Towards Indigenous National Policies and Programs: Maternal Health in Ethiopia

Background and Purpose: Since the Millennium Summit in 2000, improving maternal health has been incorporated as part of the Millennium Development Goals [MDGs]. This goal has been adopted by countries in Sub-Saharan Africa as part of their national health policy as maternal mortality continues to be one of the biggest challenges in this region, including Ethiopia. Scholars have identified the practice of homebirth without a professional assistance as a major challenge to address maternal health problems pertinent to this region. Accordingly, huge investments have been allocated towards achieving this goal through promoting birth at health care facilities and availing emergency obstetrics care. This paper explores why mothers in Ethiopia prefer homebirth over facility-based birth and examines the interface between national maternal health policies and grassroots practices.

Methods: This was a qualitative study informed by Indigenous approaches. Data was collected using in-depth, semi-structured interviews, visual dialogue, and observation. Interviews were conducted in Amharic [native language], with 29 women (18 years old and above), living in North Wollo Zone, Ethiopia. Participants were recruited using gatekeepers in the community. The interviews were transcribed verbatim and coded thematically using ATLAS.ti qualitative software. The analysis was guided by the interactive model. Field notes and reflective journals were used to capture the sociocultural, economic and physical differences in the interview settings, thereby providing additional data for the analysis. Memoing and member checks were used to ensure trustworthiness and authenticity of the data.

Findings: Data analysis revealed that participants’ perception of birthing as a natural phenomenon and death [maternal mortality] as destined by God/Allah influenced their health service seeking behavior.  Most participants confirmed that they did not and would not go to health facilities to give birth unless there was some complication.  For the participants birth was not a disease, but a natural phenomenon which was part of being a woman. And death was a destiny that could not be prevented by health facilities and/or health professionals. Moreover, homebirths allowed the women to perform their traditional rituals in the company of their loved ones. Participants also identified other reasons for not utilizing health care facilities including: the majority of health professionals [doctors, nurses, midwives] being male, lack of trained midwives, large number of interns and frequent checkups during birth, inaccessibility of health facilities, and lack of basic infrastructure and amenities in the community as well as health facilities.

Conclusion and implication: The findings highlight the importance of culture, religion and spirituality in shaping mothers’ health service seeking behavior during childbirth. Thus, it is vital to train traditional birth attendants who deliver babies at home, and create a friendly space for birthing and prenatal care. Birthing centers might attract more mothers than birthing wards within health facilities or hospitals.

These findings are important to social work as they emphasize Indigenous knowledge, promote bottom-up approaches to policy and program design, and shift the discourse on maternal health to a human rights and social justice issue that require structural responses.