Maternal Health

Ethiopia has one of the highest rates of maternal mortality in the world. With a total population of 102 million, there are still very few trained midwives or medical professionals, especially in rural and remote areas where over 80% of the population resides. This results in less than 16% of births taking place with a skilled attendant present, and a life of despair for many women with obstetric fistula. The latest statistics indicate that there are 3,000 new cases of obstetric fistula each year, in addition to over 36,000 untreated cases.

Maternal Health

ETHIOPIAID’S AIM: Increase access to quality maternal health and safe childbirth, and help eradicate fistula throughout Ethiopia

The Challenge

  • High maternal and newborn mortality rates, as well as adolescent mortality due to pregnancy
  • High rates of pregnancy-related disabilities, namely obstetric fistula (a condition that was eradicated in Canada over a century ago)

This is mainly due to:

  • Lack of access to adequate maternal, newborn, and child health (MNCH) services; a very low number of midwives; insufficient access to education and training;

The most recent data available shows that every year,  approx. 13,000 women die in Ethiopia because of complications related to childbirth, and 84,000 newborn lives are lost. While care is more accessible in major cities, the biggest challenge is the availability of adequate maternal, child, and neo-natal services to rural communities, compounded by the inadequacy of the country's road network and the rugged terrain in a very mountainous country.

Most maternal and infant 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, with complications in pregnancy and childbirth among the leading causes of death. This can be prevented by the presence of a skilled birth attendant before, during, and after birth.  It is estimated that over 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 obstetric fistula and other pelvic floor disorders.

What is 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. Obstructed labor can last up to six or seven days. During labor, contractions push the baby’s head against the mother’s pelvic bone. The soft tissues between the baby’s head and the pelvic bone do not receive adequate blood flow. The lack of blood flow causes the tissue to die, creating holes between the mother’s bladder and vagina and/or between the rectum and vagina. This is what produces incontinence in a fistula patient. 

With obstructed labor and in the absence of skilled birth attendants, the death of infants is often inevitable. In addition to incontinence and losing their babies, many women with fistula suffer severe nerve damage as well as psychological trauma. And as a result of their incontinence, women are rejected and ostracized. In Canada, the fistula was eradicated over 100 years ago. In Ethiopia, the latest statistics estimate there are still 3,000 new cases of obstetric fistula each year, occurring largely in rural and impoverished regions of the country, a USAID study found that an estimated 36,000 to 39,000 women in Ethiopia living with fistula are unable to access treatment and suffering in silence.  

Our Solution

Healing Hands of Joy (HHOJ)
Healing Hands of Joy's main mission is to eliminate obstetric fistula from Ethiopia. They help prevent obstetric fistula by training previous survivors as Safe Motherhood Ambassadors to provide education and access to safe delivery options for pregnant mothers. They also help women to identify existing cases of fistula for treatment to bring them into the hospital for treatment.

HHOJ is unique in the fact that they don't only focus on providing surgeries for women suffering from fistula; they empower survivors to become Ambassadors to educate communities. When you have more people that know about fistula, the stigma around it decreases and early detection of fistula happens within communities. Treatment is just as important as rehabilitation and awareness of the issue. 

Hope of Light Civil Society
In late 2020, we started funding Dr. Ambaye's brand new organization; Hope of LIght Civil Society. Dr. Ambaye is a well-known fistula surgeon in Africa and was previously employed by one of our partners, the Women and Health Alliance. With WAHA closing its doors, Dr. Ambaye made the brave decision to start this non-profit. 

Hope of LIght Civil Society provides surgical treatment for patients with fistula and other pelvic floor disorders, trains health professionals, and conducts awareness activities about obstetric fistula in rural communities. Through Hope of Light Civil Society, we are funding the hands-on skills training to General and Medical Practitioners, midwifery, and clinical nurse students in the conservative management and prevention of obstetric fistula. They will also be working to support outreach activities in the community, awareness and prevention activities as well as the creation of mass community awareness through radio.


  • Treatment

    2021: Hope of Light Civil Society, since opening its doors in 2020 has provided 140 surgeries to fistula patients

  • Community Awareness

    2021: Fistula survivors are being trained to become Safe MotherhoodAmbassadors for their community, in order to spread awareness of fistula; reducing the stigma and increasing early detection. 

  • Prevention and empowerment

    2021: Five stakeholder workshops have been conducted to connect Safe Motherhood Ambassadors with midwives, extension workers, and other community stakeholders.

Our Impact

Through our partnerships , to date we have achieved the following:

  • Provided free fistula and pelvic floor disorder repair surgery and holistic care to 1,447 women (Addis, Gondar)
  • Referred obstructed labour cases to specialized care facilities, and reduced early marriage practice through the work of mobile maternal health advocates in rural communities (Gondar)
  • 566 children and adults with disabilities received physical aids - crutches, orthopedic shoes, wheelchairs, vision and hearing devices (Harar)
  • Increased awareness about fistula as a treatable condition through the work of mobile maternal health advocates in rural communities (Gondar)
  • Trained one of the very first contingents of 29 midwives, deployed in their home communities (South Omo)
  • 29,000 expectant mothers will receive maternal (pre- and post-natal care) from trained midwives in 2017 and 2018 (South Omo)
  • 5,800 newborns will be safely delivered by a trained midwife in 2017 and 2018 (South Omo)
  • Increased knowledge of safe pregnancy and safe childbirth through community sensitization workshops (Amhara, Oromia)
  • Registered over 5,000 pregnant women across 50 health clinics (Oromia)
  • Increased maternal health and family planning knowledge through 12 support groups for expecting mothers (Oromia)

Success Stories

Read our success stories here