Of all the health statistics monitored by the World Health Organization (WHO), maternal mortality has the highest discrepancy between developing and developed countries. Maternal mortality and disability levels in many developing countries are similar to those of the more developed regions of the world at the late nineteenth century. The reduction of maternal mortality by three quarters by 2015 was endorsed as a Millennium Development Goal. Starting with the theory of international development and the presumption that biomedical health interventions will reduce maternal mortality and disability if governments devote resources to health care and delivery assistance, the
thesis documents the need to take a more comprehensive perspective to understand the problems of maternal mortality to include social, cultural, economic and political
determinants of health in addition to the transfer of health service interventions. It draws on the Three Delays model which emphasises the importance of delays between
the onset of obstetric complications and its outcome and proposes that most maternal deaths are preventable with prompt and adequate medical interventions. This study
employed qualitative techniques to determine how reproductive health, in particular the goal of reducing maternal mortality, fits into Ethiopia’s development agenda. In Kafa
Zone in south-west Ethiopia, most women give birth with the assistance of their neighbour, mother, mother-in-law, or husband. Less than five percent of women give
birth in a health institution or with the assistance of a trained health worker or trained traditional birth attendant. Using semi-structured interviews with key personnel in
government and non-government organisations, in health institutions, and with women in rural and semi-urban areas in Kafa Zone, the research juxtaposes women’s experiences of birth at home with that in a ‘modern’ health care setting. It is likely that women who give birth at home feel ‘safe’ because that is where birth normally takes place and where they are supported by close relatives and neighbours. Women always feel it is ‘unsafe’ to go to a health facility because of the very real possibility they will die on the way. For this reason, a picture emerges of ‘unsafe’ childbirth denoting those births that are transferred to a health facility. The study confirms that as maternal health has been identified as a key development goal in Ethiopia, there is a need to consider social and cultural issues alongside biomedical health interventions.