Maternal Health Care in Ethiopia

Setting

Meskan, Mareko and Sodo districts of the Gurage Zone, Southern Nations, Nationalities and Peoples’ Region of Ethiopia, 100 to 130km south of the capital city, Addis Ababa. The Butajira Health and Demographic Surveillance Site (HDSS) is nested within the Meskan and Mareko districts. One general hospital (Butajira hospital), one primary hospital (Buee hospital), 18 health centres (8 in Sodo, 7 in Meskan, 3 in Mareko) and 125 health posts (58 in Sodo, 41 in Meskan and 26 in Mareko). 

Disease Prevalence

Mothers wait outside Washe Faka Health Post with their children in Mareko Woreda (district) in the SNNP Region. © UNICEF Ethiopia/2016/Ayene

Although Ethiopia has made great strides in reducing maternal mortality, the MMR is still five times higher than the global SDG target for 2030. Fewer than a third of women attend four antenatal care assessments, or have skilled birth attendance. Disrespectful, unfriendly or abusive treatment from healthcare providers may contribute to low uptake.3,4 Health system bottlenecks are likely to make an important contribution to high maternal mortality at each step in the care pathway, from detection of danger signs, through prompt referral and communication of risk, the primary care response, the timely escalation of care and the quality of definitive care available in secondary healthcare facilities. Most studies from Ethiopia have focused on the poor quality of routine maternal healthcare4. Little is known of health system responses to emergency maternal conditions, key system barriers, and how they may be overcome.   

In Ethiopia, intimate partner violence is more frequent in pregnant women,5  with 77% of pregnant women reporting physical violence in their current pregnancy.6 Despite evidence for adverse impacts of maternal mental health problems, alone or in conjunction with intimate partner violence, there is no service provision at the primary care level.7 As part of the Programme for Improving Mental health carE (PRIME),8 midwives and primary care clinicians have been trained to deliver mental health care using MhGAP, but detection is extremely low.

Reference

  1. All Party Parliamentary Groups on Global Health; HIV/AIDs; Population, Development and Reproductive Health; Global Tuberculosis; and Patient and Public Involvement in Health and Social Care. Patient empowerment: for better quality, more sustainable health services globally. London, UK: : APPG on Global Health 2014. http://www.appg-globalhealth.org.uk/reports/4556656050
  2. Central Statistical Agency [Ethiopia], ICF. Ethiopia Demographic and Health Survey 2016: Key Indicators Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: : CSA and ICF 2016.
  3. Jackson R. The place of birth in Kafa Zone, Ethiopia. Health Care Women Int 2014;35:728–42. doi:10.1080/07399332.2014.914940
  4. Fisseha G, Berhane Y, Worku A. Quality of intrapartum and newborn care in Tigray, Northern Ethiopia. BMC Pregnancy Childbirth 2019;19:37. doi:10.1186/s12884-019-2184-z
  5. Pryor L, Da Silva MA, Melchior M. Mental health and global strategies to reduce NCDs and premature mortality. Lancet Public Health 2017;2:e350–1. doi:10.1016/S2468-2667(17)30140-8
  6. Moussavi S, Chatterji S, Verdes E, et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet Lond Engl 2007;370:851–8. doi:10.1016/S0140-6736(07)61415-9
  7. Baron EC, Hanlon C, Mall S, et al. Maternal mental health in primary care in five low- and middle-income countries:  a situational analysis. BMC Health Serv Res 2016;16:53. doi:10.1186/s12913-016-1291-z
  8. Fekadu A, Hanlon C, Medhin G, et al. Development of a scalable mental healthcare plan for a rural district in Ethiopia. Br J Psychiatry J Ment Sci 2016;208 Suppl 56:s4-12. doi:10.1192/bjp.bp.114.153676