In our world, the annual number of maternal deaths has sustainably declined since 1990. 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.
According to UN estimates, Ethiopia has reduced maternal mortality by 72 percent since 1990 with a five percent annual rate. The maternal mortality ratio has declined to 353 per 100,000 live births in 2015 from 1250 in 1990.
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 per1000 live births.
While the major causes of maternal death and neonatal mortality in Ethiopia are hemorrhage, hypertension in pregnancy, obstructed labor, sepsis, and anemia, in case of neonatal mortality, they are asphyxia, pre-maturity, sepsis and congenital abnormalities
Since 2008, Ethiopia has seen substantial improvement in the availability of Emergency Obstetric and Newborn Care (EmONC) facilities per 500,000 populations (UN recommended standards).
In 2008, Ethiopia had just 11 percent of the recommended number of fully functioning EmONC facilities, nationally. In 2016, the proportion increased to 40 percent. Despite the improvements, a large gap remains to reach 100 percent of the recommendation, as the Ministry of Health report shows.
Some 85 percent or more of facilities provided focused on antenatal and postnatal cares, family planning diagnosis and treatments of Sexually Transmitted Infectious (STIs) and the Prevention of Mother-To-Child Transmission (PMTCT) package.
Maternal and Child Health Directorate Director Dr. Ephrem Tekle Lemango said that the Ministry has constructed a remarkable number of new facilities over the past eight years, but gaps remain in the number of primary hospitals and rural health centers if Ethiopia is to meet its own standards of facilities to population size.
Identifying the cases that are affecting the health condition of the people particularly women, the government is endeavoring to address the needs of women and make sure that every pregnancy is wanted. Every family planning is supported by health practitioners to make sure that every child has the opportunity and potential to grow and become educated young person to utilize their full potential.
The Ministry has a 20 year Health Sector Development Program that aimed at increasing access to health services and addressing equity.
"We were highly tangled in making sure coverage increases 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," said Dr. Ephraim Tekele, Mternal and Child health director under the Ministry of Health.
The agrarian regions, which were the most unreached part of the country some 20 years back, have now better access to service. "We build about 60,000 health posts in every village so that we make sure every pregnant mother does not have to travel far to get service. And we also play the health extension worker to support every mother's choice."
When a mother wants to get family planning service, she can have her choice from health extension workers at her house without the need of going to health centers, which is unlike any other countries' service. "So, over the last 20 years, we have built about 3,600 health sectors to ensure at least one health center is available for 25,000 populations," he said.
The Ministry has seen considerable improvements in increasing the number of human resources available in the health center, primary hospital and health posts. Provisions of medicines, and logistics have also significantly improved over the past two decades. This improvements and efforts have paid on the lives of mothers and saved hundreds of thousands from dying during childbirths. A great number of women, both married and unmarried have now got better access to contraceptives whenever they want. So that, they have the choice and right to make a difference in their own life; and enabled to decide when to have a baby or not.
The quality of services available in health facilities have also manage to decrease the mortality associated with mothers and children, adolescent and young. "However, we understand that the success is also covered by some of critical challenges including equity."
Improving equity is a clear indicator that the total fertility rate in Addis Ababa which is predominantly city is 1.8. But if we go to Somali, in the most pastoral areas it reaches up to 7.7 per cent. There is a high skewed variation in the total fertility rate.
Concerning the rate of using of contraceptive, the number of women who uses contraceptives in cities like Addis Ababa, Dire-Dawa and Harar increases as high as 60 percent but they are as low as five percent in Afar and Somali. As of this disparity, substantial difference is seen in women who are doing well economically and those do not. The poor one's have least access to services. Educational status also has shown the same disparity among women with regarding to contraceptive use. Access to contraceptive and attendance of birth (family planning services) improves with the level of education of women. It was registered to be better among women to attended secondary education.
"All this clearly put that even though we have achieved a lot, a lot remains in achieving our agenda. That is why our health sector transformation plan has clearly dedicated in improving equity as our transformation agenda," Dr. Ephraim said.
"And this requires concerted efforts of all sectors, agencies and development partners to sustainably empower women, improve their economic capacity and livelihood and the ability to make choices."
The government, particularly the Ministry of Health is highly committed to ensure the successful realization of the program as part of nation's commitment to the Sustainable Development Goals.