Demographic and Health Profile. Ethiopia. Nigeria. Population is currently 73 million, annual growth rate is 2.4%

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1 Adebola Adedimeji

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3 Demographic and Health Profile Nigeria Population is currently 150 million, annual growth rate is 2% Political structure- Federal Republic; 36 states, almost 800 local governments Multi-ethnic, multi-religious Life expectancy is 52 years Largely rural population, increasing urbanization HIV prevalence 3.8% Maternal mortality estimated at /100,000 live Ethiopia Population is currently 73 million, annual growth rate is 2.4% Political structure- Federal Republic; 9 ethnically based states, 2 self-governing administrations Multi-ethnic, multi-religious Life expectancy is 49 years Largely rural population HIV prevalence 2.2% Maternal mortality estimated at estimated at 673/100,000 live births

4 Why Focus on Maternal Health care in Sub-Saharan Africa? Maternal mortality and morbidity levels reflect the quality of maternal health care women receive in a population In developing countries, pregnancy and childbirth complications are the leading causes of death among women of reproductive age Pregnancy and childbirth present morbidity and mortality risks for women in sub-saharan

5 Determinants of Maternal Health Inequalities Biomedical determinants Socio-ecological determinants Household characteristics Financial status Educational status Regional and ethnic dimensions of maternal health inequalities: Rural vs. Urban Northern vs. Southern Cultural notions and interpretations of fertility Weak health systems Lack of investment in health sector Role of HIV

6 Ongoing Research Nigeria Rationale Understand the dynamics of maternal health care among migrant communities in southwest Nigeria Research Questions What are the existing knowledge, perceptions and practices relating to safe motherhood among migrant women and the larger [male] community? How are decisions regarding prevention and response to obstetric complications made in the household? What health care services do migrant women use for obstetric care? Methodology Study setting is Sabo, a migrant community in Southwest Nigeria Community based participatory methods incorporating Qualitative Verbal and Non-verbal methods Data collection followed an iterative process 200 community members selected by mixed sampling techniques Ethiopia Rationale Investigate trends in maternal and child mortality, focusing on the role of HIV and access to antiretroviral therapy Research Questions What are existing knowledge and practices regarding maternal health among HIV positive pregnant women? What are the dynamics of decision making with regard to prevention of mother to child transmission of HIV? Methodology Study setting is two health facilities in Arba- Minch, SNPPR Mixed methods approach incorporating quantitative and qualitative data Study involved more than 150 respondents

7 Findings- Nigeria Pluralistic health care system Mallams Traditional Birth Attendants Herbalists Private Hospitals Public Teaching Hospital Community Health Centres Local pharmacy shops/drug hawkers Universal attendance for antenatal care, however poor attitudes to hospital deliveries due to financial, cultural and religious reasons Unassisted home births are celebrated as an enduring aspect of culture Planning for hospital births is uncommon; birthing is considered a natural event that should not be medicalised unless complications arise Skilled attendance at birth is considered appropriate only when self-treatment, traditional or religious remedies fail to address obstetric complications. Women are able to take decisions regarding where and when to seek health care, but husbands, in laws, parents, older women and neighbours are also key decision makers There are varying perceptions of severity of obstetric complications, and at what point they become life threatening

8 Results-Ethiopia

9 Results-Ethiopia

10 Results-Ethiopia

11 Results- Ethiopia It is a shameful thing to be diagnosed with HIV. How would you say you got it? Even if your husband is responsible, the people will conclude it is your fault. To avoid trouble, most women don t give birth in the hospital where their status is known so that relatives will not become suspicious when they give special medication [ART] to the mother and baby shortly after birth (FGD participant) It [HIV] is a big issue in this community, so people do whatever is necessary to prevent others from knowing their status because of stigma. That is why women who are positive do go back to where they are diagnosed for fear of meeting someone who will know them and tell their family (FGD participant) The rules clearly state that we must initiate follow up and aggressively so, but unfortunately, many HIV positive women run away from giving birth in the hospital because they don t want anyone to know they are HIV positive, especially their relatives who will accompany them into the labour room (Nurse Midwife) Some women are very cooperative when it comes to testing for HIV and being put on ART. However, there are problems when we expect them to return to the facility to give birth. Several things are responsible for this problem including the cultural practices, the nature of the women s work, low socioeconomic status and frequent change of their addresses, which makes follow up very tedious (PMTCT Nurse)

12 Barriers and Missed Opportunities for Improving Maternal Health Barriers are both (i) Individual and (ii) Systemic Demographic- age, gender, education and socioeconomic circumstances Unstable political environment (Governance, leadership and corruption) Reliance on foreign aid and lack of direct investment in the health Socio-cultural and economic constraints at individual and societal levels Geographic (e.g. Urban vs. Rural; North vs. South) Lack of community based participatory mechanisms for engaging with cultural gatekeepers Health Human resource crisis Public-Private Partnership Policy environment

13 Socio-Ecological Model as a Framework for Addressing Maternal Health Challenges

14 From Cells to Society : A model for analysis of population health and health disparities. Warnecke et al. (2008) AJPH.

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