News / Africa

Greater Spacing Between Pregnancies Makes for Healthier Families

Coffee is the leading crop in the Wonago district of southern Ethiopia. Farmers living in the area usually lead good lives. In normal harvest seasons with good commodity prices, they produce enough to feed their large families.

A local government worker says it's been two decades since they received emergency food aid. But this year, farmers who were once carrying sacks of coffee beans into the market are bringing their starving children to emergency feeding centers.

Abraham Astatke of the zonal rural development bureau says farmers in Wonago are usually self-sufficient.  They have some of the largest families in Ethiopia, and now they are struggling to provide for them.

"This district is densely populated. As many as 140 people live in an area of one square kilometer," Abraham says. "The combination of large family size, drought and the falling price of coffee has made the situation worse. "

Benefits of birth spacing

No matter what a family's economic situation, experts recommend spacing out pregnancies over time.

“There is now definite evidence from large scale surveys in many countries that pregnancies too early in adolescence and too closely spaced - that means if a mother has more than five children - they carry a much higher risk for the mother and the child,” says Dr Abdulhamid Yishaq, a gynecologist working for the Center for Disease Control in Addis Ababa.

Part of the reason, health officials say, is that women’s bodies are not given enough to time to restore nutrients needed to form a healthy fetus, and breast milk for the infant.

Aberu Shibru feeds her malnourished child at Jemjemo
Aberu Shibru feeds her malnourished child at Jemjemo

The World Health Organization recommends that a couple wait two years between pregnancies. Statistics from the WHO reveal that intervals of 18 months or shorter increases the risk of neonatal and infant mortality, low birthweight and preterm births. Intervals of six months or earlier increase the risk of maternal mortality.

When food shortages are a factor, the benefits of spacing out births are even greater.

Health officials say food pressures would likely be less severe for smaller families, and for couples that allow more time between pregnancies. Having fewer children also helps alleviate some of the expenses related to purchasing, or growing, more food. And, they say smaller families could increase living standards, by making it less expensive to educate all of the children.

The lack of food often affects children and pregnant women most severely. Malnutrition increases the risk of anemia, maternal mortality, and underweight or unhealthy newborns.

Children and malnutrition: the tale of one village

At this clinic in Jemjemo village in southern Ethiopia, Amarech Tadele has come for help.

When the harvest was good Amarech and her husband produced enough to feed the family. But this year, both the market and rain failed, leaving the family of 10 in dire situation.

"The coffee plants flowered on two cropping seasons, but due to lack of rain, the flowers failed to give fruits," Amarech says. "Some nights we eat some food; others we just go to sleep on an empty stomach. It is not easy to be in a house where eight kids are asking for food."

To make things worse, a disease has hit their food of last resort – enset, also called the false banana.

Amarech Tadele and part of her family
Amarech Tadele and part of her family

As a result, she has come to the clinic with four children who are severely malnourished. Two belong to her brother, whose wife has died.

Amerech is receiving a highly nutritious product called Plumpy'nut for the children. Health extension worker Tigist Flasa uses a plastic arm band to measure the circumference of the child's arm to determine the level of malnutrition.

"This child is malnourished. Her face has swollen, which is the first stage of severe malnutrition. If there is a swelling on the arms, legs and face, they have to be immediately admitted to a hospital," Tigist says.

Today, only two of the children show severe signs of malnutrition. The others are suffering from lack of a balanced diet. The clinic worker says they will recover after a couple of weeks of eating the high-protein Plumpy'nut.

Back at the house, Amarech braids hair to make extra cash. Village women come here to get their hair braided and to talk to each other about their problems.

One of the customers is 31-year-old Aberu Shibru. She is three months pregnant. Aberu is having trouble feeding her children because she's been abandoned by her husband.

Aberu tells her peers about how he left her for a younger wife. She says her husband stopped working on her farm when he married a second wife. As a result her three children are starving.

"I cannot feed them," Aberu says. "He has other children from the new wife that he takes care of. He has built a nice house for the younger wife and left me in an old hut. I feel abandoned. He comes to my hut when he pleases."

And that is how she got pregnant again. At the time she was not taking birth control pills because he had not visited in months. She says the last time she saw him was the night she got pregnant.

Will family planning take hold?

Wonago district has an average of five families living in a household. Jemjemo village has the highest, with as much as eight families per household. Family planning campaigns run by the government have not made a difference.

Health worker Tigist says there are encouraging signs in family planning habits but it takes a long time to bring about meaningful change.

"We give them family planning lessons. We also give them options to control their family size. Some women are on birth control pills others take a three month injection we call Depo [depo-provera]. But we still have a long way to go overcoming logistical and cultural barriers to enhance access to birth control," Tigist says.

Aberu has her hair braided
Aberu has her hair braided

The organization Planned Parenthood says only 13% of Ethiopian women, including 4% in rural areas, use contraception. Some groups, like Population Action International, attribute the problem in part to emphasis on abstinence-only education and restrictions on the distribution of condoms to prostitutes.

The lack of infrastructure is another problem. Activists complain of a shortage of health care workers and of easily reachable clinics. It’s not uncommon, say activists, for women to walk miles to a doctor, who may be responsible for tens of thousands of patients.

Health care specialists also say traditional attitudes make it harder for women to use contraception. “Some husbands say if a woman takes contraception, she can enjoy herself (with other men) rather than her husband,” according to Hailu Bernahu, medical director of the Lalibela hospital. Some men complain that smaller families mean less free labor available for farming.

