Ethiopian female 'army' revolutionising childbirth, over coffee!
Last month, Dr Ruth Jackson attended a crucial 'Health Development Army' (HDA) Antenatal Forum in Ethiopia. Here's what happened:
"I bought a kilo of green coffee from a woman who had befriended me on the street - and invited me to her home for coffee, fresh bread and roasted broad beans - and ordered 80 bread rolls from a local bakery. Sixty women were expected to attend the forum - but there were more than 100 women and many children in the end.
The location for the forum was in Gowadama, a small rural neighbourhood (kebele) in Aleta Wondo Woreda (district) (population 9,683), in the coffee-enset-maize-medium latitude, sub-humid highlands in southern Ethiopia. (Enset or Ensete ventricosum is popularly known as false banana. Extracts from the stem and root provide a widely consumed stable carbohydrate). Aleta Wondo is in a lush, green part of Ethiopia that produces quality garden coffee and has a strong tradition of tree planting on farmland.
Most women in Aleta Wondo, and in all of rural Ethiopia, give birth at home without skilled assistance. Both maternal and neonatal mortality are high in Ethiopia. As one of the least urbanised countries in the world (83.6 percent of people live in the rural areas), Ethiopia has set objectives and various strategies and actions to guide policy makers, development partners, training institutions and service providers in efforts to attain the Millennium Development Goals (MDGs) related to maternal and neonatal health. There are an estimated 2.6 million births each year in Ethiopia - around 15 percent of all pregnant women (worldwide) are estimated to develop life-threatening obstetric complications.
One strategy in the 2012 National Road Map for Accelerating Reduction of Maternal and Newborn Mortality and Morbidity in Ethiopia is to work through Health Development Teams (up to 30 women and a one-to-five network of women that serves as a support system to the health extension program in rural areas). Activities include monthly meetings to discuss birth preparedness and facilitate the participation of health workers from Primary Health Care Units. Health Extension Workers (HEWs) and the Health Development Army disseminate information to create demand and awareness about pregnancy related danger signs and the benefits of seeking skilled attendance at delivery.
At Thursday's forum, as the coffee beans were washed, roasted, ground and brewed in a clay coffee pot (jebena) we discussed women’s experience of pregnancy and childbirth. The women talked about giving birth at home in the past as they didn’t know about 'safe' delivery at a health facility. When women give birth at home they pray to God to help them. Their mother-in-law is usually the birth attendant. One woman who has had two children said that she went to the health centre for the second birth as she was in severe pain. Another woman described how her neighbour gave birth at home but had to be transferred to the hospital because of severe bleeding (postpartum haemorrhage). Women described how a 'short' labour takes one to three hours but that a 'long' labour takes up to five days.
At the end of the forum I told a story about a woman I had met during my PhD research who had also been in labour for a number of days. When she was finally taken by stretcher to the road (five hours) and then by bus to the hospital, her husband then had to return home to sell the ox and borrow extra money to take his wife to another referral hospital for the now dead baby to be removed by Caesarean Section. When I said that the woman had later been forced to leave her husband because of ongoing ill health, the women at the forum responded with clear understanding and feeling.
The message I tried to leave with the women was that they must call the HEWs to assist 'early'. If a woman's labour starts in the night and in the morning it is time to make coffee and she is still in labour and no one has prepared the coffee - then that is the time to call the HEW or take the woman to the health centre."
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This project has been funded under the Australian Development Research Award Scheme (ADRAS).