-A Damaged System: Ethiopias Maternal and

Newborn Healthcare
Helena Getachew
Independent Research
June 3, 2016
Advisor: Dr. Senait Fisseha and Dr. Lia Tadesse Gebremedhin
Instructor: E. Leila Chawkat

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Abstract
The nation of Ethiopia has consistently been met with obstacles that halt their maternal and
neonatal health progress, and identifying those obstacles is vital to countering their effects. In order to do
so, a research study was performed, incorporating meta-analysis and conducting interviews with
professionals in the field. The findings suggested that poverty and cultural practices tend to contribute the
most to the instability of the nations womens health system, for many other detriments stem from these
two factors. In addition to defining the barriers, the question what can be done? was addressed and the
various approaches to combat the regression of Ethiopias maternal and newborn health system were
compiled. Some of these tactics include increased prevalence of family planning, innovative
infrastructure, and the implementation of medical transportation. To communicate these ideas, a brochure
was composed and placed in doctors offices, broadcasting the research. Overall, the research sought to
secure health benefits for a significant portion of Ethiopias population and to reiterate the notion that
adequate care should be made accessible for everyone.

Introduction

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Ethiopia- a nation known for its rich, flavorful cuisine and its Olympic gold medalists- has done
much to challenge the paradigm that reiterates a negative perception of the nation. By expanding its
industrial projects to solidify their global economic presence, the country has aimed to redefine itself as a
competitor on the world market. Despite this, maternal and neonatal health in Ethiopia has been and
continues to be a pressing matter that upholds the current portrayal of Ethiopia. To combat this,
organizations, such as USAID and the International Federation of Red Cross and Red Crescent Societies,
strive to ensure all women access to care, targeting the nations more rural and underdeveloped regions.
The efforts of these organizations should not go unacknowledged; however, much more needs to be done
in order to guarantee Ethiopian mothers their right to adequate care. As a result of poor economic
conditions coupled with various cultural pressures, Ethiopian mothers and their children are deprived of
basic health necessities.
Review of Literature
Numerous problems arise from Ethiopias economic instability; one issue concerns the lack of
medical staff. As the population spikes, the need for trained professionals to treat the ill increases as well.
Data suggests that there are only 1,806 practicing doctors in Ethiopia, greatly limiting the opportunity for
care (Poverty). Ethiopias insufficient number of professionals prevents patients from seeking
immediate medical attention and increases the risk of worsening conditions. Another problem would be
the geographic inaccessibility to health services. Acting as an obstacle, the lack of ...physical access to
health care facilities in rural areas makes seeking care literally out of reach for some (The Health
System). Public transportation services, such as buses or cabs, are not prevalent in the nations
countryside, requiring the disadvantaged to reaching their destinations on foot. This greatly hinders

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maternal and neonatal health progress since many women resort to performing at home-deliveries,
knowing that the likelihood of reaching a maternity unit in time is slim, which raises the risk of medical
complications for both the mother and newborn. In addition, the lack of up-to-date hospital equipment is
inadequate for the Ethiopian peoples constantly changing medical needs. Medical technology should be
able to meet Ethiopias broadening maternal and neonatal health demands.
Over the past few years, there has been an evident shift in a womens place in Ethiopian society.
Statistics demonstrate that there was an increase in female enrollment in Ethiopias primary and secondary
schools, spiking from 32% to 39% in the span of just ten years (Abate). Data also exhibits that 78.4% of
Ethiopian women have a role in the nations workforce (Schwab).
As more women begin to defy the cookie-cutter standard theyve been conditioned to for years
and as more women make education their number one priority, Ethiopian women should be able to direct
their attention towards their professions and/or schooling, rather than worrying about whether or not they
have access to care. The cultural shift should indicate that more effort should be invested into this
growingly successful population to guarantee them care; then again, satisfying the basic health needs for
both women and newborn children should have always been considered a right. Poverty-stricken
Ethiopian women should not perceive maternal and neonatal healthcare as a system only available for the
privileged, and the only way to rid of this misconception is to address the cultural barriers that limit
pregnant Ethiopian women from receiving the health benefits that they deserve.

