I am living in Ethiopia. I work on various development projects. One of the sectors that I contribute technical assistance to is the maternal health sector. Recently, I began representing the organization I work with on the Safe Motherhood Awareness Raising Team (SMART).

One of the first things I should tell you about development work is we love acronyms. I could write this entire blog with acronyms and no one would know what I was talking about except those that work in development. It is an unwritten rule that all projects, interventions, groups, and ideas are legitimized by an acronym. If Connections for Women was involved in development it would be CFW and in Ethiopia you would sound out the acronym, "se fe dub."

My first meeting with SMART was last Friday. I have to say there is something inspiring about a group of multinational midwives discussing ways to educate policmakers and community groups about the importance of prenatal care and having a medically trained person attending one's birth. It is also frustrating because we can't decide if we should work on the supply side of the issue or the demand.

Women and their families throughout Ethiopia do not completely understand the importance of having at least one prenatal visit to a health professional and there is certainly a lack of awareness on the importance of having a medical professional attending one's birth. Unfortunately, it is not just women that need to know this. In many communities in Ethiopia it is the man of the house that decides on this type of care. There are many programs that focus on reaching men to educate them on maternal and reproductive health care. If you are American and reading this it may make your blood boil but this is the way the culture and society are structured. An integral piece to achieving success in saving women and children's lives is involving men in the process.

I mentioned the struggle between supply and demand earlier. Well, if we focus our awareness on potential patients and increasing the demand for services we run the risk of having women in labor showing up to a health post with no trained staff. This could severely backfire as women and their families' faith in a medical system are shattered. On the other hand, we struggle with developing skilled professionals and health posts with no one attending because there is no trust, money or perceived importance for the service. It is quite a dilemma here.

Another issue I am finding with many of the family planning programs is the issue of location of health posts. The government has successfully placed health posts with health extension workers throughout the country and, rightly so, boasts at this achievement. This is a huge success. However, many communities are a long walk from these posts and most people need the entire day for their livelihood labor. This is not just an issue for accessing family planning service but also prenatal care and childbirth attendance. What laboring woman is able to travel by foot or be carried by community members miles to health care? I know it sounds cliche but this is the reality in Ethiopia.

So, while efforts are being made and successes are being seen, 21,000 women each year are still dying in Ethiopia due to pregnancy complications, childbirth and unsafe abortions. That is 58 women per day or 2.5 per hour.

One of the most sobering details I have heard to date is the fact that most women in Ethiopia and, as I understand it, in many African countries, say goodbye to their families when they go into labor. Maternal mortality is so common and women are so resigned to it as a fact of childrearing that they prepare to not survive at the onset of each labor.