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 35,000 untreated cases.
ETHIOPIAID’S AIM: Increase access to quality maternal health services, and 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, 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 child birth, 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, fistula was eradicated over 100 years ago. In Ethiopia, 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, and that there are between 30,000 to 40,000 women living with fistula throughout Ethiopia, unable to access treatment and suffering in silence.
Women and Health Alliance (WAHA): a beacon for women in need
Since 2009, our partner WAHA works in three locations in Ethiopia, to increase access to quality maternal health care, and to obstetric care in particular. It provides free obstetric fistula repair surgeries to marginalized women in three regions. WAHA provides quality pre and post operative care, nursing care, psychological counselling and physiotherapy, nursing each woman back to health. The surgeries usually take under an hour with over 90% success rates. Within weeks a healed patient can return to her community, ready to embrace her second chance at life. In WAHA’s three regional fistula hospitals, surgeons have also been coping with an increase of cases of a long-neglected medical condition: pelvic organ prolapse. Women suffer prolapse due to hard work such as carrying water or firewood over long distance , and because of the lack of skilled birth attendants during childbearing. This causes their pelvic organ to descend. Working in some of the most rural and isolated areas of Ethiopia where there is a high prevalence of fistula and pelvic floor disorders, WAHA's team work tirelessly to locate and refer women to receive repair surgeries and specialized care.
Ethiopiaid Canada supports WAHA's fistula program in Gondar University's Teaching Hospital. Local hospital staff are trained to treat and rehabilitate women suffering from obstetric fistula. In addition, WAHA runs a network of Maternal Health Advocates, former fistula patients, who scour the countryside to identify and refer cases of potential obstructed labor, and engage with local communities to raise awareness about this condition and the importance of giving birth in a hospital.
Hamlin Fistula Ethiopia (HFE): the model for holistic fistula treatment
Since moving to Ethiopia in 1959, Australians Dr Catherine Hamlin and her husband, Dr Reginald Hamlin, devoted their entire careers to save and restore the lives of obstetric fistula sufferers from all regions of the country. Catherine Hamlin has worked tirelessly to provide Ethiopian women with a second chance. According to Dr. Yakob, the current CEO, the organization has treated more than 50,000 women who suffered from fistula, and most of them were rehabilitated and returned to their community. Before leaving the hospital, every patient receives a new dress provided free of charge as part of our care package.
HFE has established its own college of midwives with the objective of improving maternal health and access to a clean and safe birth for women. HFE has been successful in raising worldwide attention and support for its medical facilities based in Addis-Ababa and five regional centres. Ethiopiaid Canada supported HFE from 2009 to 2016 with over 1,000 free surgeries and care for fistula patients, and is now focusing its ressources in the more remote rural areas where there is still a high prevalence of fistula.
Amref Health Africa: building capacity where it is needed most
As mentioned above, 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 2015, Ethiopiaid Canada partnered with Amref Health Africa to support two maternal health projects to make an impact in particularly disadvantaged rural communities. The first was a midwife training project in the country’s remote South Omo region. By the end of 2016, 29 midwife students in South Omo completed a three-year midwife training program, and began providing maternal health care services, often for the very first time, in their respective communities.
In 2016, Ethiopiaid Canada partnered with Amref Health Africa to support a four-year maternal and child health program in the Afar region, one of the most underserved regions in essential health services. Amref Health Africa will deliver essential health care services in 100 villages in the region. Approximately 230,000 women will benefit directly from these new maternal and child health care services .
2017: In Gondar University Hospital, 200 women suffering from obstetric fistula or pelvic floor disorders will have access to free surgeries, treatment and rehabilitation services. This will restore their dignity and gives them an opportunity to return to a productive life in their communities
2017: training of 20 midwives and community health workers in Afar region; continuation of medical and nursing staff training in Gondar University Hospital (obstetrics); this will have a sustainable long term impact to address maternal, neonatal and child health care needs
Prevention and empowerment
2017: improvement of essential maternal and child health care services in 2 regional hospitals, and in 23 health centers serving 100 villages in the Afar region; community level engagement and discussions on gender awareness, on nutrition, on early marriage and on female genital mutilation
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)
Read our success stories here