Ethiopian Culture Impact on Perinatal Health Care

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Overview of culture, religion, demographic and geographic information of Ethiopia

Ethiopia, officially known as the Federal Democratic Republic of Ethiopia, is the subject of this study with regards to its cultural influences on perinatal healthcare. It is a landlocked country in the horn of Africa with over 82 million inhabitants and covers 1, 100, 000 km². The majority of people in Ethiopia are Christians; slightly more than a third of them are Muslims while the rest belong to religions such as Jewish. The country has over 80 ethnic groups which contribute to its world-renowned cuisine (Howard, 2009). The music of the country is as diverse as its ethnic groups. The countrys main sports are athletics and football; the former having worldwide recognition.

Health and Illness

Traditional medicine thrives in Ethiopia mainly because modern health care professionals are few in the country, and the average person is too poor due to lack of employment to seek alternative healthcare. In addition to these reasons, the government has invested very little in healthcare for its citizens (Schirripa, 2011). Traditional healers, who are both men and women, employ home-based therapies for the purposes of treating common illnesses (Pankhurst, 1965). However, only about 10% of these are considered genuine traditional healers. There are false healers whose trade in traditional medicine is a result of the commercialization of medicine as well as the high demand for medical services (Getahun & Berhane, 2000).

Traditional healers existed even before Christian Missionaries arrived in Ethiopia (Rajkumar et al., 2011). Their practice is strongly based on supernatural and magical beliefs which are part of the culture of the Ethiopians. Their medicine is derived from plants, animals and minerals. As a result of their incompetence, diseases such as Malaria, AIDS, Tuberculosis and Dysentery are the leading causes of death in the country.

The causes of diseases in Ethiopia are attributed to God and supernatural forces, as well as contaminated food and water. Miscarriages are attributed to evil spirits. Female genital mutilation is practiced by these healers and more than four-fifths of the women in Ethiopia are circumcised (Getahun & Berhane, 2000). This is usually done in unsanitary conditions. Anesthesia is rarely used and it often results in heavy bleeding, intense pain and even death. There are three medical training schools in Ethiopia but the distribution of medical facilities and personnel is insufficient for the population. There is only one psychiatric treatment unit in the country as the residents are averse to psychiatric treatment (Schirripa, 2011).

Psychosocial/Spiritual Characteristics

Ethiopian people are very humble and respectful when communicating with others and they expect the same from others (Kitaw et al., 2007). They are eloquent and employ the use of metaphors, allusions and wit which they also expect from others; exaggerated language is commonly used to emphasize points (Schirripa, 2011). They are non-confrontational and they often say what they think is expected of them so as not to embarrass other people. Honor and dignity are highly regarded and they will do anything to avoid bringing shame and disrespect to others which they expect of others (Girma, 2002).

The Geez Frontier Foundation has developed keyboards for use by Ethiopians using the Standard English keyboards. They are available for Unicode-coded Amharic, Awngi, Bench, Geez, Meen and Sebatbeit among others. These allow intuitive, phonetic-based input for Ethiopic script languages. Pointing fingers is considered rude but hugging and kissing as a form of greeting are acceptable among people who know each other. Hands are used to express a variety of positive and negative emotions whereas anger and disappointment may be expressed through withdrawal by some individuals (Howard, 2009). Soft tones are preferred in conversations as loud tones are viewed as signs of aggression. Anger is expressed in loud and emotive tones.

It is considered acceptable by Ethiopians to keep a fair distance in the course of conversations and maintain eye contact which is viewed as a sign of openness or honesty. Eye contact is not recommended for people that are of different gender. While talking, touching on the shoulder or arm is acceptable, it is only considered proper only between people that are of the same gender (Howard, 2009). Ethiopian women may visit hospitals and be attended to by male health professionals without any restrictions. The presence of another female is not required while an Ethiopian woman is in the examination room. Ethiopian women do not expect to be attended to by female healthcare professionals only while at hospitals.

