From Fear to Joy: Transforming Childbirth in Rural Ethiopia

By Natalie Doyle, Program Development Officer

Photo by Natalie Doyle
Halima with her eighth child, three days after his birth. Thanks to the delivery techniques that Halima’s birth attendant learned from IMC, Halima was spared from the infection and gratuitous pain that many women in rural Ethiopia endure during childbirth.

Halima is a 36-year-old mother of eight children from the rural community of Tamuc in eastern Ethiopia. Situated in the desolate lowlands of the Somali region, Tamuc remains untouched by modernization. To reach the nearest healthcare facility, villagers in Tamuc must travel more than 50 miles on foot through arid and dusty lands where only herdsmen venture in search of better pastures to feed their cattle. Traditional ways of life and practices shape the lives of its inhabitants. Like most people in the region, Halima’s family relies on pastoralist activities for their income. Her family owns two cows and 20 goats, which they raise and breed to produce milk to feed the children, and exchange for food, cattle and small goods.

Halima’s first seven children were delivered by a traditional birth attendant (TBA), as is customary in her community. In the Somali region, TBAs often place women giving birth in a standing position, and have two assistants hold them up by their arms, one on either side. The assistants then thrust the pregnant woman up and down, which is thought to help the baby come out faster. This traditional birthing method can last for more than 10 hours, especially if there are complications, and it often induces vaginal tearing and excessive bleeding. The resulting wounds are vulnerable to infection, particularly in women who have undergone female genital mutilation, who make up 90% of the female population in the Somali region. Because professional medical assistance is so hard to access from this remote village, the infections often prove fatal. Death and childbirth are tragically linked in Tamuc: Halima can name 20 women in her village who have died over the past three years due to complications during pregnancy and child delivery.

When Halima delivered her eighth child in April 2007, however, she was spared from the painful procedure she had previously undergone. Her TBA, Selam, had been taught clean, safe delivery methods during a five-day training course initiated by International Medical Corps. Though TBAs must often walk for one or two days to reach the health facility where the trainings are held, they are eager to learn techniques that reduce the risk factors of childbirth.

The project was made possible by co-funding from the UN Office for Coordination of Humanitarian Affairs' Central Emergency Response Fund (CERF) and the United Nations Fund for Population Advancement (UNFPA)'s Humanitarian Reponse Unit. UNFPA also worked closely with IMC on project monitoring and provided safe and clean delivery kits, condoms and STI and post-rape treatment kits.

	Photo by Natalie Doyle
	IMC is providing traditional birth attendants such as Selam, above, with training and hygiene kits that help ensure that women and their babies remain healthy both during and after delivery.

Among the most important lessons IMC midwife-nurses teach birth attendants like Selam is to have pregnant women lie down during delivery, which allows the woman to push the baby out herself using her muscles, as opposed to forcing the baby out, as in the traditional birthing practice. IMC also provides the TBAs with clean delivery kits, which include sterilized tools, gloves, and antiseptics; these simple tools protect the birth attendants and their patients from blood contamination and infection. Thanks to the sanitary delivery techniques and tools used by Selam, Halima and her new baby did not develop infections. “This new practice will help save lives,” Halima says emphatically.

The training sessions also educate TBAs about important reproductive health issues, including family planning and HIV/AIDS prevention, and they are encouraged to share their new knowledge with their patients. After Halima’s child was born, Selam continued to visit her in her home to discuss nutrition, family planning and post-natal care.

Halima now proselytizes about sexual health among her community every chance she gets. “Some ladies give birth every year, and eventually they become too weak to give birth again and they die,” she says. “These deaths wouldn’t happen if they understood the importance of family planning and using a trained birth attendant.”

Through IMC’s reproductive health program, more than 100 traditional birth attendants have been trained to date. As they disseminate their knowledge through remote communities using messengers like Halima, the experience of childbirth promises to become a safer, more joyful one.