Eritrea makes substantial progress reducing maternal mortality – further gain likely hampered by stability issues
Maternal mortality rates have fallen dramatically over the last two decades from over 880 deaths per 100,000 births to about 240 deaths per 100,000 births ((WHO)). This dramatic drop has happened despite numerous wars and economic challenges. Further progress though will likely be hampered by these conditions.
The small, coastal nation of Eritrea declared its independence from neighboring Ethiopia in 1993 following three decades of civil war. Eritrea has one of the most authoritarian governments in the world, with virtually no freedom of press and limited external access. The nation is still very much defined by both its independence struggle and also renewed war with Ethiopia from 1998-2000. With conflict defining the entirety of Eritrea’s history, both men and women are still required to undergo a period of mandatory military service. The Eritrean People’s Liberation Front (EPLF)’s long history of struggle for independence relied heavily on female fighters, and employed innovative strategies to accommodate women in the years of fighting, including promoting – at least nominally – female officers to high ranks within the EPLF structure, and instituting local tampon production to help deal with reproductive needs.
However, the unique women-centered features of Eritrea’s independence struggle have been muted as the former rebel group has settled into the task of nation building. Years of war and economic isolation have left the country crippled in poverty. The country survives mainly from remittances and mandatory taxation of more affluent Eritreans in the diaspora, while the typical Eritrean mother is forced to undergo pregnancy and delivery with virtually no developed infrastructure and poor service provision. It is estimated that only 1 in 4 women give birth with a skilled attendant, and over 70% of women cite problems in accessing care ((Eritrea Demographic and Health Survey 2002)). Major challenges for women include lack of money, distance to health facilities, and limited transportation options. The poor quality of care compounds the challenges women face in attending clinics, as one half of women complain about waiting inordinate amounts of time in over-crowded facilities. 1 in 10 women still don’t even know where to receive health care if desired ((Eritrea Demographic and Health Survey 2002)).
Encouragingly, figures for antenatal coverage have improved since the first national survey was conducted in 1995, while the average age at first marriage is also rising. These two figures are positive signs of a bettering situation for Eritrean women, in addition to a very slight – but noticeable – drop in the number of women who undergo circumcision (from 95% in 1995 to 89% in 2002) ((Eritrea Demographic and Health Survey 2002)).
Eritrea’s dynamic but troubled history did include a space for women and displayed the first steps towards achieving reproductive rights. However, instability, authoritarianism, and general poverty have slowed their trajectory towards ensuring universal safe motherhood practices. While improvements have been made, the closed nature of the country makes outside observation of actual conditions for women challenging – there are no reliable statistics for Eritrea beyond 2002, and any improvements or regression in maternal care are impossible to determine.