Preventing premature births is a community effort

Nov 17, 2021
Written by Marie Bettings, Born On Time Program Director and Manager, Development Programs

World Prematurity Day is today, and I find myself reflecting on a trip I took to the breathtaking Ethiopian Highlands as part of World Vision’s Born on Time grant–the first public-private partnership to focus on the prevention of preterm birth.
Ethiopia is a country of many contrasts. Back in October of 2018, Ethiopians elected Sahle-Work Zewde, the country’s first female president, just a few days after approving a gender-balanced cabinet.

At the same time, life for most women in Ethiopia is undeniably difficult. According to statistics from UN Women, Ethiopia has some of the lowest indicators for gender equality in sub-Saharan Africa. And the war raging in this part of the country for the past year has been especially harrowing for women and girls.

One of the most devastating effects of negative gender practices in Ethiopia is preterm birth. Every year, 23,000 babies die from being born too soon in Ethiopia each year, according to Every Preemie Scale Prevention of these preterm births is complicated.

Preventing preterm births in Ethiopia

Just over five years ago I don’t think any of us could have imagined what Born On Time would go on to achieve, especially its unique work around addressing gender equality issues in Bangladesh, Ethiopia and Mali.
Born on Time has been critical to the on-the-ground walking out of Canada’s Feminist International Assistance Policy. This was done by centering gender equality in the approach to preventing pre-term birth, improving access to gender-responsive health services and realizing community level transformation that upholds the rights and agency of adolescents and women for their sexual and reproductive health and rights.

Mahlet, a midwife who worked with Born On Time, learned a lot about proper nutrition for mothers. Photo: Paul Bettings

Gender inequality can be a significant driver of preterm birth. When girls eat least and last, are married too early, and then go on to have babies of their own with little to no say in decisions that affect their health, the consequences can be lifechanging.

Working for Born on Time, our staff faced the weight of generational discrimination against women and girls, which often contributes to preterm births.

I came face to face with one of those practices while reviewing registers at an Ethiopian health clinic. Skimming down the ages of women receiving support on family planning, the number 12 jumped off the page. That’s only a few years older than my own daughter. Early marriage in this region of Ethiopia, although illegal, is still a common practice, driven by poverty and discriminatory social norms that value the chastity of girls over their life choices.

Working with local leaders

No one knows the devastating consequences of the practice more than priest Jejaw. The religious leader lost his 14-year-old daughter to a protracted labour.

“We didn’t know what to do. She bled in front of our eyes and we didn’t know what to do. I still hold the pain of losing a child,” Jejaw told me. The girl’s small and weak baby struggled to survive over the next few weeks, ultimately winning the fight to live but without his young mother by his side.

Priest Jejaw suffered great loss after the death of his 14-year-old daughter. Photo: Paul Bettings.

Many in these communities are not aware of the dangers of such a young girl birthing a child of her own, including the knock-on consequences of teenage pregnancy which can include a higher probability of preterm birth.

Born on Time trained not only faith leaders but also nurses, doctors and midwives on the prevention of preterm birth and quality pre-and-post-natal care, along with adolescent girls and boys in school groups, newly married couples through dialogue sessions, and even thousands of Malians under the night sky through mobile theatre programs.

Mahlet smiles at the camera. She is wearing a white labcoat and sitting outside.
Mahlet is one young leader making change in the prevention of preterm birth in her community.

Twenty-five-year-old Mahlet, a midwife in Ethiopia noted that before Born on Time she didn’t have a lot of training. The program helped her gain more knowledge in how to prevent preterm birth, including proper nutrition of mothers, healthy birth-spacng, and preventative contraception. She’s the kind of midwife any new mom would want around, gentle and patient, “We try to make it warm, clean and safe for our women,” she says, “whether they are here for a checkup, giving birth, or healing.”

The next generation

On my last day, I meet Tigist—a confident ninth-grader, about the same age that Jejaw’s daughter would have been when she died. Tigist is part of a peer-to-peer group that Born on Time has trained on sexual and reproductive health and rights.

A few months before, Tigist heard a rumour her closest friend Anguach, also a ninth-grader, was to be married. The two friends mustered up enough courage to confront the parents.

Along with her friends, Tigist is learning how to advance gender equality in her community. Photo: Paul Bettings

“They told us that there is no use in educating a girl, that she’s just going to end up a housewife anyway. Her father even tried to beat us with a whip,” Tigist told me.

Chased away from Anguach’s home and still facing the prospect of an imminent marriage, the girls decided to go to the police. Tigist’s face beamed as she shared her ultimate victory, “The marriage was cancelled!”

There is always more work to be done in support of women and adolescent girls’ health. But stories like Tigist’s, Mahlet’s and Priest Jejaw’s remind me that although Born on Time has now officially closed, women and girls, along with their families and communities, that benefited from increased access to healthcare, knowledge and education around the prevention of preterm birth through school-groups, theatre programs, house-to-house visits, and so much more, will continue to carry the heartbeat of the program.
A peer-to-peer group with Born On Time, a group of students sitting at desks.
Young people involved with Born On Time learned more about early marriage prevention and sexual health and reproduction. Photo: Paul Bettings

In small and large ways the more than 50 staff across three countries, working hand-in-hand with women, adolescent girls and their communities, have created a positive, measurable difference across a continuum of changemakers, duty-bearers and duty-holders. And that wave can’t be stopped by the endpoint of a grant.
It’s my greatest hope that the work begun through Born on Time to further understand prematurity and its causes will inspire others to take this important work forward and move us all towards a future where every child is born on time.

Help us continue to deliver vital programs to ensure families everywhere can have healthy lives.

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