Over the last 20 years, Ethiopia has made concerted efforts to improve maternal and child health in collaboration with local and international development partners. Maternal mortality was reduced by 70% between 1990 and 2014 and the Ministry of Health has focused on improving universal health coverage by making health systems and health facilities accessible across the country.
Despite the significant improvements made in the last decades, maternal and newborn health outcomes are still alarming. With a population of over 90 million, of which 87% live in rural areas[i], Ethiopia has one of the world’s highest rates of maternal deaths and disabilities in the world. Women have a one-in-52 chance of dying from childbirth-related causes each year. Every year, more than 257,000 children under the age of five die; 120,000 during the neonatal period.
The Ethiopian government has turned to midwives as the key to reducing maternal and newborn deaths. Since 2012, several midwifery teaching institutions and accelerated midwifery programs have been launched by the national government. This has resulted in a significantly increased number of midwives, from 4,725 to 12,600 midwives over the last four years. An additional 38,000 government health extension workers (community workers equipped with basic health knowledge and skills) have been deployed to over 16,000 health posts across Ethiopia to provide basic preventive and curative services at community and household levels, including information regarding maternal health and referrals to health centres, where midwives work.
More than 3,245 health centers have been constructed since 2000 to support universal primary health care coverage and the Health Extension Program. This rapid expansion of rural health services and the integrated management of health cases have laid the groundwork for a significant reduction in child mortality.
The Ethiopian Midwives Association, 5,000 members strong!
The Ethiopian Midwives Association (EMwA) was formally established in 1992 and has been a member of the ICM since 1993. EMwA is headquartered in Addis Ababa, has 11 regional offices throughout the country and is over 5,000 members strong! The association delivers training in basic emergency skills (BEmONC), Respectful Maternity Care, Implanon (a family planning program) and Clinical Teaching Skills through regional expert trainers. It also advocates on behalf of midwives and advises the government on policy documents related to maternal and newborn health.
Midwives Save Lives Project
The rapid expansion of Ethiopia’s midwifery workforce has resulted in a large pool of newly trained midwives, often with limited birth experience and often working in remote and low-resourced settings. The Midwives Save Lives (MSL) project, is designed to work with national stakeholders, including the Ethiopian Midwives Association, to address the critical gaps caused by this rapid growth. Funded by the Government of Canada through Global Affairs Canada and implemented by the Cuso International in partnership with the Canadian Association of Midwives, the project will, amongst other activities, train midwifery educators and in-service midwives in basic emergency skills and respectful maternity care.
The Canadian Association of Midwives is working closely with sister association EMwA on this project. CAM Board Member Evelyn Harney and MSL Project Officer Cindy Hénault Robert were recently in Addis Ababa to meet with midwives from the MSL project. Two Canadian midwife volunteers are scheduled to travel to Ethiopia in August 2017 to offer Respectful Maternity Care (RMC) training, alongside EMwA expert trainers, to in-service midwives in the project’s two target regions.
With the profession’s exponential growth, an increased number of midwifery instructors are also needed to train students. Instructors are often taken from a pool of their institution’s best students. In some cases, these students have very little clinical practice experience and clinical teaching skills, creating knowledge gaps in the newly trained workforce. The MSL project will help address this need by training instructors and lab assistants working in training institutions and preceptors working in clinic settings in Clinical Teaching Skills. Two Canadian midwives are scheduled to travel to Ethiopia — the first in September 2017, the second in January 2018 — to work alongside EMwA expert instructors to offer this training. Two Canadian midwives will also be flying to Ethiopia in July 2017 to work with EMwA on the revision of Clinical Practice Guidelines.
A total of 500 in-service midwives will be trained in Emergency Skills and/or Respectful Maternity Care through the MSL project. An additional 50 instructors will also be trained in Clinical Teaching Skills, RMC, and Emergency Skills.