Abdella Isse, Monitoring & Evaluation Coordinator for the Afar Pastoralist Development Association, sat down with mother of six, Kulsuma Ahmed, to talk about her experiences of giving birth in Afambo in the Afar region of Ethiopia.
Many pastoralist women such as Kulsuma Ahmed, pictured above, from Afambo in the Afar region of Ethiopia, give birth at home. It is the cultural norm within the nomadic Afar community, despite not being the safest delivery setting for mothers and their newborns.
In the portable dome-shaped huts in which nomadic families live and women give birth, sanitation and hygiene are constant issues, water is not always readily available, and mothers are a long way from skilled medical support if they run into complications. Communities often live 30-40 kilometres from the nearest road.
Traditional birth attendants (TBAs) usually assist women during pregnancy and childbirth due to challenges of distance and lack of health facilities. The percentage of deliveries assisted by qualified health personnel in the Afar region is just 6.2 percent – compared to the national average of 18.4 percent.1
The Afar Pastoralist Development Association (APDA), Anglican Overseas Aid’s partner in The Road Less Travelled project, has been working with pastoralist women to educate the community about the benefits of attending a health facility at the time of birth. This education is delivered to the pastoralist women through the organisation’s Women’s Extension Workers and Health Extension Workers.
Kulsuma is 30 years old and has six children: three girls and three boys. Her first five children were born at home with the help of a traditional birth attendant. During her sixth pregnancy, Kulsuma became anaemic and the Women’s Extension Worker and Health Extension Worker told her that the baby should not be born at home. She was also very thin, so she decided to go the hospital.
Although not familiar with hospital practices before her visit, Kulsuma said that her experience of giving birth at the hospital was very positive. Kulsuma said that there were many advantages to a hospital delivery, such as the care provided by the doctors and the anti-pain medicine she was given. She also said that she did not have any infection after the birth, which is common when women deliver at home.
Kulsuma said that cultural traditions play an influential role in women’s decision to give birth at home. For this reason, many Afar pastoralist women do not know the advantages of delivering at a hospital.
As traditional birth attendants have helped the majority of women at the time of delivery, many think it is better for their children to be born at home than in the hospital. Due to sociocultural beliefs regarding modesty, pastoralist women do not like being supported by men during childbirth. This is a challenge in the Afar region, where most of the health clinics are run by men.
After her positive experience in the hospital, Kulsuma now understands why APDA encourages women to deliver at a health facility. Kulsuma is now an advocate for hospital delivery, and advises other expectant women about the advantages of having their baby at a hospital.