Ethiopia has one of the highest rates of maternal mortality in the world. There are 3,500 new cases of fistula each year, in addition to over 35,000 untreated cases in different regions. In a country of 102 million, there are still very few trained midwives, especially in rural and remote areas where 80% of the population resides. This results in only 6% of births taking place with a skilled attendant present.
ETHIOPIAID’S AIM: 1) Increase access to quality maternal health services; 2) Contribute to the eradication of obstetric fistula.
- High maternal and newborn mortality rates, as well as adolescent mortality due to pregnancy
- High rates of pregnancy related disabilities, including obstetric Fistula (a condition that has been eradicated in Canada)
This is mainly due to:
- Lack of access to adequate MNCH services, low number of midwives: caused by insufficient access to education and training
- High number of births in rural and low income settings where care is unavailable: caused by high rural population (farmers and pastoralists) without adequate access to health care facilities or culturally appropriate skilled health workers
Ethiopia is one of 73 countries that, combined, account for 92% of global maternal and newborn deaths and still births while only having 42% of skilled medical staff in the world. The most recent data available shows that every year, 13,000 women die because of complications related to child birth and 84,000 newborn lives are lost. While care is slightly more accessible in major cities (e.g. Addis Ababa), one of the major challenges is getting maternal, newborn and child health (MNCH) services to rural communities.
By 2030, 84% of all births will occur in a rural setting. Most MNC deaths occur in low-income rural settings and are usually caused by severe bleeding, infection, high blood pressure, and complications during delivery. The risk of maternal mortality is also highest for adolescent girls under 15. Alarmingly, complications in pregnancy and childbirth are among the leading causes of death among adolescent girls in developing countries. Many of these deaths and disabilities can be prevented by the presence of a skilled birth attendant before, during, and after birth. However, about 80% of Ethiopian women lack access to proper medical care during pregnancy and childbirth. Approximately 15% of pregnant women in Ethiopia develop potentially life-threatening obstetric complications (State of Ethiopia’s Midwifery, UNFPA, 2012).
A devastating consequence of inadequate maternal health care in the country is the high prevalence of fistula. An obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labor, leaving a woman incontinent of urine or feces or both. In addition to incontinence, many women with fistula suffer severe nerve damage as well as psychological trauma. In Ethiopia alone, there are an estimated 3,500 new fistula cases per year, occurring largely in rural and impoverished regions of the country. Current estimates suggest that there are between 30,000-40,000 untreated women still living with fistula throughout Ethiopia.
Improve access to sustainable maternal health care in three main ways:
- Training: Currently, midwives only meet 23% of the need for MNCH service in Ethiopia. If we could double the number of trained midwives by 2020, we could meet 58% of the national need by 2030. Training midwives as well as community health workers and other medical staff is one of the most sustainable and impactful ways to address MNC needs.
- Treatment: Disabilities from pregnancy such as Obstetric Fistula are easily treatable, however surgeries are often inaccessible for the most vulnerable women. Providing access to treatment and rehabilitation services gives women an opportunity to return to their communities and live a dignified life.
- Prevention and Empowerment: In addition to training midwives, improving health outcomes can be achieved through providing gender sensitivity training, discussing nutrition, early marriage and female genital mutilation. Community engagement works to address the underlying challenges that seriously impact women, newborns, children and adolescent girls.
Women and Health Alliance (WAHA): A beacon for women in need
WAHA works in three locations across Ethiopia with the mission to increase access to quality maternal health care; particularly emergency obstetric care. Headed by the remarkable Dr Mulu Muleta, WAHA provides free obstetric fistula repair surgeries to some of Ethiopia's most marginalized women. The operation itself only takes a few hours. WAHA provide quality pre and post operative care, medicine, fluids and nutrition; nursing the woman back to health. Within weeks she can return to her community, ready to embrace her second chance at life. WAHA's staff are working tirelessly to locate and help these women suffering from this debilitating condition, located in some of the most rural and isolated areas of Ethiopia.
Ethiopiaid Canada is supporting a program to train more local health staff to treat and rehabilitate women suffering from obstetric fistula, run by WAHA at Gondar University's Teaching Hospital. In order to help prevent new cases from occurring, WAHA trains former fistula patients to become Health Extension Workers; fuelled with the knowledge to return to their communities and teach other women about the risk of obstetric fistula and the importance of having their births in a hospital.
Hamlin Fistula Ethiopia (HFE): Holistic Fistula Treatment
Since moving to Ethiopia in 1959, Australians Dr Catherine Hamlin and her husband, Dr Reg Hamlin, have been undertaking incredible work to save the lives of obstetric fistula sufferers from all across the country. For more than five decades, Dr Hamlin has tirelessly worked to provide Ethiopian women with a second chance. HFE provides free obstetric fistula repair surgeries to some of Ethiopia's most marginalized women. The operation itself only takes a few hours and has a 90% success rate.
We work with HFE to provide patients with holistic treatment that includes quality pre and post operative care, medicine, fluids, nutrition, physiotherapy, and rehabilitation. Within weeks, most women are healed and ready to return to their communities. Before leaving the hospital, every patient receives a new dress provided free of charge as part of our care package.
Amref Health Africa: building capacity where it is needed most
“Midwives who are educated and regulated to international standards can provide 87% of the essential care needed for women and newborns” – UNFPA, 2014
The contribution of trained Midwives cannot be understated in preventing deaths before, during or after birth and in ensuring the health of women, newborns and children. In Ethiopia there is a severe shortage of qualified midwives to manage pregnancies and births. Currently, the number of trained midwives only meets 23% of the need for care in the country. If, by 2020, we could double the number of trained midwives in Ethiopia, we could meet 58% of these needs!
In 2016, Ethiopiaid Canada began a partnership with Amref Health Africa to support two maternal health projects to make an impact in particularly disadvantaged rural communities. The first is a midwife training project in the country’s remote South Omo region. By the end of this year, 29 Midwife students in South Omo will complete their three-year Midwife training program, and will begin providing maternal, newborn and child health (MNCH) services, often for the first time, in their respective communities. This training project is the last component of a three-year program supported by the Government of Canada, which was designed to reach and benefit over 480,000 community members across South Omo, with a focus on pregnant women and children under the age of five.
Through our partnerships with Women and Health Alliance, Hamlin Fistula Ethiopia and Amref Health Africa, we have achieved the following:
- Provided free fistula repair surgery and holistic care to over 1,250 women.
- Registered over 5,000 pregnant women across 50 health clinics in rural Ethiopia.
- Increased awareness about fistula as a treatable condition through the work of mobile maternal health advocates in rural communities.
- Reduced early marriage practice through the work of mobile maternal health advocates in rural communities.
- Trained one of the very first contingents of midwives in South Omo region, who will be deployed back into their home communities; they were trained in their native Mursi language.
- Increased maternal health and family planning knowledge through 12 support groups for expecting mothers
- Increased awareness of safe pregnancy and safe childbirth through community sensitization workshops.
Read our success stories here