Over the last six months, as I have been praying and learning about Ethiopia, several blog posts about the desperate situation at a rural hospital caught my attention. The first blog post, written by the leader of YWAM’s Ethiopia Adoption Ministry, describes how unsafe abortion and limited access to medical care lead to high infant and maternal mortality. A second article, written by a nurse serving at the rural hospital, explains the situation in heart breaking detail. I have thought about the significance of these blogs for months, but this week I felt compelled to learn more. Here is a little of what I have discovered.
In Ethiopia, one in seven women dies from pregnancy related complications. An astonishing one in 16 African women die in pregnancy. In comparison, only one in 2,800 women in high-income countries die in pregnancy. Due to limited resources and the lack of midwives and doctors, 94% of women in Ethiopia give birth without the help of a properly trained health worker.
The situation in Gimbie where desperate mothers are performing abortions with a stick, killing their child and risking their own life, is just the beginning. Unsafe abortion is a major contributor to maternal death rate in Ethiopia. It is the second leading cause of death for women of reproductive age, accounting for 55% of maternal mortality. In one survey of 15-24 year old women in Addis Ababa, half the women reported having been pregnant and 74% told interviewers they had an abortion. Another study estimated that at least 70% of young women have had an abortion. The vast majority of these abortions are unsafe.
When I began to research the issue of unsafe abortion in Ethiopia, I found plenty of articles from pro-choice organizations. They advocate for a strong national family planning program. They believe the answer to unsafe abortion in Ethiopia comes down to more widespread use of contraceptives and easier access to safe, legal abortion. They also write about the importance of education, as there are relatively high levels of knowledge about methods for inducing an abortion and low levels of knowledge about contraceptive use.
Ethiopia has a relatively conservative abortion law, permitting abortion when the pregnancy results from rape or incest, when the health or life of the woman is in danger, in cases of fetal abnormalities as well as for disabled women or minors who are unable on unprepared to raise a child. Organizations like IPAS and IPPF suggest that abortion should be legal for a broader range of indications, effectively giving women the choice to have an abortion.
But if the goal is freedom of choice, simply increasing access to safe and legal abortion does little to truly give Ethiopian women the ability to freely choose. What if a young woman wants to choose life?
Sadly, there are numerous obstacles to a culture where young women can freely choose life for themselves and their children. What follows is my attempt to piece together just a few of the complicated issues that drive young women to kill their babies and risk their own lives.
The statistics – and the realities of life in much of Ethiopia – are harsh. Over 85% of Ethiopian women live in rural areas where poor families are primarily engaged in subsistence agriculture. Over 65% of the population of 75 million people live below the poverty level. One in five children will not live to see their fifth birthday. Life expectancy is not quite 55 years. Nearly half of the population is undernourished and famine is a recurring problem.
Ethiopia has among the worst rates of school enrollment for girls in Africa. The literacy rate for girls and women in Ethiopia is just 35%. When girls and women have access to education and are able to read, their status and the wellbeing of their families improves significantly.
Violence against women
In Ethiopia, almost 60 percent of women have been subjected to sexual violence including rape. Abortion is linked to violence, as approximately 25% of women seeking an abortion are pregnant as a result of rape. Ethiopian women face further violence in the form of early and forced marriage or marriage by abduction. Although it is hard to believe, an estimated 72% of women are married by abduction, a practice that often involves rape. According to one study, 85% of women believe their husbands have the right to beat them if they burn food, refuse sex, or go somewhere without their husband’s consent.
Access to Medical Care during Pregnancy
Another issue affecting Ethiopian women is fistula, which is a hole in the birth canal caused by prolonged labour without prompt medical intervention. When labor is obstructed and the woman does not have access to a c-section or other medical treatment, there are severe consequences: the woman is left with chronic incontinence and, in most cases, a stillborn baby.
To prevent fistula, rural women are told to eat little and work hard while pregnant in order to have a small baby, but this doesn’t work. When women give birth, they are weak and malnourished and at higher risk for complications.
When complications occur – as they do in approximately 5-15% of births – women have extremely limited access to medical care. Rural women in Ethiopia may need to walk an average of sixty miles while in labor to reach a medical clinic where it is unlikely there would be an OB or midwife. There is approximately one midwife to every 20,000 women of childbearing age in Ethiopia, and the majority of those are not in the rural areas where 85% of the women live. As a result, 94% of women in Ethiopia give birth without the help of a doctor or midwife. It takes women in Ethiopia an average of 2.5 days to reach a hospital where they could have a c-section if needed. Sadly, by the time a woman makes it to a hospital, her baby may be dead and she may have undergone significant physical trauma, including fistula or uterine rupture.
The HIV/AIDS epidemic has made matters worse. An estimated 2% of the population is HIV positive, although the rate of HIV infection is significantly higher in urban areas, close to 10%. An estimated 1.5 million people in Ethiopia have HIV or AIDS and there are approximately 650,000 AIDS orphans. Although most men and women have some knowledge about AIDS, high rates of unprotected sex persist.
While access to medicine in the West has made AIDS a chronic condition rather than a death sentence, few HIV positive men and women in Ethiopia have access to these lifesaving drugs. Only 7% of HIV positive pregnant women received antiretroviral drugs to reduce the risk of mother to child transmission.
So what can we do to help young women choose life?
I know all of this information is overwhelming. And these are just some of the issues facing women and children in Ethiopia. Where do we even begin to make a difference? Try to imagine what it would be like to be a young, unmarried woman in rural Ethiopia facing an unwanted pregnancy. As Mark and I are continuing to pray about adoption, we’re aware that international adoption is a very small part of the solution. I don’t have any answers, but I hope that you will join me in praying. I hope that you will feel this burden too. I hope that your heart will be broken like my heart is broken. I hope that together we can make a difference – one child, one woman at a time.