Title: Exploring Maternal Health in Ethiopia Using Indigenous Approaches: Policy and Practice Implications

Abstract

The World Health Organization reports reveal that the average risk of dying from pregnancy-related causes in sub-Saharan Africa is about 1 in 45 compared to 1 in 5,400 in high-income countries. In Ethiopia, maternal mortality remains a tremendous problem. Several studies associate the high maternal mortality ratio to the widespread practice of home birth, household income, and lack of transportation. Absent from the findings of these studies is any discussion of the sociocultural contexts that might influence maternal health service utilization. Birthing bears cultural significance accompanied by rituals. Thus, any solution to maternal health problems must consider the sociocultural and grassroots context. To this end, the needs and priorities of mothers should be central. This study utilized Indigenous approaches to explore gaps in maternal health services in Ethiopia from the grassroots perspective. Indigenous approaches require participant-level engagement and acceptance of autonomy of the grassroots as research collaborators (Denzin & Lincoln, 2000; Smith, 2012). The study occurred in North Wollo Zone, Ethiopia. Gatekeepers were used to identify potential research collaborators. Data were collected using in-depth, semi-structured individual interviews with 27 research collaborators. The interviews were conducted in Amharic, the native tongue. Visual dialogue was also used during the interview. Research collaborators were asked to express certain concepts through drawings or using natural settings as a metaphor or a symbol. Their representation was photographed and saved along with their interviews. Then, all interview data were de-identified and transcribed verbatim in Amharic. The transcribed data was then imported into computer-based qualitative analysis software, ATLAS.ti (Version 7.5.11), to manage, sort and code the data. This data was analyzed using, Miles, Huberman, and Saldana’s (2013) interactive model. Circles were used for member checks. In a nutshell, this study explored the gaps in the implementation of Ethiopian maternal health policies and programs and identified culturally relevant solutions that could bridge these gaps and address the needs of communities based on the recommendations of research collaborators.