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Research on the topic of Maternal Mortality and Pregnancy Care in South Ethiopia

Introduction

Ethiopia is a federation of nine autonomic states and two chartered cities (Addis Ababa and Dire Dawa). Every State is subdivided in Zones, and those again subdivided in Weredas. A Wereda is the smallest administrative entity, making its own independent policy and receiving a budget.

Ethiopia - nine states and two chartered cities
Ethiopia - nine states and two chartered cities

Three different studies - described hereunder - were organized in the most southern state Southern Nations, Nationalities and People’s Region (SNNPR).

This state is subdivided in 20 Zones and 140 Weredas; with an area of 105.476 Km2, and is harbouring 16.276.417 inhabitants (in 2011). During a nine months investigation (during 2010 - 2011) research was done on three subjects - described here:

  1. Access to Health Centers
  2. Maternal Mortality (per 100.000 deliveries)
  3. Experiences of pregnant women around pregnancy and pregnancy care

This research was accomplished with two different research skills:

  • structural research with questionnaires about pregnancy and pregnancy care
  • focus group interviews regarding pregnancy experiences and pregnancy care

This research was accomplished as a Master’s in International Development Studies at Utrecht University in the Netherlands, and executed in the SNNPR under supervision of Hawassa University and the consent of the Regional Health Bureau in Hawassa.

Research

1. Accessibility of Health Centers

For this research - about access to Health Centers - all figures were derived on Wereda level. (that is for 140 distinctive areas in the SNNPR, called Weredas). For this research calculations were made of the total number of people living within an area of 10 kilometre distance from a Health Center in that Wereda. In order to reach that Health center you must walk for 2 hours back and forth. And many times even longer, when living in the mountains.

Note: In the meantime (in 2014) two times as many Health Centers have been constructed, as there have been established before. This is enhancing the health care situation in the orange and orange-red coloured areas; but not turning these areas into the light yellow colour, like the situation in the North East.

Access to Health Centers within 10 Km - ligh yellow = good / orange-red = very bad
Access to a Health Care Institution within 10 Km walking distance. | light yellow = good | orange = bad or very bad |

Now - in 2014 - more than 700 Health Centers have been established. In the year 2011 only around 350 Health Centers were functional. The results are visible in the next map (access to Health Centers in the SNNPR - situation in 2011)

Note: Light yellow colours = good access, orange to orange-red = bad access.

This map maybe appears a bit misleading, as the light yellow area is the most densely populated area. About 80% of the total population lives here in comfort of reasonable to good access (walking distance) to a Health Center. The size of this densely populated area is around 25% of the total surface of the SNNPR.

Nevertheless around 70% of pregnant women is complaining about transport problems (or the money needed for transport) in the period of labour.

At last: the rest of the population - around 20% - lives in a scarcely populated area, incorporated in roughly 75% of the total surface of the SNNPR. In this area, access to Health Centers is bad or very bad.

Population Density in 2004
Population Density in 2004

The inspiration for this research has been encouraged by the very important research, Too Far to Walk, Maternal Mortality in Context, done in 1994 (in Ghana, Nigeria and Sierra Leone) by Sereen Thaddeus and Deborah Maine, Columbia University, and possibly also a ground for the statement in Key Finding 5 (of Chapter 9 of the Demographic Health Survey 2011 - see next).

internet: https://www.researchgate.net/profile/Deborah_Maine/publication/46505614_Too_Far_to_Walk_Maternal_Mortality_in_Context/links/00b495283bb7b3ece3000000.pdf

Abstract: https://www.ncbi.nlm.nih.gov/pubmed/8042057
Direct link to pdf: Thaddeus and Maine - Too Far to Walk - 1994.

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Another research that stipulates to access problems in Health Care, is the Ethiopia Demographic and Health Survey 2011. This report has been financed by a combination of NGOs: (USAID), (CSA), (HAPCO), (UNFPA), (DFID), (UNICEF) and (CDC).

One conclusion from this report, which is important to mention here, is: The most important barrier to access to health services that women mention is (page 119):

  • taking transport to a facility - (71 percent), followed by
  • lack of money - (68 percent), and
  • distance to a health facility (66 percent).

This is ‘Key Finding 5’, Chapter 9 of the Ethiopia Demographic Health Survey 2011 (on page 119 (139)

Find this report on internet: http://www.unicef.org/ethiopia/ET_2011_EDHS.pdf

Direct link to pdf: Ethiopia Demographic and Health Survey 2011.

MORE TEXT will be soon available - this website is still under construction.

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Six research locations have been visited for a structural research and four locations with focus group interviews (in 2011) about pregnancy opinions and pregnancy care.

Legend

  • Health center
  • Nearest Hospital