Ethiopia is the second populous nation in Africa with predominantly rural, young and impoverished population which is growing by 2.6 percent annually. Ethiopia is the home of a variety nations, nationalities and peoples with more than 80 different spoken languages. The average size of a household is 4.7. The pyramidal age structure of the population has remained predominately young with 44.9% under the age of 15 years, and over half (52%) of the population in the age group of 15 and 65 years. The population in the age group of over 65 years accounts for only 3% of the total. While the sex ratio between male and female is almost equal, women in the reproductive age group constitute 23.4% of the population.
The major health problems of the country remain largely preventable communicable diseases complemented by malnutrition. Over the last two decades, Ethiopia has made significant gains in family planning and reproductive health indicators as observed in the Ethiopian Demographic and Health Survey (EDHS) 2016. Between 2000 and 2016, total fertility rate (TFR) has declined from 5.5 to 4.6 children per woman and modern contraceptive use has increased from 2.9 percent to 42 percent. The 2016 EDHS reported that the maternal mortality ratio (MMR) seven years preceding the survey is 412/100,000 live births which is a significant decline from 871/100,000 live birth of the EDHS 2000 survey findings.
Ethiopia, similar to other countries in sub-Saharan Africa, has made the issue of maternal and child health a top priority. It has taken great initiatives to reduce the burden through an aggressive human resource for health strategy, including the Accelerated Midwifery Training Program, to increase the supply of midwives. Developing capable, motivated and supported health care workers is essential in achieving any country’s national and global health goals. Indeed, it has been shown that properly trained and supported midwives at the community level are among the most effective interventions for addressing and reducing maternal and infant mortality.
But key challenges and system gaps remain including midwifery quality standards, lack of medical ethics and commitment, and skill upkeep and upgrading of midwives. Other challenges pertain to inequitable distribution of skills across the country, and a lack of fair and equitable access and empowerment of rural women to quality education. The role of midwives remains limited to anti-natal, delivery and post-natal care, when their role should be expanded to other areas, such as adolescent health, family planning, the prevention of harmful practices such us female genital cutting, nutrition and violence against women. A midwife should be a woman’s life partner. Underlining these challenges is an under-resourced country where public sectors lack funds for basic tools and infrastructure in general, and where service delivery models are dependent on donor funding that are not sustainable in the future, due to the continuing decline of donor funds globally.
The founder of LeDeG Midwifery College, Dr. Teguest Guerma, is a highly experienced global health advocate and currently retired medical professional with extensive grassroots level experience in global public health, and an advocate for creating equal access to education for rural girls. Having seen the challenges of various models in her country, she has undertaken the important task of addressing key gaps in the health delivery system, by proposing a social enterprise model for establishing a Center of Excellence and a high quality Midwifery College in Ethiopia, that inspires, nurtures and puts vulnerable women and girls at the center of the current development efforts in Ethiopia.