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Some traditional practices, such as female genital mutilation (FGM), halt Ethiopias maternal and
newborn progress. FGM is a practice performed on three-fourths of Ethiopian women that attributes to
various complications including infertility, infection, and newborn death (Poverty). Despite this, FGM
still receives societal acceptance and preservation, which ultimately drives Ethiopian women to place
cultural conservation over health care. People may perceive traditional practices, such as FGM, as vital
aspect of their culture, but the detriments that these women face trump the preservation of cultural
behaviors. Another traditional behavior that hinders Ethiopias maternal and newborn health progress
would be its high maternal and infant mortality rates. For every 100,000 live births there are 676 maternal
deaths (Cultural Barriers).These women may feel as though, whether or not they receive care, they have
a high likelihood of a medical complication, so they voluntarily decline medical assistance. Factors like
these perpetuate a cycle of women rejecting medical assistance because of societal pressures and
ultimately halting Ethiopias maternal and newborn health progress.
Although it is important to acknowledge these barriers, it is equally as important to develop an
approach to solving these problems, answering the pressing question, what can be done? One solution
concerns the expansion of health care facilities. This idea can be interpreted in a variety of ways, for
example, geographically. The Ethiopian government should invest in infrastructure projects in Ethiopias
countryside and incorporate transportation services into medical care. To assess the impact of ambulances
on maternal and neonatal health, a study was conducted in which six of Ethiopias districts implemented
an ambulance system. For every 19,179 live births, 51 mothers died (Godefay), demonstrating a decline in

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maternal mortality rate associated with the increase of ambulance utilization. By encouraging access to
treatment, these efforts provide women with the immediate medical attention that they deserve.
In addition to expanding medical services geographically, the Ethiopian government should look
into reducing the cost of health services. With its damaged economic status and a GDP per capita of
$573.6 as of 2014, poverty is not uncommon in Ethiopia (Data). Not being able to afford something as
basic as medical assistance draws more of their attention towards their financial struggles and holds these
women back from pursuing their immediate medical needs. To counter this, the reduction of cost will
reiterate the notion that maternal and neonatal health care is not privilege, but a right.
Stemming from the poor financial states of much of Ethiopias population, malnutrition is a
significant contributor to the high infant mortality rate. Young children lack a substantial food intake, and,
although newborns can rely on their mothers breast milk, children around the age 2 still must rely on
other sources of food to satisfy their nutritional needs. With the limited food supply in impoverished areas
coupled with the unreasonable costs of food, malnourishment becomes a recurring factor to the deaths of
these children. To tackle this issue, the production and distribution of vitamin supplements intended to
compensate for missed meals should be emphasized.
Another solution to consider would be the encouragement of community involvement. A
community actively working together with the same end goal in mind challenges cultural obstacles and
provides these struggling women a support system. In an interview with Dr. Lia Tadesse, University of
Michigans new executive director of the Center for International Reproductive Health Training, she

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describes the activity of the Health Development Army, a network of households who engage in various
efforts to ensure health opportunities for everyone in their community. Dr. Tadesse explains, They (the
Health Development Army) meet regularly...to discuss all issues like the health of their children, hygiene.
Do they have toilets appropriately made? Do they have to have their child vaccinated? If a woman is
pregnant, they make sure she follows up with her care and make sure she delivers in a health sector or a
hospital. Their donation of time energy as a community to promote the advancement of Ethiopias
maternal newborn health surpasses any monetary donation from someone who isnt constantly affected by
this issue.
Lastly, by educating women about contraceptives and other precautions and creating new
medical technology, the reduction in maternal and neonatal care complications will be evident. Ethiopias
Health Sector Development Program (HSDP) has actually made increasing the contraceptive prevalence
rate to 66% to combat inaccessibility to womens health services one of their top priorities, emphasizing
the importance of contraceptives and reminding women that they have the right to decide when they want
to be pregnant (Berhan).
To conclude, poverty and traditional practices are the primary conditions that contribute to
the regression of Ethiopias maternal and newborn health system. By increasing humanitarian efforts, the
Ethiopian government can combat those challenges and provide millions of women access to proper
health care. Women and children serve a vital role to the functioning of a society, and the limitation of
their basic health needs holds them back from pursuing that role. The right to adequate health care should

