20 October 2016

Ethiopia: Midwives, Stewards of the Next Generation


The birth of one's baby means the birth of a new generation. It is a new gift with a new flavour that the world of tomorrow will be looking for. And it is a bright hope for its family society, country and even the whole world if it is welcomed in a way that assures its safety and health. For this, the role of midwives is indispensable.

However, before 1942, children born somewhere in Ethiopia had to go through the hardest delivery which is assisted by traditional (local) midwives. It all started in 1942 E.C at Yekatit 12 Hospital.

Sr. Assegedech Zerefa is one of the first trained midwives in Ethiopia. She says there were no Ethiopian professional health workers in the hospital by the time but only foreign doctors, nurses, health officers and laboratory technicians from Europe. Twelve Ethiopians were hired as janitors while the first maternity room was opened for service by the time, according to her. And she was one of them.

They started their cleaning job with 25 Birr pocket money. She was a little girl promoted to sixth grade student while she got the job. "We were working and taking midwifery training delivered by the British medical workers at the same time. After two years of training eight of us graduated because the remaining four quitted the training because they thought the training was difficult. Then they hired us there in the hospital as midwives with 150 Birr salary", she said.

In 1950s Ethiopian doctors and medical workers began to come to the scene and foreigners were replaced. Midwives went on doing their job by following up mothers' and newborns' health and giving care. There used to be so many mothers who reach hospital after two or three days of painful maternal periods of birth. Mothers from the countryside used to suffer most of the time as they travel a long distance without medical care. As a result maternal mortality was high. Dearth of midwives had also its own impact, reminisces Assegedech.

According to Ethiopian Midwives Association, not including the first midwives, three levels of midwifery professionals exist in Ethiopia. The first are midwives who were nurses who took a year midwifery courses, which was started in 1948 E.C; the second level are junior midwife nurses who directly enrolled from high school to midwifery school for a one year programme, which was started in 1988 E.C. One year later the direct diploma midwife nurse programme opened in Gondar University and at Hawassa Health Professional Training Institute. The third is the bachelor level midwifery programme that was first started in 1996 E.C at Gondar and Addis Ababa universities.

Through such gradual progress, the master level midwifery programme started in 2002 E.C at Gondar University, which is currently in the process of implementing a PhD level midwifery programme. All these steps aim at ending preventable maternal and child deaths and improving mother's and infants health. According to the Ministry of Health a spectacular improvement was made over the last 15 years. This was achieved utilizing the prevailing peace and stability in the country; health care reforms with community empowerment and ownership through the flagship Health Extension Programme and midwives' efforts.

Speaking on the recently celebrated 25th EMA's silver jubilee, UNICEF representative to Ethiopia Gillian Mellsop said a tremendous progress has been made in addressing maternal and child survival and in the overall strengthening of the health sector in Ethiopia. Ethiopia saw 72 per cent decrease in maternal mortality just short of the MDG 5 target of a 75 per cent reduction. Gillian emphasized that these achievements were made possible by high level political commitment, strong leadership, collaboration and partnership and of course the tireless efforts of Ethiopia's midwifes.

Even though the progress is promising, there is still a lot to be done to end preventable maternal, newborn and child deaths. The Ministry of health says it has developed a 5 year Health Sector Transformation Plan(HSTP) and will be made possible by ensuring quality an equity in health care, developing caring, respectful, and compassionate health professionals, continuing the Woreda transformation, and through sustaining the Information Revolution agendas so as to make the health system strong and resilient.

With effective implementation of the HSTP in collaboration with health practitioners including midwives, the Ministry is looking at reducing maternal, under-5, and neonatal moralities by more than half and plan to reach the targets of 199/100000, 30/1000 and 10/1000 live births respectively by 2020.

"This demands that every woman and new born receives quality care during antenatal, labour, childbirth and early postnatal periods from a competent, caring and compassionate midwife", said Gillian.

Association president and founding member Sr. Yezabnesh Kibe says EMA has been through several significant progresses in its 25 years existence. For instance its members has reached 5,000 from 150 when it was established. The most important part is that midwives' educational status has improved from diploma to first degree and masters. In this case the midwives role in health care service has improved beyond delivery because there are midwives who involve in surgical and other activities, according to her.

Providing family planning, antenatal, delivery and postnatal care services to mothers and their babies means participating in ensuring the health of families across the continuum of their life, says Yezabnesh.

There are 12,000 midwives throughout the country and 5,000 are members of EMA. In this case if extra empowerment training are given and professionals in the field are technologically and ethically updated, there is no way why the above mentioned goals wouldn't be achieved.


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