Unpacking reproductive health

Just this past week, as I was having coffee with friends, a question was posed. If you were to have a meeting with the Ethiopian prime minister, what issue would you raise?

As I was deep in thought, a friend quickly answered; improved maternal health services. As a recent mother she remarked, it guts her to see women and children on the streets with no access to health services or social services to better their lives. Numerous times, driving through the streets of Addis, I have stopped at red lights and seen women carrying babies, or women pregnant, but seldom have I thought about the kind of maternal health services they receive when giving birth to the next generation.

Since then, I cannot shake this thought from my mind.

History has dubbed Ethiopia to be the birthplace of mankind, the cradle for humanity.  We celebrate and vaunt over the fact that Lucy was born on our land, and that after her many more humans walked this earth. There is however a great tragedy here. It’s alarming to hear of the number of mothers that are dying or becoming disabled due to preventable and treatable complications during pregnancy and childbirth.

So what must be done?

We must go beyond the classical thinking that reasons for high maternal mortality are low utilization and of modern health services.  In theory, it is logical to expect that low use of medical services is directly related to awareness, accessibility, affordability, availability and alternativity of health services, but these factors plays less off a role compared to other dimensions. It isn’t their awareness that is lacking; rather the gap is in their behaviour and in internalizing what it is they already know.

Findings from Grace Kyomuhendos study suggest that pregnancy is a test of endurance; and maternal death, although sad and unfortunate is a normal occurrence. And this health seeking behavior is one that needs to be addressed. Social factors such as gender relations, family relations, myths and taboo, ideology and lack of structure affect the choices people make towards their maternal health and the demand they create.

Demand is more than how services are delivered and made available, but also about who delivers them and if these services tally with the needs of the community. I.e  its about giving users a voice as well as exit options. It is by studying and understanding the fabric of society and its elements that we can assess weather or not women voice and articulate their needs, and demand such services. What is apparent now is lack of agency and urgency for women to voice their needs. Women lack the agency to make decisions about their own health.

We must question the value and importance women and communities at large attach to their health and well-being.  “Rural communities fully recognize the life threatening risks associated with pregnancy and childbirth, but by emphasizing endurance and tolerance of physical pain and other life threatening symptoms, they have unwittingly taught women to suppress concerns about conditions which require urgent attention, so that they  may not communicate with anyone until it is too late ( G kyomuhendo, pg 24).

Reproductive health is an integral part of general health and a central feature of human development. It is not only a reflection of health during childhood, but also sets the stage and affects the health of the next generation.  Presently addressing health and its service delivery appear at an urgent time for the current global debates, and indeed this is a critical issue to raise with our prime minister.