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be emphasized nationwide to increase opportunities for women and counter the worlds negative
perception of Ethiopias health care system.
Research Methods and Data Collection
Using a data collection notebook on an online format, the information, gathered after much
analysis of other studies, was compiled to answer the hypothesis: who/what is to blame for the problems
that halt Ethiopias maternal and newborn health progress, such as traditional practices and poverty, and
what can we do to improve it? The notebook assisted my research by organizing trends, inconsistencies,
comparisons as well as observations and statistics. In addition to that, the conclusions drawn were
recorded in the notebook, offering an effective platform for the material to be displayed, and the articles
assessed were thoroughly annotated. To prevent from reiterating known information, the extraction of data
from prior studies coupled with the composition of conclusions made up a large portion of the research.
Such a method of research, or meta analysis, plays a vital role in ensuring an outcome to the
research, and, with that in mind, the information requires a format that would accurately convey all the
gathered information in an organized and easily accessible fashion. After much data collection, it was
evident that meta analysis was able to meet those needs.
The sources I analyzed were dense, and meta analysis forced me to digest every detail, providing
me with volumes of information. Because of my data collection method, I can present my research with
the assurance that I am contributing something new to the field.
To introduce the problem, the journal, Success Factors for Womens and Childrens Health, offered
much contextual evidence to pinpoint where Ethiopias maternal and newborn health issues stemmed
from. This source described Ethiopias geographic scene and current economic state. To shed a more

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narrow light, the journal discussed female employment rates, school enrollment, political presence, and,
most importantly, health. The nation has done much to combat the detriments of their lack of economic
facilities and poor economic conditions; however, there are more areas that need to be invested in. These
areas include malnutrition, lack of health workers, underdevelopment of technology and infrastructure,
and limited access to clean water. The journal provided insight on these issues, and how to reduce the
impact that they have on Ethiopias maternal and neonatal health, concluding with defining the nations
future priorities.
In the study, entitled Can Innovative Ambulance Transport Avert Pregnancy-Related Deaths?
One-Year Operational Assessment in Ethiopia, the Ethiopian government considered the implementation
of ambulances. Government officials hypothesized the effects of ambulances on access to maternal and
neonatal care and death rates. To assess the impact, this study was conducted in which six of Ethiopias
districts implemented an ambulance system. Results demonstrated that, for every 19,179 live births, 51
mothers died (Godefay). These statistics exhibited a decline in maternal mortality rate associated with the
increase of ambulance utilization. For the future, they concluded that the government should invest in
projects that not only focus on increasing the number of healthcare facilities but increasing the number of
medical transportation outlets.
The Ethiopian government along with the help of missionaries, organizations, the community etc.
have invested much time and effort into tackling maternal health, according to Yebeteseb Mela: Dedicated
to Maternal Health, Volume 6, 2&3. To inform the public of these efforts, the journal goes into explicit
detail, demonstrating the cost-effective ways that have helped make care more accessible and efficient.
For example, they inform women about the use of contraceptives to introduce them to the idea that
women have the power to control when they want to conceive. Additionally, a woman recounts her