Talismans are carried around even by Christians to ward off evil spirits. Spiritual leaders from all denominations and sects are readily available in Ethiopia. Some taboos relate to a language where reference to religion, anatomy, sex, diseases and animals must be done in some ways and not others. Taboos also govern the types and kinds of food that can be eaten especially by pregnant women (Haidar et al., 2010).

Prenatal Care

This is low in the country and is attributed to a lack of access to prenatal services. Women are also not willing to take tests such as the HIV test. Ethiopian women do not eat any special diets in the course of pregnancy but some foods are avoided such as hot mustard (Haidar et al., 2010). Warm food is usually preferred. Hot and cold are viewed as diseases by themselves among the Ethiopians and not as signs and symptoms of underlying diseases. The Ethiopian diet is composed of various kinds of meats which are a source of proteins.

Lentils, cabbages, and green beans are sources of vitamins whereas teff is a source of minerals such as phosphorus, iron, copper and aluminum among others. Recently, some women in urban areas have begun using vitamin supplements during pregnancy (Rajkumar et al., 2011). Ethiopians believe that factors such as moral behavior and the will of God can influence the outcome of pregnancy (Haidar et al., 2010). The Virgin Mary, who is called Miriam here, is prayed for the wellness of the mother and the child.

Labor & Birth

No anesthesia is offered by traditional midwives. Hospitals however may be able to offer anesthesia. One woman stays near the head of the woman who is giving birth, and another woman stays behind her and cradles her/ holds her upright only 6% of women have birth at the hospitals (Granot et al., 1996). The rest give birth at home, preferably in their mothers homesteads (Getahun & Berhane, 2000). Ambulation is not a priority for new mothers in Ethiopia. In contrast, they are encouraged to rest for at least forty days. Women are sometimes allowed to eat and drink in the course of labor and childbirth but not always (Haidar et al., 2010). The neighbors, relatives as well as young children are allowed to come in and out of the delivery room to encourage the woman in labor. Men however are strictly forbidden from being near the woman in labor (Schirripa, 2011).

Postpartum Care

The mother rests in the house for forty days after the birth of her child. She is separated from her husband and is sexually inactive. Cold showers are believed to strengthen the body and aid healing at this point. Thick hot porridge referred to as genfo is eaten by the new mother. It is made from barley, whole wheat flour, and spiced ghee. A drink of flax seeds, oats and honey is also given to encourage the production of milk. Special diet is provided to the mother to ensure she produces enough milk (Haidar et al., 2010).

Neonatal Care

Sons are circumcised on the seventh day or the twelfth day. The circumcision of girls is dying out in Ethiopia. For Christian families, a priest blesses the child with holy water and christens boys at 40 days and girls and 80 days. The child may sleep in a crib or lie next to the mother at all times at least for forty days. Breastfeeding is commonly practiced as compared to bottle feeding (Rajkumar et al., 2011).

Family Involvement

Fathers are normally absent in the course of labor and birth and do not usually bother themselves with the progress of the pregnancy. However, educated fathers/husbands have started showing more concern (Rajkumar et al., 2011). Women are required to be submissive and not talk when men are talking. This leaves the role of making decisions for the father/husband in the household. However, with increasing education opportunities for girls, this is slowly changing. Fathers are available in their homes for their families but it is generally accepted that they cannot resolve womens problems in the homestead. Children are allowed to be present during the birth of others in Ethiopia. All the women in the neighborhood as well as young children participate in the care of the newborn by helping the mother with the household chores so that she is free to attend to the baby (Schirripa, 2011).

Pregnancy Termination / Miscarriage

This is a common occurrence as women get married and pregnant while very young. Miscarriages are more common in younger girls. Illegal and consequently unsafe abortion is widely available in Ethiopia (Browning et al., 2010).

Death / Burial Rites

There are traditional organizations within the community that is known as Edirs. Members help each other financially as well as morally and emotionally in case of death. Burial is carried out by ones religion.

