From Australia to the Afar desert, all mums matter.

by HANNAH FORD

The road to motherhood isn’t easy, especially for women and girls from the Afar region of Ethiopia.

The Afar pastoralists who call this region home are often cut off from services many of us take for granted, as a result of their extremely remote location and nomadic way of life.

Here in Australia, we expect to have access to safe, respectful health care. In the Afar, it’s a very different story. Cost, distance and attitudes often prevent women and children from accessing formal health services and receiving the quality health care they deserve.

Few births take place in a health facility, and few women are supported through pregnancy and delivery by a skilled birth attendant. The barriers to safe motherhood are significant – and when an Afar mother dies, her baby has less chance of surviving.

Inspirational Aussie nurse, Valerie Browning, is determined to change this. She has lived among the Afar nomads for more than 20 years, and has worked tirelessly to improve their lives.

In the early ’90s, Valerie and a group of community members founded the Afar Pastoralist Development Association (APDA).

“They seemed to be living alone in a bubble, in that as pastoralists, they were outside of development entirely,” says Valerie. “No health, no education, no nothing …”

APDA is now a partner in The Road Less Travelled (TRLT) – a maternal and child health project being delivered by Anglican Overseas Aid, with the support of AusAID.

The project recognises that improving maternal and child health must involve a holistic approach that addresses connected issues such as education and literacy, improving access to water, food security and livelihoods, along with the relevant health needs.

More than 90 per cent of Afar women give birth at home with the assistance of traditional birthing attendants (TBAs). The project realises that the struggle for safe motherhood must take place within Afar homes – led by the community and managed by the local government, including the traditional leadership.

The project aims to improve understanding and strengthen the links between traditional birthing practices and formal health services, and to increase the rates of skilled birth attendance within these communities. How do they do this?

“Through involving the people themselves,” Valerie explains. “In each community, they choose someone to be a health worker, a women’s extension worker. The women’s extension worker is working with other women, and is working with the TBAs. And those three work together as a team in the aim to lower maternal death.”

“We found TBAs were doing six things that were dangerous to mother or child at the time of birth, and if they stop those six things, you reduce deaths enormously. And it’s not just maternal deaths, you get a lot of maternal injury and that goes down as well.”

Having selected the most active and popular TBAs in the community, APDA provides training in basic hygiene, sanitation, clean delivery, antenatal care, recognition of risk pregnancies, and reducing harmful practices.

APDA also forms community health units, made up of community health workers, women’s extension workers and the trained TBAs. Each member brings different skills in pregnancy and birth management. They perform home antenatal checks, deliveries, and postnatal care. Working together, they are better placed to assist with delivery and identify possible complications early, and therefore get the woman to a health facility.

Increasing female education is also an essential element of the program. It is a major challenge for pastoralist communities in the Afar, and one that intersects with many challenges for their overall development.

The Road Less Travelled project has identified, for example, that literate pastoralist women are more likely to have a skilled health worker present at their birth. This in turn increases the chances of survival for both mother and baby.

The education program Valerie and the APDA team have developed involves training literacy teachers, offering flexible mobile education opportunities, and actively promoting the wider benefits of female involvement in education.

These efforts have the potential to significantly enhance future initiatives in maternal and child health.

“From illiteracy to literacy is like a change of life … literacy is a huge doorway to much change. We have seen that time and time again and it works for helping women, it works for helping men, it works for helping children,” says Valerie.

Valerie is currently in Australia, sharing stories of her experiences along The Road Less Travelled and raising awareness of the challenges faced by the nomadic Afar communities.Find out more at The Road Less Travelled blog. Follow @ARLTafrica on Twitter.The Road Less Travelled is being delivered by Anglican Overseas Aid, in partnership with the Afar Pastoralist Development Association (Ethiopia), the Mothers’ Union (Kenya), the Nossal Institute for Global Health and Australian Volunteers International. This initiative is supported by AusAID.