Clinical Topics — Pregnancy and Delivery

Mortality Rates

Despite improvements, and infant mortality rates in Ethiopia remain high. The maternal mortality rate in 2005 was 673 per 100,000 live births, compared with 816 per 100,000 in 2000.1 Infant mortality was 77 deaths per 1000 in 2005, an improvement from 95 deaths per 1000 in 2000.1

Place of Delivery and Birth Assistance

Nearly all births in Ethiopia are delivered in the home. From 2000-2005, 94 percent of 11,163 births were delivered at home, 5% at a public facility, and <1% at a private facility. 1 Urban areas constitute a disproportionate share of births delivered in a health facility, with children born in urban areas 20 times more likely to be delivered in a health facility than rural-born children. 1 Addis Ababa, the Ethiopian capital, delivers nearly four out of every five health facility births.1

Overall, 6% of births were delivered with the assistance of a doctor, nurse, or midwife, in comparison with 28% delivered by a traditional birth attendant (yelimd awalaj). 5% of all births were delivered without any assistance. In urban areas, nearly one in two births (45%) was assisted by a trained health professional, compared with 3% of births in rural areas.1 Men are typically not present during labor, and are rarely involved in the delivery process 2,3. Women usually continue working and performing household chores until delivery. Pregnancy is typically not discussed until it is noticeable.

Feeding

Newborns are sometimes fed butter for several days in advance of breast feeding, which is considered to prepare the intestines to receive food and aid with the expulsion of meconium.4,5 Breast feeding may also be delayed in order to avoid the feeding of colostrum, which is considered unhealthy for the newborn.6

In Jimma, the regional capital of south-west Ethiopia, 80% of infants were still breast fed at 1 yr. Many were given also cows’ milk from 4 mo onwards.7 Duration of breastfeeding varies greatly by region, with 64% of 162 infants in the northern province of Tigray breastfed 19 months or more, compared with 26% of 154 infants in the southern Sidamo province and 7.5% of infants in Arsi, a province slightly south of Addis Ababa.5

Postnatal Care

Ethiopian mothers may keep newborns inside for approximately one week to avoid buda.8. Some Ethiopian mothers rest for a 40 day period following birth6.
Of 1158 rural women in southern Gondar, lifetime history of abortion was reported by 20.8%, of which 91.4% were spontaneous.9

1.) Ethiopia Central Statistical Agency. 2005 Ethiopia Demographic and Health Survey. Calverton, MD: ORC Macro, 2006, 104,105,117,118.
2.) Kassaye KD, Amberbir A, Getachew B, Mussema Y. A historical overview of traditional medicine practices and policy in Ethiopia. Eth J Health Development. 2006; 20(2) 127-134.
3.) Hodes, R. A Birth in Tedda. Ann Intern Med. 1993;118:738-740.
4.) Selinus, R. Home made weaning foods for Ethiopian children. J Trop Pediatr. 1970; 16(4): 188-194 doi:10.1093/tropej/16.4.188.
5.) Knutsson KE, Mellbin T. Breast-feeding habits and the cultural context: a study of three Ethiopian communities. J. Trop. Pediat. 1969; 15:40-49.
6.) Warren, C. Care of the newborn: community perceptions and health-seeking behavior. Ethiop J Health Dev. 2010;24 Special Issue 1:110-114.
7.) Asefa M, Hewison J, Drewett RF. Traditional nutritional and surgical practices and their effects on the growth of infants in south-west Ethiopia. Pediatric and Perinatal Epidemiology1998; 12, 182-198.
8.) Hodes RM. Cross-cultural medicine and diverse health beliefs — Ethiopians abroad. West J Med 1997; 166:29-36.
9.) Getahun H, Berhane Y. Abortion among rural women in north Ethiopia. Int J Gyn Ob. 2000;71: 265-266.