Towards Indigenous National Policies and Programs: Maternal Health in Ethiopia

Maternal mortality is a great challenge disproportionately affecting developing countries. To address this problem, the United Nations (UN) designed international policies including Millennium Development Goals (MDGs) and required developing countries, to adopt these policies in order to access loans or grants. However, these policies failed to bring sustainable change. They are also criticized for being expert-led and embedded in the neo-liberal agenda. This study examines the interface between maternal health policies and their implementation at the grassroots in Ethiopia; and evoke recommendations to address the needs of communities, using indigenous qualitative research methods. The use of indigenous methods decolonizes the study and explore the impact of the 3Cs - colonialism, capitalism, and Christianity (Anderson, 2007) on maternal health policies. The primary research questions were: 1) How do mothers define their needs? 2) To what extent have their needs been met? 3) What interventions have helped the most? 4) If any gaps remain, what do mothers think would improve their situation? Data was collected using in-depth interviews, visual dialogue with 27 women. Miles, Huberman, and Saldana’s (2013) interactive model was used to shape the analysis process. And, ATLAS ti (Version 7.5.11) was used to manage, sort and code the data. Member checks was conducted to verify the analysis, decrease the chances of misrepresentation, and increase local validity. Research participants identified access to basic needs, basic infrastructure, economic/financial support, education and reproductive health as maternal health needs. They also indicate the gap in facility based services due to lack of cultural considerations. The majority of health professionals being men created a disconnect. The other important finding was the perception of birth as a natural phenomenon and death [maternal mortality] as destined by God/Allah. Participants also confirmed that the community support for mothers outweigh the facility based support since community members accompany mothers throughout the rituals of the birthing process. Research participants believe that ensuring economic independence for mothers will improving their well-being and health. They also raise importance of equipping traditional birth attendants and allowing them to assist home-birth. To enhance facility-based birth, is necessary to create culturally competent space and services.