Frequently eaten food choices

Table 1: Common Ethiopian food and its nutritional value

Food	Nutritional value
Injera bread	carbohydrate
teff	Protein, iron, calcium, thiamin
wot	Vitamins and minerals
Meat (beef, lamb, poultry)	proteins
Beans and other legumes	proteins
Dairy products	Calcium, vitamins A and D

References

Browning, A., Allsworth, J. & Wall, L. (2010). The Relationship between Female Genital Cutting and Obstetric Fistulae. The American College of Obstetricians and Gynecologists, 115, (3):578-582.

Getahun, H. & Berhane, Y. (2000). Abortion among rural women in North Ethiopia. International Journal of Gynecology and Obstetrics, 71(3): 265-266.

Girma, S. (2002). Ethiopians Are Proud of Their Traditional Clothes. Silver International Newspaper, 16(3):67-100.

Granot, M., Spitzer, A., Aroian, K., Ravid, C., Tamir, B. & Noam, R. (1996). Pregnancy and delivery practices and beliefs of Ethiopian immigrant women in Israel. Western Journal of nursing research, 18(3):299-313.

Haidar, J., Melaku. U. & Pobocik, R. S. (2010) Folate deficiency in women of reproductive age in nine administrative regions of Ethiopia: an emerging public health problem. South African Journal of Clinical Nutrition, 23 (3):132-137.

Howard, S. (2009). Ethiopia Culture Smart! The essential guide to customs & Culture. London: Kuperard Publishing.

Kitaw, Y., Ye-Ebiyo, Y., Said, A., Desta, H. & Teklehaimanot, A. (2007). Assessment of the Training of the First Intake of Health Extension Workers. The Ethiopian Journal of Health Development, (21):232 239.

Pankhurst, R. (1965). A Historical Examination of Traditional Ethiopian Medicine. Ethiopian Medical Journal, (3):157-172.

Rajkumar, A., Gaukler, C. & Tilahun, J. (2011). Combating Malnutrition in Ethiopia: An Evidence-Based Approach for Sustained Results. New York: World Bank Publications.

Schirripa, P. (2011). Health System Sickness & Social Suffering. New Jersey: Lit Verlag Publishers.

Annotated Bibliography

Browning, A., Allsworth, J. & Wall, L. (2010). The Relationship between Female Genital Cutting and Obstetric Fistulae. The American College of Obstetricians and Gynecologists 115(3):578-582.

This study investigated if there is any connection between female genital mutilation and the incidence of vesicovaginal fistula during obstructed labor. The study focused on 492 fistula patients 255 of whom had undergone some kind of FGM and the rest had not. Factors such as age, parity, length of labor, labor outcome, size, size, scarring and type of fistula, outcome of surgery and the methods used for the surgery among others. The only significant relationship that was revealed by the research was that women that had not undergone FGM needed urethral catheters more during surgery in comparison to women that had undergone FGM and that type I and type II female genital cutting are not independent causes of fistula as a result of obstructed labor.

This paper documented the findings of a qualitative study that was carried out among Ethiopian women that lived in Israel. The study revealed that these womens beliefs concerning the determinants of pregnancy outcomes were unchanged; they still thought moral behavior, God, and nutrition were responsible for negative or positive pregnancy outcomes. The study also showed that the women preferred hospital deliveries to home deliveries which were the norm in Ethiopia. There are aspects and practices of hospital deliveries that they did not like and which made them uncomfortable, but hospital births were preferred as they were considered clean, safe, and expert.

Haidar, J., Melaku. U. & Pobocik, R. S. (2010). Folate deficiency in women of reproductive age in nine administrative regions of Ethiopia: an emerging public health problem. South African Journal of Clinical Nutrition, 23(3):132-137.

This is a cross-sectional study that sought to determine the extent of folate deficiency and risk factors among Ethiopian women. 970 women aged between 15 and 49 years were included in the study which sought to establish their demographic, health, food frequency, ferritin and folate status. 46% of the participants had severe folate deficiency, most of them were unmarried, had parity, used oral contraceptives, had no illnesses, had internal parasites, had no iron deficiency, had no anemia, and followed lower plant food and animal products diets. A low plant food diet coupled with inadequate iron was a particularly predisposing factor to folate deficiency.

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