PlusNews (Johannesburg)

Ethiopia: Hospital Births Still Unpopular

Addis Ababa — Ethiopia is boosting its health worker numbers, building thousands of health centres and working with donors to prioritize the prevention of mother-to-child HIV transmission (PMTCT). Even so, most women still prefer to have their babies at home.

"During the 2009-2010 Ethiopian fiscal year, only 6,990 pregnant women received [the full range of] PMTCT services - around 8 percent of the estimated HIV-positive pregnant women. It is very alarming and a serious problem," Assefa Ayde, senior public relations officer in Ethiopia's Health Ministry, told IRIN/PlusNews.

An estimated 2.4 percent of pregnant women in Ethiopia are thought to be HIV-positive - rising to 3.5 percent in the 15-24 age group. The national average is just over 2 percent. About 20 percent of children born to HIV-positive mothers annually are also infected with HIV, according to government statistics.

Hawi Debele, 29, lives in the capital, Addis Ababa, where state and private heath facilities abound. However, she has delivered both her children at home.

"My mom gave birth to me and my two brothers at home. All the people in my village give birth at home assisted by some people who have done it for decades," she told IRIN/PlusNews. "Though now I live in Addis, both my husband and I were in agreement when I went to my mum to have my kids. It is easier that way so that my mum can take care of me after I have a baby."

Some indicators are looking up - the number of Ethiopian women who visit antenatal clinics has grown from 616,763 in 2008-2009 to 796,099 in 2009-2010, while the number of mothers who received HIV testing as part of PMTCT services has also grown to over 70 percent. However, just 6 percent of births are attended by a skilled health worker, according to the UN World Health Organization.

"A considerable number of them don't come to give birth here unless they have complications from earlier deliveries like Caesarean sections or face complications giving birth at home," said Martha Kebede, family health officer at a clinic in the capital. "Breaking this culture and educating about the benefits of institutional delivery could be the major task."

I remember once we pushed two couches together because all the beds were occupied and we couldn't send the woman [to another health centre] because she had begun labour

Health system problems

According to Martha, the poor quality of care at health centres also keeps women away.

"We often run out of beds - I remember once we pushed two couches together because all the beds were occupied and we couldn't send the woman [to another health centre] because she had begun labour," she added. "You can easily imagine that mother or others who hear her story not coming to government institutions to give birth."

She noted that small health centres such as hers had to send babies' dry blood samples to regional laboratories for polymerase chain reaction HIV tests and often did not get the results back for weeks, frustrating mothers and reducing the likelihood that their children, if diagnosed with HIV, would receive the treatment they needed.

So far, the government has built more than 2,600 centres out of a planned 3,000 - over 1,300 of which offer PMTCT - but still, women continue to give birth at home. In addition, the government has trained more than 30,000 "health extension workers" to provide healthcare at community level.

"We have deployed two female heath extension workers in every kebele [village] who go from home to home and can assist in delivery," said Assefa. "They can refer women to health posts [in each kebele] and if necessary [to larger] health centres.

"All women are exempted from payments related to delivery across the country and... no matter where you live in Ethiopia today, there is a health facility at least within a radius of 10km," he added. "While there is more to do, the problem now is to bring the women to the health centres; this remains a big challenge."

Large donors are also prioritizing PMTCT. Carmela Green-Abate, Ethiopia coordinator for the US President's Emergency Plan for AIDS Relief (PEPFAR), says: "This [PMTCT] has been a focus programme, so even though PEPFAR had a budget cut [of 5 percent] this year, we still increased our funds to supporting PMTCT."

More pregnant women are being tested for HIV, but just 8 percent receive the full range of PMTCT services

Addressing stigma

According to Martha, beyond institutional improvements, it is important to educate the community about HIV and reduce levels of stigma. "The lack of male participation is another reason why most pregnant women who access ANC [antenatal care] are lost when tested positive for HIV," she said. "We track down very few of them as the resources and the system are not there to do so; their main concern is fear that their husbands would kick them out of the house if they found out about their HIV status."

The government has launched a nationwide publicity campaign, backed by a number of Ethiopian celebrities, to bring home the importance of health facility delivery. Tsedina Gebremarkos, a popular local singer and Kora Award winner, has teamed up with another local singer, Mekia Behailu, to release a single showing how women suffer while trying to give birth at home.

"It takes professionals to put together good music, and it also needs professionals to have a mother give birth safely," Tsedina says in a TV message. "Deliver at health facilities and let the mother be safe and the child healthy."

Theme(s): Children, Care/Treatment - PlusNews, Education, Gender Issues, HIV/AIDS (PlusNews), Prevention - PlusNews, Stigma/Human Rights/Law - PlusNews,

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