The Afar people in northern Ethiopia have lived a pastoral life for centuries, moving their livestock herds and communities as the seasons and weather conditions change.
This nimbleness and adaptability has helped them survive and maintain their traditional way of life. But for women in their child-bearing years, moving frequently and setting up remote camps takes them far from health facilities, where they could access health care services during and after their pregnancies.
Medina Humed and her husband travel in the Chifra woreda (district) of the Afar region with their children. Medina is 27 years old and is on her seventh pregnancy. She has five children and had one stillbirth. For each of her previous pregnancies, Medina felt anxious throughout, uncertain where the family would be living and who – if anyone – would help her as her time neared.
When her last child was born, only six percent of pregnancies in her woreda were attended by a skilled health care worker. Less than one percent of women were getting iron and folic acid during their pregnancies, and consequently, nearly half were anemic. In Ethiopia generally, a woman’s risk of maternal death is one in 67 (compared to one in 5,200 in Canada).
But this pregnancy is different for Medina. This time, she was able to visit a health post when her pregnancy was at 20 weeks. There, a nurse assessed her health, gave her iron and folate tablets, counseled her and gave her an appointment for a follow-up visit. She also met with her guide team, who continued to counsel her throughout her pregnancy.
Since early 2013, all of the pregnancies in the Chifra and three other woredas in the Afar region have been protected through a program designed by the Micronutrient Initiative (MI) and delivered by Emory University’s Maternal and Newborn Health in Ethiopia Partnership, along with Ethiopia’s regional and federal health authorities.
MI’s Community Based Maternal and Newborn Health and Nutrition (CBMNH) program brings maternal health and nutrition services to the community level, so that pregnant women and their babies don’t have to travel to far-away facilities for these services. It also sensitizes the community to the importance of nutrition and care throughout the pregnancy.
The Program approach is to enable each community to provide pregnant women with the services and support needed during pregnancy, delivery, and after the child is born. This is accomplished in part by training local leaders and traditional birth attendants to become guide team members and quality improvement team members.
The guide teams are trained to detect signs of pregnancy, such as changes in the way a woman works or balances water on her head. The guide teams then reach out to the women and offer counselling, vitamin and mineral supplementation, and birth planning. The quality improvement teams in each kebele oversee the work of the guide teams and report back on essential monitoring data, to ensure project success. Medina’s guide team is critical to her health during and after.
The program also uses local media as well as direct contact with community leaders to change behaviours: working to persuade pregnant women to use the health services provided by the guide team members, but also reaching out to those who can influence women during their pregnancies, such as husbands, grandmothers and local leaders.
MI hopes this Program will become a model for all 30 woredas in the Afar region, after seeing such positive results in the most challenging four woredas, and serve other nomadic groups in Africa.
MI is also delivering programs to other communities in Kenya, Senegal and Niger to strengthen maternal nutrition within maternal and neonatal health systems.
Medina speaks with quiet confidence and touches her belly with love and pride as she explains to a visiting Canadian ambassador why she is feeling so much better about this pregnancy.
“Unlike my earlier pregnancies, I feel more healthy and stronger now,” said Medina.
She knows that the vitamins and minerals she took this time around have made a difference, and she knows no matter where the seasons take her and her family, she will be taken care of when her baby comes.