Every day, approximately 35 women die in Ethiopia from preventable causes related to pregnancy and childbirth. Although maternal deaths have declined by 70% in Ethiopia between 1990 and 2013, maternal mortality remains unacceptably high and more efforts are needed to meet the Millennium Development Goal 5 target of 267 per 100,000 live births. Access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth are what makes the difference between life and death. Moreover, a functioning maternal death surveillance and response (MDSR) system that includes maternal death identification, reporting, review and response can provide the essential information to prevent future maternal deaths.

Essentially the MDSR system provides a tool for opening dialogue between health workers and the community, building bridges to save mothers' lives, especially in rural areas where many women still give birth in their homes without skilled birth attendance. One example of such a tool is the verbal autopsy, in which family and community members are interviewed about the circumstances leading up to a maternal death. For example, in late 2014, a Health Extension Worker alerted midwives working in a rural health centre of a maternal death in a village nearby. Following the national MDSR guidelines, the midwives performed a verbal autopsy of the woman who had delivered at home unattended. The village leader was present and became aware of the risk factors related to delivering at home. He then started advocating for safer delivery in a health facility. This example shows how MDSR has contributed to raising community awareness of the risk factors to prevent future maternal deaths

The Federal Ministry of Health (FMoH) launched the national MDSR system in May 2013 and in 2014 maternal deaths were integrated into the national Public Health Emergency Management (PHEM) programme delivered through the Ethiopian Public Health Institute (EPHI). By the end of 2014, the MDSR system had been introduced in areas covering roughly 40 million people. Ethiopia’s MDSR system is still in its early phase, but there are already signs that an increased focus on the preventable determinants of maternal deaths are leading to improvements in quality of care and health system functioning in both facilities and in the community. 

The WHO Country Office for Ethiopia has been supporting the national MDSR system since its inception, particularly through hosting the Evidence for Action (E4A) programme. Evidence for Action is a DFID-funded programme to improve maternal and newborn survival in six sub-Saharan African countries, including Ethiopia. Running until 2016, the programme uses a strategic combination of evidence, advocacy and accountability to save lives and acts as a catalyst for action. Globally, the London based consultancy Options oversees E4A, but in Ethiopia, technical support is provided by the University of Aberdeen’s IMMPACT initiative and the programme is hosted by the WHO Country Office for Ethiopia.

For more information, please contact: Dr Joanna Busza, Evidence for Action Ethiopia; Email: Joanna.Busza [at] lshtm.ac.uk; or Dr Ruth Lawley, Evidence for Action Ethiopia; Email: ruthlawley [at] hotmail.com

Photo: Evidence for Action Ethiopia