A sisterhood of support: Improving maternity care in Ethiopia’s climate change-ravaged Somali region

SOMALI REGION, Ethiopia – Abeba Birhanu, a 46-year-old midwife, has spent more than half her life delivering babies at the Karamara Hospital in Jigjiga, the capital of Ethiopia’s Somali region. Throughout those years, she has seen the impact of drought after drought on the women coming through her maternity ward.

“These mothers entrust their precious moments to my care – there are over 600 deliveries in the ward each month,” she told UNFPA, the United Nations sexual and reproductive health agency.

Rates of anaemia and undernutrition among pregnant women in Ethiopia are extremely high – and one of the leading causes of maternal mortality. They are also directly linked to the droughts that have afflicted the country, and the Somali region in particular, for the last decade. 

Climate crises are known to have disproportionately harsh effects on women and girls living in the most disadvantaged and remote rural areas: Heat stress has been shown to increase pregnancy risks – including miscarriages and stillbirths – and undernutrition in pregnancy is linked to greater chances of obstetric complications. 

In the Somali region, many women live over an hour’s walk from the nearest health facility, and there is no guarantee that it will be functional when they get there. Fortunately, Ms. Abeba’s hospital is able to continue providing care. 

“I felt safe and cared for when I knew Sister Abeba was by my side,” said Halima, who gave birth in the maternity ward. “Her experience and kindness made all the difference during one of the most important moments of my life.”

UNFPA supports the Karamara Hospital with life-saving operating and delivery equipment, sexual and reproductive health supplies, trainings and emergency medicines. But this is one of only two referral hospitals in Jigjiga, with more than 30 other health centres in the area sending pregnant women and new mothers there, particularly those with complications.

As the droughts drive up health needs among her community and in surrounding areas, Ms. Abeba worries they may not have the capacity to support everyone: The hospital currently lacks a maternal intensive care unit and has only three delivery beds.

“If these beds are occupied and pregnant women don’t receive services on time, they could lose their lives,” the midwife explained. “With the growing number of deliveries, basic supplies like gloves, [thread for] stitches, catheters and an upgrade for our ultrasound machine are desperately needed.”

Sisterhood of support

Not all of the increased traffic in Ms. Abeba’s maternity ward is due to hardship – much is thanks to the advocacy of women encouraging one another to seek skilled care during childbirth.

In the small village of Bombas, some 50 km from Jigjiga, 60-year-old Amina Adem spent much of her life as a traditional birth attendant, delivering babies without formal medical training. She followed methods passed down through the generations, and was initially reluctant to change her practices; with six children of her own, she felt her knowledge and experience were enough.

But in 2018 UNFPA launched a mothers’ voluntary support group together with Ethiopia’s Somali Regional State Health Bureau. Through the group, mothers from Bombas and nearby villages gathered to support and inform each other about maternal and child health, with resources and guidance provided by UNFPA.

As she listened to the women’s stories and heard their struggles and shared experiences, Ms. Amina began to see the value in this work.

Today, she is an active member and works with other women to organize workshops, training sessions and community outreach programmes on maternal health and well-being. More women are aware of the dangers of delivering in remote areas far from skilled medical care, and the number of home births in the community has decreased significantly – a trend Ms. Amina has embraced. 

“As I look back on my journey as a traditional midwife and now as a proud member of the women’s support group, I am reminded that true progress is made when we come together, share our knowledge and experiences and empower one another.” 

Zahra Nur was also moved by her experience with the group, and encouraged her 23-year-old daughter-in-law to give birth in a nearby health clinic, just in case anything went wrong. “I realized that many of my past struggles were because of a lack of proper medical attention,” she said. “I am glad my words at least were able to help my daughter-in-law – this is my reward for all my hardships.”

Underfunded crises

Leaning on one another for support is increasingly critical as communities in the Somali region grapple with the wild uncertainties caused by climate change and persistent conflict (which can itself be exacerbated by climate change). 

“What I love most is when mothers come here, give birth safely and go home happy with their babies,” Ms. Abeba told UNFPA.

In the Somali region, UNFPA is currently supporting 14 maternal waiting homes that provide care for women with high-risk pregnancies and who must travel long distances to reach health facilities. Yet an additional 250 of these maternity homes are required to assist affected communities – a response gap mirrored in many countries worst hit by climate change.

So far in 2024, UNFPA has received just over one third of the funding requested for its programmes in Ethiopia. At the COP29 climate conference this year, UNFPA is calling for greater financing for climate-resilient healthcare, family planning services and ensuring safe births for millions of women and girls across the world with otherwise scarce access to this support.