Reducing Maternal Mortality in Djibouti Faces Substantial Challenges
Many different conditions from cultural practices, to infrastructure and the economy make reducing maternal mortality rates extremely difficult. Djibouti is an exceptionally small nation, with only 632,000 inhabitants. While over 80% of the population lives in urban areas, poverty remains a crippling problem, particularly for women. Socio-economic determinants of health are particularly acute in the nation, with approximately one in ten poor women dying in childbirth throughout their lifetimes ((State of the World’s Midwifery 2011)). In addition, the population living outside of cities is principally nomadic in nature, making it difficult to provide comprehensive and consistent social services. Djibouti has managed to lower its maternal mortality rate, from 740/100,000 live births in 1994 to 690/100,000 in 2002, but barriers to accessing safe maternity care remain in place for both urban and rural women ((IRIN, Djibouti: High maternal mortality despite improved health services, 2004)) ((WHO))
High user fees at health facilities, poor follow-up of patients, and uneven distribution of personnel in a select number of urban facilities, leave many women no choice but to deliver unattended at home. Even for those women who manage to come to facilities, poor quality of care still results in deaths from easily preventable causes like post-partum hemorrhage ((Parker, Julianne 2013)).
The practice of female genital cutting only compounds issues of poor access to care. An estimated 90% of women in Djibouti undergo the procedure, further placing these women in danger of obstetric complications. (UNICEF, A report card on maternal mortality, 2008)
Djibouti is a small nation with a large urban population, and improving maternal health would not prove as large a challenge as neighboring nations like Ethiopia and South Sudan. However, despite the promise of a “Safe Motherhood” program strategy from Djibouti’s government, there has been a notable absence of political will from the country’s leadership to improve the status and health of Djibouti women. Health professionals often move elsewhere, seeking better remuneration and more secure employment in neighboring countries. If Djibouti is to continue to reduce figures of maternal mortality, the government needs to more actively recruit skilled health providers and build better infrastructure to improve access to maternal care.