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Our View from the Ground: Why Do Women Die in Childbirth?

Photo of Dr. Ephrem Ashagrae

The Nexus for Better Care

It’s not easy keeping up with Dr. Ephrem Ashagrae. He moves with confidence and purpose through the corridors of Yekatit 12 Memorial, a hospital in Ethiopia’s capital city, Addis Ababa, where he serves as Medical Director. He also teaches medical students and interns, responds to emergencies, and still finds time for his first love—direct patient care.

Since 2001, Dr. Ashagrae has collaborated with EngenderHealth to improve reproductive health and HIV services all across Ethiopia, by training health professionals in the fundamentals of client-focused, high-quality care. As a leader at a hospital that trains Ethiopia’s future doctors, Dr. Ashagrae is well aware that tomorrow’s changes start today. It’s a lesson he learned when he was a medical student, working in one of the most remote rural hospitals in Ethiopia, where there were few doctors. Like elsewhere in rural Africa, access to reproductive and maternal care was limited and often far from those who needed it. “Some mothers died en route to the hospital, and some died after reaching the hospital, because they didn’t get immediate help,” Dr. Ashagrae recalls. “My interest in becoming an obstetrician-gynecologist started from this reality, which motivates and gives me energy to this day.”

Dr. Ashagrae knows that for many women, a visit to the hospital for maternity care is their first encounter with the health care system. The experience they have can make or break a decision about whether to ever return. As such, it presents a golden opportunity to start a conversation about their overall health, to discuss their long-term goals for planning a family, and to offer HIV counseling and testing. Those who test positive for HIV can receive care and treatment, as well as assistance in preventing transmission of HIV to their infants.

“High-quality reproductive health care means that it is possible for women to receive comprehensive services in one place,” says Dr. Ashagrae. “Doctors across the country should offer this kind of care—that is respectful to women and shows them choices they didn’t know they had.”

That is precisely the strategy EngenderHealth and Dr. Ashagrae are using to support some 68 sites throughout Ethiopia, integrating maternal care, family planning, and HIV prevention, treatment, and care. Dr. Ashagrae gives this example to illustrate what the strategy means in practice: “A young, pregnant woman came to Yekatit 12 for prenatal care. She decided to be tested for HIV, and the results were positive. We explained how we could help her prevent HIV transmission to her baby and, months later, she delivered a healthy, HIV-negative child with us. Later, she and her husband came to us for family planning and were grateful for the options they had and the attentive care they received.”

Providing high-quality, comprehensive care and building trust are the hallmarks of Dr. Ashagrae’s leadership—doctors like him help ensure better health for generations to come.