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experience with fistula and the difficulties she faced when trying to access care and how organizational
efforts were able to save her.
Ethiopia being considered an underdeveloped country coupled with the fact that a good portion of
the nation has limited access to the schooling, cultural behaviors are not as progressive as they should be.
Cultural Barriers to Seeking Maternal Health Care in Ethiopia: A Review of the Literature discussed how
some of these traditional practices act as barriers to the advancement of Ethiopias maternal health care.
These practices include many women's personal decision to reject care or the cultural acceptance of athome deliveries, which, without some sort of medical attention, can be detrimental. With increased
education (especially in those rural regions where education is not as prioritized), these traditional
practices that discourage the progression of maternal health can be challenged to ultimately demonstrate
improvements in womens health across the nation.
Results and Data Analysis
Similar to the conclusions of experts in this field, the results of my data collection demonstrate
that many of the problems that hinder Ethiopias maternal and newborn health progress do stem from the
nations poor economic conditions and cultural barriers. However, my data collection also led me to
identify ways to counteract the effects of these problems.
To effectively display my results, I will be composing a brochure. Brochures provide creators the
flexibility release content that can both address an issue, but also keep the audience engaged with its
elaborate visuals. In addition, a brochure is an easily accessible and easily readable medium for my
research. Knowing this, the creation of a brochure would be the most effective way to convey the research
I have conducted.

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Article Title

What the Article Had To Offer

Success Factors for Womens and Childrens

pinpoints where Ethiopias maternal and newborn

Health

health issues stemmed from

female employment rates, female school
enrollment rates, female political presence, and
female reproductive health
malnutrition, lack of health workers,
underdevelopment of technology and
infrastructure, and limited access to clean water
determined Ethiopias future goals

Can Innovative Ambulance Transport Avert

implementation of ambulance services correlated

with the decline in maternal deaths

Pregnancy-Related Deaths? One-Year

Operational Assessment in Ethiopia
Yebeteseb Mela: Dedicated to Maternal Health, describes the cost-effective ways that have helped
Volume 6, 2&3
Cultural Barriers to Seeking Maternal Health
Care in Ethiopia: A Review of the Literature

make care more accessible and efficient

discussed how some of these traditional practices
act as barriers to the advancement of Ethiopias
maternal health care
at home deliveries

Discussion and Conclusion

There are many implications to the data Ive collected, for they show that there is a way to tackle
the many issues that prevent Ethiopian women from receiving care. By launching projects and enacting
legislation that would explore areas such as malnutrition and medical transportation, Ethiopia can begin to

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ensure quality health services to its women. My audience will recognize this because of the extensive
information Ive collected which will, not only introduce them to these problems, but will also inspire
them to publicize the issue to garner more support.

Works Cited
Abate, Yohannis. A Country Study. N.p.: Federal Research Division, 1991. Print. Vol. 4 of A
Country Study: Ethiopia.

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Berhan, Yifru, and Asres Berhan. Commentary: Actions in the Pipeline and the Way Forward to
Reduce Maternal and Perinatal Mortality in Ethiopia. The National Center for Biotechnology
Information. National Lib. of Medicine and National Institutes of Health, 24 Sept. 2014. Web. 9
May 2016. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4249202/>.
Cultural Barriers to Seeking Maternal Health Care in Ethiopia: A Review of Literature. Dec.
2012. PDF file.
Data. The World Bank. World Bank, 2016. Web. 11 May 2016.
<http://data.worldbank.org/indicator/NY.GDP.PCAP.CD/countries/ET-US?display=graph>.
Godefay, Hagos, et al. Can Innovative Ambulance Transport Avert PregnancyRelated Deaths?
OneYear Operational Assessment in Ethiopia. June 2016. PDF file.
The Health System. Cente for National Health Development in Ethiopia. Ed. Awash
Teklehaimont. The Earth Institute at Columbia Univeristy, n.d. Web. 23 Feb. 2016.
<http://cnhde.ei.columbia.edu/healthsystem/>.
Maternal, Neonatal, and Child Health. USAID. N.p., n.d. Web. 16 Dec. 2015.
<https://www.usaid.gov/ethiopia/global-health/maternal-and-child-health>.
Poverty & Healthcare. Our Africa. N.p., n.d. Web. 11 Feb. 2016. <http://www.ourafrica.org/ethiopia/poverty-healthcare>. Reproductive, Maternal, Newborn, and Child Health
Today. Sept. 2014. PDF file.
Schwab, Klaus. The Global Gender Gap Report. 2013. File last modified on 2013. PDF file.
Tadesse, Dr. Lia. Personal interview. 21 Jan. 2016.