Making Childbirth Safer for Pastoralist Mothers in the Afar Region of Ethiopia

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By: Hannah Ford, Communications Coordinator, The Road Less Travelled

This blog post is cross-posted from The Road Less Travelled.

In the Afar region of Ethiopia, 93 percent of mothers deliver their babies at home with the assistance of traditional birthing attendants (TBAs). Safe motherhood is fundamental to overall community development, and the Afar Pastoralist Development Association (APDA) is addressing the needs of the community through a holistic approach.

This includes a focus on strategies to increase access to water, since females traditionally collect water; improve the health of livestock, so that milk is readily available; improve household economies through income generation activities; and enhance access to education and literacy.

APDA’s programs aim to lessen the workload of females in daily household chores, stop harmful traditional practices that have a negative effect on women’s health and well-being, and to facilitate Afar women to be implementers of development change within their society.

The struggle for safe motherhood ideally takes place within the pastoralist home, led by the community and managed by the local government, including the traditional leadership.

Having selected the most active and popular TBAs in the community, APDA has trained 1,036 TBAs on basic hygiene, sanitation, clean delivery, antenatal care, and recognition of risk pregnancies. Trained TBAs are equipped with clean birthing kits for each delivery. This has resulted in the establishment of clean birthing processes and a referral mechanism to health institutions for ‘risk’ pregnancies.

Furthermore, APDA works with TBAs to identify the six birthing traditions used by TBAs, which are dangerous to women during delivery. By highlighting the associated risks and harm caused by these traditions, the trained TBAs have agreed to stop using these harmful practices.

However, the TBAs do not work in isolation. APDA’s strategy for safe motherhood involves the formation of community health teams, made up of health workers, women extension workers, and trained TBAs. As members of the community, this team performs home antenatal checks, delivery, and postnatal care.

Another core element of the strategy which is now being developed is APDA’s emergency referral system. This system links the Barbara May Maternity Hospital in Mille with waiting centres for expectant mothers living in remote districts within a 250 kilometre radius.

The waiting centres consist of five to six traditional Afar houses within the compound of a health centre, where mothers considered ‘at risk’ or simply wanting a safe birth can stay during the last month or weeks of their pregnancy with the ongoing support of a midwife.

The centres utilise government-employed midwives, who should be capable of diagnosing whether referral to the hospital for surgical intervention is required. APDA intends to support these midwives by providing additional training at the hospital, and adequate equipment to handle assisted deliveries. They are also required to maintain communication networks with the hospital and an obstetrician.

Education and training is an important objective of APDA and the Barbara May Maternity Hospital, with the ultimate goal being that the hospital is entirely locally-managed – no longer requiring voluntary doctors or midwives as it has in the initial set-up phase. The centre also aims to focus on deliberately building community awareness and fostering an understanding of safe motherhood practices within the Afar pastoralist communities.

Founder and Project Coordinator, Valerie Browning, will be sharing APDA’s strategy for safe motherhood at the Global Maternal Health Conference this Wednesday 16 January. She will be exploring ways to eliminate barriers to skilled birth attendance with her presentation, “Trained Traditional Birth Attendants: Today’s Missed Opportunity.”

Please visit to view Valerie Browning’s presentation!

For all the latest updates from the conference, follow the conversation on Twitter with the hashtag #GMHC2013 or tune in to the live-stream here.

To follow stories from The Road Less Travelled, a partnership MCH project that works with nomadic pastoralist communities in Ethiopia and Kenya, please visit their blog: