Nairobi — Pregnancy-related deaths in Ethiopia have fallen by nearly two-thirds, making it the African country that has most successfully lowered its maternal mortality rate thanks to its lifesaving investment in female health workers and girls' education, Save the Children said on Tuesday.
Ethiopia's maternal deaths have fallen from one in 24 women dying due to pregnancy in 2000 to one in 67 today.
"For a country beset by natural disasters such as droughts and food shortages, this shows that concerted efforts in tough places work," Save the Children wrote in its annual report State of the World's Mothers.
Ethiopia came in 149th, faring poorly in indicators such as an average annual income of only $380 per person and only 6.6 years of expected formal schooling.
CARE FOR WOMEN BY WOMEN
A decade ago, the Ethiopian government hired 30,000 basic health workers to provide preventive and curative health care services across the country. There is a health post, staffed by two health workers, for every 5,000 people.
All of the health workers are women because it is easier culturally for them to talk to other women about family planning, healthy pregnancies, clean delivery and childcare. The health workers also connect those who need more sophisticated care with larger health centres and hospitals.
As a result, the number of women receiving antenatal care has risen from 27 percent in 2000 to 42 percent in 2011, said Metasebia Gizaw Balcha, Save the Children's regional health adviser.
"They work with the pregnant woman on birth preparedness," she told Thomson Reuters Foundation at the Save the Children office in Nairobi. "If it's a delivery that's known to have risks, definitely she would plan to have it in a health facility."
Common risks include becoming pregnant before the age of 16 or after 35, and having less than two years between deliveries, as well as anaemia, sexually transmitted diseases like HIV/AIDS, and eclampsia, a complication marked by high blood pressure that can lead to seizures.
Most maternal deaths occur during labour, delivery or soon afterwards.
Key to reducing maternal mortality is for women giving birth to have a doctor, midwife, or nurse present in case they need skilled assistance, such as the use of forceps, administration of drugs or surgery.
In Ethiopia, skilled assistance at delivery has increased from 6 to 10 percent in the last six years, according to government statistics.
Most women still deliver at home, with 57 percent helped by a relative and 28 percent by a traditional birth attendant, but now women are more educated about the risks.
"Traditional birth attendants do not know how to detect complications or conduct clean deliveries," Gizaw Balcha said. "They usually did not clean the umbilical cord and used to apply some other herbs or even cow dung on it. They used to delay women at home even if there were complications. That will not happen now with health extension workers."
A woman who becomes pregnant more often also faces greater chances of dying, so improved family planning can improve rates of survival.
Ethiopia's fertility rate has dropped from 5.5 children per woman in 2000 to 4.8 in 2011, and contraceptive use is up from 8 to 29 percent.
The government has also invested heavily in education, abolishing school fees, building more schools and hiring more teachers - thereby boosting the percentage of primary school-aged girls in school from 20 percent in 1994-95 to 91 percent in 2008-9.
"It has a significant effect," Gizaw Balcha said, noting that a more educated woman stands a better chance at survival, as do her children. "An educated mother will have a means of income and also will know how to take care of her children better than an uneducated mother."
Between 2000 and 2011, the median age of girls' first marriage has risen slightly from 16 to 16.5 years old.
"An educated mother would not be married at an early age so would not start a family early," Gizaw Balcha said. "Starting a family early would also mean that you will have many children which will also expose you to more risks during pregnancy."
Ethiopia has also made significant strides in reducing poverty, with the proportion of people living below the poverty line down from 45 to 29 percent between 1996 and 2012.