Birthing Kit Foundation representatives with a family, Traditional Birth Attendant and health worker in Ethiopia
ETHIOPIA
Project Overview
Ethiopia is a country of 80 million people in Sub Saharan Africa where 2.75 million women become pregnant every year and 93% deliver in the home.
The issue of unhygienic births is of particular concern in remote areas where there are high rates of poverty. The local customs that involve women choosing to give birth at home, together with the mountainous terrains, lack of roads and inaccessibility of health services in these areas, particularly where there are nomadic lifestyles, provided the impetus for the provision of clean birth kits.
Ethiopia has a maternal mortality rate of 470:100,000 live births. The need for a clean birth and midwifery education is obviously high.
The Australian Agency for International Development (AusAID) has funded BKFA to develop and manage the assembly and distribution of 30,000 clean birthing kits in three regions in Ethiopia: Shire, Tigray Region; Logyia, Afar Region; and Addis Ababa. This project will create employment opportunities for vulnerable and marginalised women and provide refresher training for Traditional Birth Attendants in Afar Region.
Abraham’s Oasis, Afar Pastoralist Development Association and Hamlin Fistula Ethiopia will employ women to make the kits. All three NGOs have been working with BKFA over the past 4-7 years. This program is seen as an entry point to promote community dialogue and education about issues such as early marriage, growth stunting of the female child, gender based violence, female circumcision, obstructed labour and other problems that may lead to obstetric fistula and other obstetrical problems. The NGOs also report that more and more pregnant women are attending antenatal care, seeking referral for delivery if there is a problem and completing the immunisation of their children.
We distribute our kits through Health Extension Worker and Traditional Birth Attendant training programs and to remote outposts through the following organisations:
1. Hamlin Fistula Hospital
2. Afar Pastoralist Development Association (APDA)
3. Abraham’s Oasis
The BKFA chose Ethiopia as a country to target for project expansion and monitoring. The first monitoring trip was in 2008.
Participating Organisations
1. Hamlin Fistula Hospital and Outreach Centres (www.fistulatrust.org)
The BKFA has a strong affinity to help at this hospital with its founders being two Australian gynaecologists, Catherine and Reg Hamlin. The Hamlin Fistula Hospital (HFH) is a Non-Government Organisation created in 1973 to surgically repair fistulas that result from obstructed labour. The BKFA has supplied over 97,000 kits primarily through the Hamlin Fistula Hospital in Addis Ababa since 2004. They are used by the outreach centres in Bahir Dar, Mekele, Harer and Yirga Alem in their preventative health training programmes in remote regions. The Fistula Hospital conducts training programmes for Health Extension Workers and Traditional Birth Attendants. There has been sustainable supply of kits since the initial training courses and there is anecdotal evidence that the kits are effective in reducing the risk of infection post-delivery.
BKFA will continue to work with the Hospital to provide kits for their needs in the outreach centres. BKFA will focus on working towards in-country supply of components and production of the kits at the Hospital's Desta Mender facility. They would like us to supply 30,000 kits over the next 12 months.
Afar Pastoralist Development Association (APDA) has been implementing a primary health program in the Afar pastoral society for 12 years. Because some areas are only accessible by camel or foot, traditional birth attendants (TBAs) have been trained in clean and safe delivery as an essential component of their community development program. TBAs will receive refresher training in essential hygiene and sanitation; nutrition during pregnancy and lactation; normal and abnormal symptoms during pregnancy; identifying, agreeing on and planning to stop harmful practices in childbirth including female circumcision; bleeding the mother from the cord while the placenta is in situ; delaying breastfeeding and giving the baby butter, goat’s milk or sugar and water; identifying and referring women at risk to the established health centres or hospital for delivery; and, dealing with HIV/AIDS during childbirth
Abraham’s Oasis places emphasis on women’s health generally and maternal health in particular. Representatives from Abraham’s Oasis speak at most women related venues in Tigray Zone, raising awareness for the plight and need of change for the role of women in the Zone. Abraham’s Oasis aims to provide clean delivery kits for every delivery in the area whether at home or in a health facility and has received requests for birthing kits from other areas. Reports show that even the health centres like them because the women now know about them and want the ‘clean sheet’ delivery rather than giving birth directly on the bed or floor. Abraham’s Oasis has received feedback from one nearby area that the provision of clean delivery kits reduced maternal/ infant mortality and morbidity by 10 percent during the last ten months of 2010.