Momina sits on the bed in the hut where she will give birth to her third child. The bed is a traditional Afar “oloiyta” made of thatched sticks and slightly raised. She is ready to deliver any day now.
“The baby has been moving around a lot,” Momina says. She is nine months pregnant, and is visited twice a week by a Women’s Extension Worker (WEW) from the Afar Pastoralist Development Association (APDA) – the Ethiopian partner of Anglican Overseas Aid in The Road Less Travelled project.
The WEW has monitored Momina throughout her pregnancy, and provided antenatal care. However, this has not always been the case for women giving birth in the Afar region of Ethiopia. In one district surveyed by the project, 66 percent of women reported having received no antenatal care during their most recent pregnancy. (Read more in our Baseline Report).
As a country, Ethiopia has one of the highest ratios of maternal mortality in the world, in 2011 recording 676 maternal deaths for every 100,000 live births.1 For women in the Afar, the risks of injury or death during childbirth are even greater.
Due the remoteness of the Afar pastoralist communities and their nomadic lifestyle, communication, transport and access to health services has in the past been extremely limited or non-existent. There are also significant cultural or attitudinal factors that affect the care mothers receive during pregnancy, delivery and post-delivery.
APDA is improving the chance at life for Afar mothers and their children, by mobilising members of the community in the fight for safe motherhood. With a 20-year history working within the pastoralist setting, the organisation is uniquely positioned to facilitate relief and development activities that are relevant to the community, and implemented by the community.
WEWs are literate Afar pastoralist women who APDA has trained to offer a mobile health service for mothers in remote areas. They travel between households to promote awareness and behaviour change around key maternal and child health challenges.
They work alongside Health Extension Workers (HEWs), the front-line health providers for pastoralist communities, who administer basic treatment and health education programs. The WEWs also provide training to the Traditional Birth Attendants (TBAs) who support mothers like Momina during childbirth.
Thirty-two-year-old Momina left Djibouti in the early ’90s, and has lived in Ethiopia ever since. She has two daughters, aged three and six.
Throughout her third pregnancy, the local WEW has visited to explain what is happening at each stage and to check everything is progressing well with the pregnancy. Like most women in the Afar region, Momina will give birth at home with the support of a TBA.
“I prefer to give birth at home with an Afar midwife,” she says. “With my first child, I had difficulties giving birth. The baby was inside for two days, but then when I eventually gave birth everything was fine.”
Momina knows she was fortunate, and that childbirth is a very different story for many women in her community. “I hope that this birth goes well, I pray to my god that everything will be ok.”
During the final stage of pregnancy, the TBA is staying nearby and visiting Momina every day. TBAs selected and registered with APDA undertake annual training, and are equipped with a field kit and birthing kit. After each delivery they complete a pictograph reporting sheet, which is collected by the health workers who report back to APDA. They provide the TBA with a new birthing kit, and follow up after delivery with postnatal check-ups and reporting.
Momina is raising her daughters alone, while her husband is in another district of the Afar region. Reflecting on the future, she says that apart from a safe delivery in the coming days, her main hope is that her girls get an education, as she missed out on this opportunity herself.
“My eldest daughter is six years old and in first class,” she says with pride. “I don’t want them to be ignorant, I want them to get an education.”
For much of APDA’s work mobilising the Afar to improve maternal health, education is an underlying factor – with a particular focus on increasing female participation in education. In doing so, they can ensure the next generation of Afar pastoralist women will continue to be implementers of development change within their society; and that more women like Momina will be able to access locally-appropriate, quality health care.