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MILLE, Afar, Ethiopia—“When I had fistula, I never thought I would be able to have a normal life or get pregnant again,” said 32-week pregnant Fatuma Hamad at the Barbara May Maternity Hospital in Afar Region.

Fatuma Hamad at Barbara May Maternity Hospital in Mille, Afar. She will remain there under medical observation for three weeks before undergoing a C-section, to ensure her baby is delivered safely. © UNFPA Ethiopia

Fatuma’s first delivery changed her life. After six days of prolonged labour at home, she was taken to a nearby health centre for a C-section but the intervention was too late for her baby, who had already died. The medical staff were able to save Ms. Hamad’s life.

Adding to her the trauma of her tragic loss, she began leaking urine uncontrollably due to an obstetric fistula. This is a childbirth injury caused by an unassisted, extended and obstructed labour, affecting between 50,000 to 100,000 women every year around the world.

“My life was miserable. I was traumatized and isolated from my community. I was afraid they would beat me for my condition,” said Ms. Hamad.

It was not until six months later that she was able to get treatment at the Barbara May Maternity Hospital run by the Afar Pastoralist Development Association (APDA), UNFPA’s partner in the Afar Region. The hospital provides comprehensive maternal and obstetric care, including surgical repair and rehabilitation of fistulas.

“Fatuma’s case showcases the incredible progress we are making to decrease maternal mortality and obstetric-related complications such as fistula in the region. However, there is still a lot to be done,” says Valerie Browning, founder of APDA and the Barbara May Maternity Hospital. Valerie is an advocate for universal access to maternal and reproductive health among the pastoralist communities of Afar Region.

A challenging place for motherhood

Afar Region has a high newborn mortality rate of 38 deaths per 1000 live births.  

“For every mother who dies during delivery, we have six newborn deaths. Maternal mortality has declined but the newborn mortality rate is still high in the region,” explained Ms. Browning.

For every mother who dies during delivery, we have six newborn deaths.

Afar women endure long journeys to access maternal care and when they do, most of them have serious obstetric complications after labouring for an average of three to seven days at home.

“More than half of the [interventions] here are life-saving,” says the Medical Director from the Barbara May Maternity Hospital.

Access to safe and dignified pregnancy and childbirth services is challenged by the low number of health facilities available, the long distances pregnant women have to travel to reach them, and by cultural misconceptions. “Delivering at a health facility is considered a thing [for women] from Western countries. It’s the Afar culture to deliver at home,” said Ms. Browning.

Supporting maternal and reproductive care in a pastoralist context

UNFPA has partnered with APDA to expand access to quality maternal and reproductive health services, with a focus on underserved communities across the Afar Region’s rural areas. 

My hope is to bring a strong and healthy child into the family.

Through UNFPA’s humanitarian portfolio, UNFPA has provided the Barbara May Maternity Hospital with emergency reproductive health kits to ensure comprehensive emergency obstetric and newborn care services, including C-sections and blood transfusions for high-risk mothers. In addition, dignity kits, COVID-19 personal protective equipment and capacity building training sessions for health-care personnel have been provided on a regular basis to ensure quality services at facility and community level.

UNFPA works closely with APDA for fistula repair and rehabilitation, as well as reintegration of survivors into their communities.

Ms. Hamad shines with joy when she is asked about her pregnancy. “I still can’t believe I am pregnant. My hope is to bring a strong and healthy child into the family,” she said.