REASONS FOR PERSISTENTLY HIGH MATERNAL AND PERINATAL MORTALITIES IN ETHIOPIA PART II-SOCIO- ECONOMIC AND CULTURAL FACTORS

Abstract

BACKGROUND: The major causes of maternal and perinatal deaths are mostly pregnancy related.However, there are several predisposing factors for the increased risk of pregnancy related complicationsand deaths in developing countries. The objective of this review was to grossly estimate the effect ofselected socioeconomic and cultural factors on maternal mortality, stillbirths and neonatal mortality inEthiopia.METHODS: A comprehensive literature review was conducted focusing on the effect of total fertility rate(TFR), modern contraceptive use, harmful traditional practice, adult literacy rate and level of income onmaternal and perinatal mortalities. For the majority of the data, regression analysis and Pearsoncorrelation coefficient were used as a proxy indicator for the association of variables with maternal, fetaland neonatal mortality.RESULTS: Although there were variations in the methods for estimation, the TFR of women in Ethiopiadeclined from 5.9 to 4.8 in the last fifteen years, which was in the middle as compared with that of otherAfrican countries. The preference of injectable contraceptive method has increased by 7-fold, but theunmet contraceptive need was among the highest in Africa. About 50% reduction in female genitalcutting (FGC) was reported although some women’s attitude was positive towards the practice of FGC.The regression analysis demonstrated increased risk of stillbirths, neonatal and maternal mortality withincreased TFR. The increased adult literacy rate was associated with increased antenatal care and skilledperson attended delivery. Low adult literacy was also found to have a negative association with stillbirthsand neonatal and maternal mortality. A similar trend was also observed with income.CONCLUSION: Maternal mortality ratio, stillbirth rate and neonatal mortality rate had inverse relationswith income and adult education. In Ethiopia, the high total fertility rate, low utilization of contraceptivemethods, low adult literacy rate, low income and prevalent harmful traditional practices have probablycontributed to the high maternal mortality ratio, stillbirth and neonatal mortality rates.