By: Madeline Taskier, University of Michigan, Global Initiatives
In Ethiopia, women are 200 times more at risk of dying from pregnancy-related causes than women in developed countries. Almost a third of all maternal death and morbidity in Ethiopia is caused by unsafe abortion procedures., and the country has a strikingly high health workforce shortage. Due in part to these factors, Ethiopia has one of the highest maternal mortality rates in the world.
In order to address the physician shortage, the Ethiopian government has opened 13 new medical schools in the past 3 years which will significantly increase the number of medical school graduates. But what happens once they’ve graduated? The majority of these young physicians are deployed to rural areas and become frontline health workers providing primary healthcare, but have little knowledge of family planning or safe abortion methods.
While the Ministry of Health has worked hard to fill the gap by training nurses, midwives, and birth attendants, there is still an unmet need for quality care for women who suffer from obstetric complications or the morbidities caused by unsafe abortions. The ratio of obstetrician/gynecologists (OBGYNs) per population is 1:1.8 million.
Senait Fisseha, M.D., J.D., an associate professor of obstetrics and gynecology at the University of Michigan (UM) is working to meet this need by partnering with St. Paul Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia to train OBGYNs after graduating from medical school. Based on the UM-Ghana partnership model, Dr. Fisseha has learned that well-trained OBGYNs work as leaders in the health system and generate positive public health impacts including increased family planning provision, better pregnancy management, more facility-based deliveries, and better surgical outcomes.
Since 2012, the program has 21 OBGYN residents who tend to 250,000 visits and 4,000 deliveries in the hospital per year. “That’s equivalent to what we do at UM,” Fisseha said. “But we have over 80 OBGYN faculty, 24 residents, and 25 fellows in addition to a large number of midlevel providers including nurses, midwives, surgical technicians and medical assistants.”
In order to address the high rates of unsafe abortions, Dr. Fisseha has made family planning and safe abortion provision a core component of the OBGYN training. After 2005, the Ethiopian government expanded the abortion law to allow it in cases of life endangerment, rape, incest, and psychological infirmity though knowledge of the new law is limited among healthcare workers.
“The St. Paul OBGYN residents learn safe abortion procedures, comprehensive family planning methods, physician leadership, and reproductive health ethics,” Dr. Fisseha added. “An OBGYN does more than deliver babies—he or she leads a multidisciplinary team of nurses, midwives, skilled birth attendants and takes care of the whole life cycle of the woman.”
Dr. Fisseha is working with medical schools and the MOH to integrate family planning and safe abortion training into the core curriculum so that they will be prepared to provide services once they graduate and become generalists. She also plans to scale up this initiative in the next year bringing the family planning and safe abortion training to 5 more training programs in Ethiopia.
Photo via University of Michigan