Maternal and child mortality in Ethiopia has been dwindling

Maternal and child mortality in Ethiopia has been dwindling

Maternal and child mortality in Ethiopia has been dwindling since women, especially that of rural localities started giving birth at health institutions.

The consequences of maternal mortality on orphaned children and the family members who support them are dramatic, especially in countries that have high maternal mortality like Ethiopia. Though hopes are rising these days, it is found that that newborns and children whose mothers died from maternal causes face nutrition deficits, and are less likely to access needed healthcare than children with living mothers. Older children drop out of school to care for younger siblings and contribute to household and farm labour which may be beyond their capacity and age, and often choose migration in search of better opportunities.

It is said that Ethiopia has more than halved its child mortality rates since 1990 through campaigns to increase the number of health workers and clinics throughout the country. The Horn of Africa nation has long suffered from one of the world’s highest death rates of children due to recurring droughts.

Reducing malnutrition, which is an underlying factor in at least half of all under-five deaths, has had a profound impact on the survival rates of children. The UN Children’s Fund (UNICEF) attributed the reductions to increased access to health posts in remote and drought-stricken areas, and a growing number of health workers.

The vigorous training of health extension workers who are on the front line in the work to provide integrated health, nutrition, sanitation and hygiene services to rural communities. Family fragmentation is common following maternal death, leading to tenuous relationships within a household with the births and prioritization of additional children further stretching limited financial resources. Impacts of maternal mortality on children are far-reaching and have the potential to last into adulthood. Coordinated, multi-sectoral efforts towards mitigating the impacts on children and families following a maternal death are lacking. In order to prevent impacts on children and families, efforts targeting maternal mortality must address inequalities in access to care at the community, facility, and policy levels.

It is well documented that infant and under five survival is highly correlated with child nutrition and other important child health care practices attributable to maternal involvement and prioritization of child health. For example, early and exclusive breastfeeding, a nutritional advantage only a mother can provide, has been shown to substantially lower the risk of neonatal death. Routine immunization, another critical healthcare practice which mothers prioritize, has similarly been associated with a reduced risk of infant mortality.

Associations between maternal death and long term child health and survival however, are less understood. A growing body of write-up is exploring the catastrophic effects of maternal death, loss of the primary caregiver, on older children in addition to newborns and infants. The costs of maternal deaths on living children, family and other dependent persons are widespread, impacting future generations of individuals as well as overall well-being and economic progress at the country level. To this effect, evidence has shown that investing in the prevention of maternal mortality through the prioritization of the education, empowerment, and sexual and reproductive health and rights of women and girls is a cost effective intervention, saving the lives and promoting the livelihoods of mothers, children, and families.

Though the magnitude of maternal death in Ethiopia has been documented, the true toll of maternal mortality is under-valued; and long-term impacts on children, families, and communities have yet to be adequately explored.

The inclusion criterion was defined as the death of a woman during pregnancy, childbirth, or 42 days following the termination of the pregnancy, as per WHO standards. Data collection occurred between August and October 2013. Patient records from Butajira Zonal Hospital were used to identify women who had died from maternal causes. Snowball sampling was then used to identify family members of these women. Among the 28 maternal deaths captured, only one woman was divorced while five were in polygamous marriages and the rest were in monogamous marriages.

Additionally, thirteen stakeholder interviews were conducted focusing on policies and programmes available for maternal orphans, and challenges for implementing such programmes and policies, such as financial issues and political will.

This support, while often critical to the health and well-being of the family suffering a loss, diminishes the supporting family’s capacity to meet their own needs.

As previously described, girl children were more likely to drop out of school following the death of a mother, given cultural gender norms regarding men and women’s roles.

In addition to the need to improve services aimed at mitigating impacts of maternal death on children, such as enhancing systemic linkages between health and social welfare programmes, strengthening social protection schemes to better address the needs of vulnerable children and families, the need to redouble efforts to combat maternal deaths, which are the root causes of the impacts on families and children, are peculiarly imperative ones. Maternal mortality is a human tragedy that could be averted through widespread provision of emergency obstetric and neonatal care, skilled birth attendance, and increased use of contraceptive methods. While interventions targeting safer pregnancy and childbirth have been evidenced in many resource-poor countries including Ethiopia, 90 per cent of women delivered at home.

This trend is now dramatically changing. Eliminating inequalities in women’s access to fully equipped facilities and improving women’s perceptions of facility delivery through the promotion of respectful maternity care, for example, are peremptory to closing the gap in excess mortality globally among poor women of reproductive age. Until the value of women as irreplaceable pillars of families and communities is recognized, the devastating ripple effects of their deaths play out in the lives of their children continue to be observed.

There is now a glimmer of hope that new measures, including a cohort of trained midwives deployed across the country, an affordable health insurance scheme, and possibly a new health law, could see the country achieve major improvements in maternal and reproductive health.

Although Ethiopia has reduced maternal mortality and attained a remarkable record so far, a lot remains to be done in this regard. According to the Ministry of Health, new efforts are under way to jump-start the campaign to improve maternal and reproductive health. For instance, a community-based health insurance scheme was launched to provide greater access for community members to a comprehensive package of high impact and cost-effective interventions that would reduce maternal and child mortality. It is targeted at populations in locations that no longer have to pay directly for health services at the point of use.

Meanwhile, an increasing number of trained extension workers and midwives were being deployed in various states to act as health educators, since ignorance of basic health issues had been identified as a key contributor to the problem. In many parts of the nation, health authorities have been training community development officers to sensitize pregnant women, while a mobile ambulance scheme helped transport hundreds of expectant mothers to health centres for safe delivery.

The main causes of maternal mortality in the country are, among others, hypertensive disorder of pregnancy, obstructed labour, anaemia. Early-age and late-age birth, the lack of child spacing, and low access to health-care facilities, are other prominent causes.

Any effort by the government to drastically reduce maternal mortality rates must address the root causes of delays in seeking healthcare, accessing healthcare, and receiving help at the centre.

Ethiopia continues to battle poverty, child and maternal deaths, according to a United Nations report on the Millennium Development Goals (MDG) that said while several key global targets have been met, more sustained effort is needed to cover disparities by the 2015 deadline.

Many more goals are within reach by their 2015 target date, a certain study portrayed, if current trends continue, the world will surpass MDG targets on malaria, tuberculosis and access to HIV treatment. It, however, said that some MDG targets related to largely preventable problems with available solutions, such as reducing child and maternal mortality and increasing access to sanitation, are slipping away from achievement by 2015, despite major progress.

It is well known that achievements have been uneven between goals, among and within states and between population groups; and unless imbalances are addressed through bolder and more focused interventions, some targets will not be met, including in key areas such as childbirth, maternal mortality, universal education, and environmental sustainability. When Ethiopia has made strong and steady progress in reducing child deaths by more than halving its under-five mortality rate, yet much more is expected of it in the years to come.

Launching the final push towards the United Nations targets, Ban Ki Moon appealed to member states that the global post-2015 objective must be to ‘leave no one behind’. He added that the world is ‘at a historic juncture, with several milestones before us.’

By Addisalem Mulat

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Source: The Ethiopian Herald

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