Photo Credit: Elizabeth Atalay
“My turning point, was I lost a mom of six from bleeding,” said Dr. Abeba Bekele when speaking about her commitment to maternal and newborn health in Ethiopia. She distinctly remembered that moment as her turning point.
After having practicing medicine for five years in deep rural areas of the country, “I saw the issues, the problems, the challenges,” she said. “What made me decide actually to go into public health…..was I lost a mom of six from bleeding. Just bleeding on a couch because there was nothing, no supplies in the facility, we didn’t have IV fluids. The family was not willing to give blood for various reasons. But there was nothing in the hospital. So we tried to do everything, I had two midwives with me, and myself, and we lost her. I said, OK this is it. I don’t want to continue my life seeing these types of challenges. I have to go into prevention.”Now the Thematic Sector lead at Save the Children Ethiopia’s Saving Newborn Lives Program, Dr. Bekele has stayed true to that vow. Maternal deaths have been reduced by two-thirds since the year 2000, from 1 in 24 to 1 in 67.Ethiopia has been praised as a success story in Child Health, having reached Millennium Development Goal #4, to reduce child mortality, ahead of the 2015 schedule. Yet while the mortality rate of children age 1 month to just under 5 years has annually declined by 6.1%, the neonatal mortality rate in Ethiopia is only declining at a rate of 2.4 %. Newborn deaths account for 43% of all deaths under the age of 5 years old.The major issue in Ethiopia is that approximately 80% of women give birth at home, often without the presence of a trained health care worker. The majority of the population lives in rural areas with poor access to health care.Dr. Abebe’s own story also illustrates that even in the presence of the most skilled physician, without resources, or transportation to a hospital from a remote area, lives can still be lost. The fact that less than half of newborns are protected against tetanus is another major contributing factor, especially for home births in unsterile conditions.The country’s success on MDG 4 illustrates that with dedicated financial and intellectual commitment, Ethiopia’s goal to reduce the number of newborn deaths by 2015 can be achieved. The Health Extension Plan implemented by the government to target the issue is deploying trained Health Extension Workers, and the Health Development Army, both key delivery platforms at the primary level.The ultimate goal is one health care post for every 5,000 regional inhabitants attended by two Health Extension Workers. Then one larger health care center serving every five health care posts and one major hospital for each of the 800 districts of Ethiopia. Health Extension Workers train for one year after graduating high school in the communities in which they will serve. The Health Development Army volunteers have been key to the success of the program on a local level by educating their own communities.
In such a large, diverse country, there are cultural challenges to getting mothers and communities to adopt new health practices. In the southern region of Ethiopia when women were not coming in to the new Health Care Center to give birth, they figured out that the women did not feel comfortable with the birthing position on the table. When they changed it to a more culturally suitable option, women began to come in to give birth. Working with formal and informal community leaders has also proved important.
Dr. Abeba Bekele has kept her pledge from that moment when she lost that mother years ago as she continues to implement change in her country through her work with Save the Children. The government of one of the poorest countries in the world seems committed to preventative health care measures, and with education the thinking in rural communities is beginning to change. The great hope is that the newborn mortality rate will soon significantly change as well.
This is a slightly altered version of an article that appeared on ONE.org. ONE Mom Elizabeth Atalay was in Ethiopia as an International Reporting Project Fellow on a New Media Fellowship to report on newborn health. Follow her journey on Twitter with hashtag #EthiopiaNewborns.