Globally, the annual number of maternal deaths is decreasing substantially. Particularly, since the 1990s, the death rate has declined remarkably.
In 2015, an estimated 303,000 women died due to pregnancy and child birth related complications. Of these, Sub-Saharan Africa constitutes 66 percent of the global burden, as some sources indicated.
Recently, Ethiopia has launched Emergency Obstetric and Newborn Care (EmONC) assessment report. EmONC refers to the care of women and newborn during pregnancy, the time after delivery if or when women her newborn experiences serious complications.
The primary objective of the report was to generate evidence on the current availability, utilization and quality of EmONC service in Ethiopia, and to measure progress since 2008 when the first assessment was implemented.
According to UN estimation, Ethiopia has reduced maternal mortality by 72 percent since 1990 with a five percent annual rate of reduction. The maternal mortality ratio has declined to 353 per 100,000 live births in 2015 which was around 1,250 in 1990.
The major causes of maternal mortality in Ethiopia are haemorrhage, hypertension in pregnancy, obstructed labor, sepsis, and anemia.
The under five mortality rate in the country has also declined from 205 to 145 per 1000 live births between 1990 and 2015. During the same period, neonatal mortality has declined from 61 to 28 per 1000 live births. The primary causes of neonatal mortality are asphyxia, prematurity, sepsis and congenital abnormalities.
The report found out that since 2008, Ethiopia has seen substantial improvement in the availability of EmONC facilities per 500,000 populations (UN recommended standards). In 2008, the nation had just 11 percent of the recommended number of fully functioning EmONC facilities, nationally. However, in 2016 the proportion increased to 40 percent. Despite the improvements, a large gap remains to reach 100 percent of the recommendation.
Nearly 85 percent of facilities provided focused antenatal care, postnatal care, family planning diagnosis and treatments of Sexually Transmitted Infectious (STIs) and the Prevention of Mother-To-Child Transmission (PMTCT) package.
Over the past eight years, the Ministry of Health has constructed a number of new facilities though gaps remain in the number of primary hospitals and rural health centers if the country has to meet its own standards of facilities to population size.
The Ethiopian government particularly the Ministry of Health (MoH) and the entire health sectors and those affecting the health condition of the people have understood that improving the health condition of women's is critical to maintain health objectives, said Dr Ephrem Tekle Child and Maternal Health Director at the Ministry.
In this regard, recognizing that every pregnancy is wanted and every birth is safe are crucial to reduce child and maternal mortality and realize the Agenda of 2030 for Sustainable Development Goals.
The Ministry has a 20 year Health Sector Development Program that gives due attention to accessing health services at all ages and ensure healthy lives.
"We were highly tangled on increasing the coverage but obviously we understand that availing facilities on its own is not enough. So, we worked hard to ensure that health sectors are available in the most pockets of the country."
Rural areas, which were once unreachable and had little or no access to medical care some 20 years back, have now access to better health services.
"We built about16,000 health posts in every village so that we make sure that every pregnant woman can have the service in the nearby health posts rather than traveling far away. We also train health extension workers to support every mothers.
For instance, if a mother wants to get family planning services, it is not mandatory for her to visit health posts. Rather, she can get the service while she is at home from house to house health extension workers, which is unlike of any other countries. Indeed, delivery requires well prepared health facility.
"So, over the last 20 years, we built about 3,600 health sectors to ensure at least one health center is available for 25,000 populations," Dr Ephrem added.
The Ministry has seen considerable improvements in the number of human resource available in health posts, health centers, primary hospitals and above.
And the supply for medicines and logistics have also completely improved over the past two decades. These efforts have borne fruit and cut down child and maternal mortality rate. These days, it is enabled to save the lives of thousands of mothers who were dying in pregnancy and giving birth in early years.
With regard to family planning, women, (both married and single) have better access to contraceptives of their choice. Therefore, apart from developing the right to decide when to have a baby and when they do not want to, they have been able to make a difference in their lives.
And these days, a number of mothers have also delivering in health institutions. The quality of service available in health facilities have also manage to decrease the mortality rate of mothers and children, adolescent and young people. However, the success is also challenged by varied critical hindrances including equity.
It is clear that improving equity is one of the indicators in accessing services for all. For instance, the total fertility rate in Addis Ababa which is 1.8 percent. But if we go to Somali, in the most pastoral areas it reaches up to 7.7 per cent. This shows that there is a high skewed variation in the total fertility rate.
With regard to contraceptives, the prevalent rate of women who use contraceptives in cities like Addis Ababa, Dire Dawa and Harar has reached as high as 60 percent. Conversely, in some of the places such as Afar and Somali, the rate goes down as low as five percent.
Indeed, economic disparity and education also have their own impacts in that regard. The utilization of contraceptive is in much better level than the ones who are less educated or illiterates.
"All these clearly put that even though we have achieved a lot, a lot remains to be done in our agenda. That is why our health sector transformation plan has clearly dedicated to improving equity and eyeing to transform the sector."
And this would not be only the responsibility of the Ministry and health sector stakeholders. Rather, it requires a concerted efforts of other sectors, agencies and development partners to further improve their livelihood, assist to make their own choice at the end of the day empower women economically.
"The government, particularly the Ministry of Health are highly committed to ensure this happens as part of our commitment of realizing Sustainable Development Goals," Ephrem remarked.