Each year, half a million pregnant women in the developing world die of complications during childbirth, and about six million children are stillborn or die within a week of birth. For the next three weeks, we?ll be looking at some of the factors that affect the chances of an African woman having a safe pregnancy and a healthy child.

This week, VOA?s Henok Fente, who recently visited Ethiopia, tells us about some of the issues that can affect a woman?s chances of having a safe pregnancy, including early marriage, malnutrition and access to pre-natal care.


In Ethiopia, pregnant women and young children face a serious problem: most of them live in rural areas, far from health care facilities. Usually, they travel for hours on foot to the nearest clinic, only to receive marginal quality treatment. For many pregnant women, even that is a luxury.

A model maternity clinic

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Mondays are busy at the Fufa village maternity clinic in south western Ethiopia. Mothers from near and far come to this clinic, the first of its kind within a 100 kilometer radius.

The hospital has a delivery room, basic equipment and trained professionals. Gebremariam Ayele is a clinical nurse who has been working in the Fufa area for decades. He describes how prenatal care was delivered in the past.

"We were limited in what we could do. [Before the clinic was built], we sent two health care workers to the villages on foot. They provided vaccinations and antenatal care to mothers," Gebremariam said.

He added most pregnant women do not get to proper clinics like the one at Fufa with the latest medical equipment and trained professionals.


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The effects are devastating. The UN reports that Ethiopia's infant mortality rate is 86 out of every thousand.

Lack of care can also be fatal for mothers. Those who survive have to deal with the emotional and physical scars left from obstructed labor. One of these complications is fistula.

Mark Bennet is the CEO of the Addis Ababa Fistula Hospital, where women who suffer from birth injuries get free treatment. He says fistula often happens in rural areas because women don't have access to healthcare during delivery.

"They live a long distance from a place where healthcare can be provided, so getting transport, getting to a health center in time and getting to a health center that actually has the facilities or the professional staff that can give some assistance takes a long time," Bennet said.

Fistula is a childbirth injury ? a hole made between the bladder and the wall of the cervix or rectum through which fluids leak.

It is caused by prolonged labor and lack of access to proper care. In fact, many women die while giving birth, but some make it to the fistula hospital in Addis Ababa, the only of its kind in the country.

"Ethiopia has a big challenge. Building roads to connect rural communities to locations where health care can be provided, that is a big challenge," said Bennett. "Providing education to rural communities is a big challenge. And providing health care professionals to a rural community that is so large is an enormous challenge. Educated people do not want to work in the country side."

Physician shortage

Adding to that is the flight of doctors leaving the country for better paying jobs overseas. The government is training health extension workers to meet the growing demand in the country, which has Africa's second largest population. These are low-level professionals with some months of training.

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Mekdes Kassahun is a midwife who works with health extension workers. She says the biggest challenge is raising awareness in rural communities, and health extension workers are helping bridge that gap.

"Health extension workers and mobile clinic workers teach mothers about basic nutritional needs during pregnancy," she said.

"They grow cabbage and carrots for sale at local markets to buy grain. We advise them to eat vegetables during pregnancy. We also consult them about possible birth complications, vaccinations and PMCT."

PMCT, Prevention of Mother to Child Transmission of HIV is a big component of the prenatal care provided at Fufa hospital.

At another maternity clinic, in the town of Durame in southern Ethiopia, farmers Amenech Haylemariam and her husband Desta Tsienew came to visit a patient. Amenech said she is likely to be four or five months pregnant, and intends to go regularly to the clinic.

The government says health extension workers will help out in efforts to expand healthcare access for millions of Ethiopia's rural women. But there is no quick fix in sight -- as poor infrastructure and a high population growth remain formidable challenges.

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