Understanding and Decolonizing Maternal Health in Ethiopia through Indigenous Methodologies

Background and Purpose: Despite several international policies and programs that are intended to enhance maternal health and reduce maternal mortality, many African countries, including Ethiopia, still have the highest maternal mortality ratios.  Sub-Saharan Africa has an extraordinarily high MMR, with some estimates concluding that 1 in 20 women die from maternity-related causes.

The purpose of this study was to analyze gaps in Ethiopian maternal health policies and implementation strategies and to identify culturally-relevant solutions to this problem.  As Pettigrew (1987) reminds us, “…where we sit not only influences where we stand, but also what we see” (p. 649).  This study looked to how the community perceives and defines motherhood and maternal health needs and how such constructions impact maternal health services utilization. 

Methods: This qualitative study utilized Indigenous approaches (Tuhiwai-Smith, 2012) to decolonize the research process. The decolonizing process began by acknowledging the expertise of the research subjects in utilizing the services being provided and offering a space for their voices to be heard.  This primary step ensured the self-determination of the women at a grassroots level.  Second, decolonization occurred through utilizing indigenous approaches and methodologies to frame the questions and to collect and analyze the data.   Data was collected using in-depth, semi-structured interviews, visual dialogue, and observation. Interviews were conducted in Amharic, with 27 women, 18 and older, 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: According to the data, motherhood entails much more than giving birth to children. It is a broader notion that is centered on woman’s role as a caretaker and nurturer of children.  Motherhood is also sacred and a place of privilege for women. Motherhood likewise involves coping with socioeconomic challenges and meeting children’s physical, emotional and spiritual needs.   Motherhood is socially constructed and has a sociocultural significance that is measured by raising children as part of fulfilling a woman’s communal expectations.

The expansive nature of motherhood was reflected in the various maternal health needs identified by the research participants.  In addition to access to healthcare facilities and pre and post- natal services, research participants identified basic infrastructure such as clean water, energy, and transportation in addition to education and economic opportunities as maternal health needs.  Therefore, any sustainable solution to Ethiopia’s maternal health problems must involve a wider array of services than promoting facility-based delivery services only.    

Conclusion and Implication:  This study captured deep reflections regarding cultural accounts of motherhood, and maternal health needs and services.  The study proposed insightful recommendations regarding how to enhance maternal healthcare in the community using bottom-up interventions and strategies.