Wonago's families continue to suffer. The rainy season started late and ended early. Drought that has affected millions in East Africa is magnified by the large family size in this district.

Back in the village, Amarech Tadele is singing for God's mercy as she prepares lunch for her children. She is making bread from fibers of false banana roots that in good times they would have thrown out.

This is part 4 of our 15 part series, A Healthy Start: On the Frontlines of Maternal and Infant Care in Africa

« Prev: Access to Pre-Natal Care Series Index Next: Malnutrition »

You May Like

Obama: Alaskans Feel Signs of Climate Change

They're seeing bigger storm surges as sea ice melts, more wildfires, erosion of glaciers, shorelines More

Katrina Brought Enduring Changes to New Orleans

The city’s recovery is the result of the people and culture the city is famous for, as well as newcomers and start-up industries More

Magical Photo Slides Show Native Americans in Late 1800s

Walter McClintock spent 20 years photographing the Blackfoot Indians and their vanishing culture at the dawn of the modern age More

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Colombians Flee Venezuela as Border Crisis Escalatesi
X
August 27, 2015 2:08 AM
Hundreds of Colombians have fled Venezuela since last week, amid an escalating border crisis between the two countries. Last week, Venezuelan President Nicolas Maduro ordered the closure of a key border crossing after smugglers injured three Venezuelan soldiers and a civilian. The president also ordered the deportation of Colombians who are in Venezuela illegally. Zlatica Hoke reports.
Video

Video Colombians Flee Venezuela as Border Crisis Escalates

Hundreds of Colombians have fled Venezuela since last week, amid an escalating border crisis between the two countries. Last week, Venezuelan President Nicolas Maduro ordered the closure of a key border crossing after smugglers injured three Venezuelan soldiers and a civilian. The president also ordered the deportation of Colombians who are in Venezuela illegally. Zlatica Hoke reports.
Video

Video Is China's Economic Data Accurate?

Some investors say China's wild stock market gyrations have been made worse by worries about the reliability of that nation's economic data. And some critics say the reports can mislead investors by painting an unrealistically-strong picture of the economy. A key China scholar says Beijing is not fudging ((manipulating)) the numbers, but that the economy is evolving quickly from smoke-stack industries to services, and the ways of tracking new economic activity are falling behind the change. V
Video

Video Next to Iran, Climate at Forefront of Obama Agenda

President Barack Obama this week announced new initiatives aimed at making it easier for Americans to access renewable energy sources such as solar and wind. Obama is not slowing down when it comes to pushing through climate change measures, an issue he says is the greatest threat to the country’s national security. VOA correspondent Aru Pande has more from the White House.
Video

Video Shipping Containers Provide Experimental Housing

Housing prices around the San Francisco Bay area are out of reach for many people, so some young entrepreneurs, artists and tech industry workers are creating their own houses using converted shipping containers. But as VOA's Mike O’Sullivan reports from Oakland, the effort requires ingenuity and dealing with restrictive local laws.
Video

Video Arctic Draws International Competition for Oil

A new geopolitical “Great Game” is underway in earth’s northernmost region, the Arctic, where Russia has claimed a large area for resource development and President Barack Obama recently approved Shell Oil Company’s test-drilling project in an area under U.S. control. Greg Flakus reports.
Video

Video Philippine Maritime Police: Chinese Fishermen a Threat to Country’s Security

China and the Philippines both claim maritime rights in the South China Sea.  That includes the right to fish in those waters. Jason Strother reports on how the Philippines is catching Chinese nationals it says are illegal poachers. He has the story from Palawan province.
Video

Video Technique May Eliminate Drill-and-Fill Dental Care

Many people dread visiting dentists because they're afraid of drills. Now, however, a technology developed by a British firm promises to eliminate the need for mechanical cleaning of dental cavities by speeding a natural process of tooth repair. VOA’s George Putic reports.
Video

Video China's Spratly Island Building Said to Light Up the Night 'Like A City'

Southeast Asian countries claim China has illegally seized territory in the Spratly islands. It is especially a concern for a Philippine mayor who says Beijing is occupying parts of his municipality. Jason Strother reports from the capital of Palawan province, Puerto Princesa.
Video

Video Ages-old Ice Reveals Secrets of Climate Change

Ice caps don't just exist at the world's poles. There are also tropical ice caps, and the largest sits atop the Peruvian Andes - but it is melting, quickly, and may be gone within the next 20 years. George Putic reports scientists are now rushing to take samples to get at the valuable information about climate change locked in the ice.
Video

Video French Experiment in Integrating Roma Under Threat

Plans to destroy France’s oldest slum have sparked an outcry on the part of its Roma residents. As Lisa Bryant reports from the Paris suburb of La Courneuve, rights groups argue the community is a fledgling experiment on integrating Roma who are often outcasts in many parts of Europe.
Video

Video Kenyans Turn to Agriculture for Business

Each year Kenyan universities continue to churn out graduates for the job market despite the already existing high rate of unemployment among youth in the country. Some of these young men and women have realized that agriculture can be as rewarding as any other business or job, and they are resorting to agribusiness in large numbers as a way of tackling unemployment. Rael Ombuor reports for VOA.
Video

Video First Women Graduate Elite Army Ranger School

Two women are making history for the U.S. Army by proving they are among the toughest of the tough. VOA's Carla Babb reports from Fort Benning, Georgia as 94 men and those two women rise as graduates of the difficult Ranger school.

VOA Blogs