extension worker or had any professional health services before.
Every Health Post is linked to a Health Center where expectant mothers are urged to give birth by a trained birth assistant. There are currently 3,500 Health Centers in Ethiopia and only 130 Hospitals, serving 90 million people.
Per the Ministry of Health, 185 new hospitals are in the process of construction and hopefully will be completed soon. However, visiting an urban and regional hospital proved that even with the new hospitals it still may not be enough. Lines of patients and their families waiting for hours to be seen is a common sight in an Ethiopian hospital. Furthermore, only 19 percent of all Ethiopian women receive prenatal care and only 7 percent for postnatal care.
The infrastructure of Ethiopia is also significantly improving yet remains lightyears behind the country’s massive needs. Some villages are so remote and rural, that it can take a laboring mother hours on foot to reach the nearest health post or center.
If she has complications, the only way to reach the nearest gravel road may be by “traditional ambulance” which basically means the woman is carried on a wooden stretcher for sometimes up to two hours to reach a dirt road where she can be transported to a hospital.
If the torrential rains come like they often due in winter, the dirt roads become impassable. Obviously improving the roads in rural Ethiopia will save many maternal and newborn lives.
After meeting Fasika and her mother at the Lie and Wait house in rural Ethiopia, I realized that much work remains to be done to save Ethiopia’s mothers and newborns.
Roads, health centers, and hospitals need to be expanded and built, doctors and midwives need to be trained, and most importantly, millions of Ethiopian’s need to be educated on the importance of pre and post natal care and of delivering in a health facility.
Fasika and her mother had never seen a health practicioner in their lives and Fasika would have delivered her child at home like her mother if it weren’t for complications.
Long held traditions, cultures and beliefs such as child marriage and desire to birth at home, need to be changed which will take time. There is hope for Ethiopia’s mothers and their children. As long as more progress is made, no woman or child should die so invisibly from a preventable cause.
This post is based on my reporting trip to Ethiopia with the International Reporting Project.
Note: This piece was first published on The Elephant Journal
*All names have been changed to protect privacy.
Amazing article! It seems like a uphill battle though trying to change tradition and get these women to agree to have children with assistance plus actually trying to provide the assistance. It really makes me grateful that I live in a country that has good medical care. It’s also incredibly admirable that you are going out to Ethiopia to change the dismal infant mortality rates. All the best of luck! With more blogs like this bringing awareness there will definitely be more change.
Thanks for the comment. Yes, tradition runs strong in rural Ethiopia and a lot also is due to lack of education. Hopefully over time life will improve for these rural mothers and their families.
it is posts like these that makes me realise how lucky I was to be born where there are facilities available.
Yes Jo, so incredibly true on so many levels. 🙂 We are very blessed.
It is good that there is some hope for these women, but it seems small and far away. Education about contraception and choice for women would be helpful.
Yes, Debra so true. There is education in the works but with a population of 90 million and over 85% in rural remote areas it will take time. The good news is that contraceptions are either free or very minimally prices so women are getting them and normally the injectibles. With more education and keeping girls in school plus decreasing newborn mortality rates I imagine women will have fewer children. It all takes time.
This is a very important issue in which we see the connection between women’s health, education, child mortality rates and women’s rights. Ethiopia has non-stop population growth even when maternal- and child mortality is that high.Something to think about. There’s definetely a lot to be done there, just like it is in many other undeveloped countries.
Thanks for the comment. Yes education and family planning is key. The government of Ethiopia has launched their army of Frontline Health Care workers to reach all the people living remotely (85% of Ethiopia’s 90 million live outside cities) but it will take time.
What terrible challenges these women face, NIcole. We are so fortunate in every way. Your last photo is very moving.
Thanks Sylvia. Yes I can’t imagine the challenges they face. I’m glad I got to see some of the progress being made as it was very powerful to see on the ground. Lots more work needs to be done but at least the country is heading in the right direction.
The post is both shocking and hopeful. I agree with Sylvia the last photo is so powerful.
Thanks Sue! Yes so much work needs to be done but it was so powerful to see the progress that has been made on the ground. It really had an impact on me.
There is so much work to be done. So many challenges to face, like infrastructure and cultural beliefs. Were you left hopeful that the country is moving in the right direction, Nicole?
Thanks for the comment Jennifer. Yes I am hopeful that a lot will change in Ethiopia but it will take a lot of time too. so many people live so remotely and roads are non-existent. We also met women who had never ever been or seen any kind of health professional in their life. WIth a country of 90 million in which 85% lives rurally, there is much work to still be done and I bet it will take decades. But the good news is that progress has been made.
Wonderful post Nicole! When we lived in Khartoum, Sudan many of the women I dealt with were refugees from Ethiopia and they would tell stories of the sad infant mortality rate in Ethiopia. Thanks for working to make a difference. 🙂 All the best, Terri
Wow, what were you doing in Sudan? I didn’t know you lived there. Have you written on it Terri? That would be quite the experience!
Nicole, we lived and worked in Khartoum for 2 years. I worked with the International School to teach business owners and teachers how to use computers. James managed geophysical exploration for Sun Oil. It was the best, most humbling experience we’ve ever had in our lives, and created the world view we share today. Thanks for asking! 🙂 ~Terri
That’s right Terri! I remember you mentioning it now before. Have you shared any stories about your experiences in Sudan on your blog? I would love to go back and read it. What is life like for women there?
This was such a moving post Nicole, both deeply sad and hopeful as well. My initial reaction was that this 15-year old is still a child herself, having a baby, but I do understand their beliefs are so different than ours. I cannot fathom living in these conditions.
Thanks LuAnn. Yes there remains a huge problem with child marriage still in Ethiopia even though it isn’t legal. Hopefully over time with education girls won’t be forced to marry so young and will stay in school, have fewer children and a better chance at a healthy life.
Let’s hope this is one of the positive changes.
Did Fasika deliver a healthy baby and how is her health after the complications? I am torn between tears of sadness for the plight of these women and children, and tears of joy for the progress in maternal and child health care services in Ethiopia. Very, very touching, Nicole.
I wish I knew what happened with Fasika. I believe based on our interview that everything was going to be fine. She just had early bleeding and was already now close to delivery. I think what is so hard is her age. The fact that she is only a mere 15 and got married at 12 like her mother. There is no other choice for their girls as most don’t even have the option to go to school since the school is hours walk away. It is sad. I’m glad that they are working on building more health care centers and schools too. Thanks as always for your wonderful comments and support! 🙂
I have read the report properly. It is nice observation and discrpition about the realites concerning the sutation of our mothers and children, here in Ethiopia. As you have indicated, we have serious homeworks on decreasing or alleviating maternal and child mortality. I would like to appriciate you. Thank you again.
Thanks for your comment. I loved Ethiopia, the people and culture are so warm and lovely. There is much work to still be done but I’m glad that the country is on the right path. More mothers and children must be saved and they only will by having better access to health care.