Leguama, Ethiopia—As her pregnancy advanced, Yeworkwuha knew she should seek prenatal care. The 39-year-old mother of six had not intended to have another child, and the news she received earlier in her pregnancy had made Yeworkwuha even more despondent: she had tested positive for HIV. Although she had started treatment, traveling the 19 miles to the nearest hospital became too costly and she stopped going. Now, concerned about the health of her unborn child, Yeworkwuha visited Leguama Health Center, where she met midwife Yesuf Adem.
Yeworkwuha didn’t share her HIV status, but instead underwent an HIV test at Adem’s urging, secretly hoping the outcome would be different. It wasn’t. Adem carefully counseled Yeworkwuha on the prospects of living positively with her diagnosis, offering her hope for the very first time.
And that has made all the difference for Yeworkwuha, who first married at age 12 and lives now with her second husband, Seid. He is a farmer and the father of her children.
Adem had previously been trained on the prevention of mother-to-child transmission of HIV (PMTCT) by the Jhpiego-led Maternal and Child Health Integrated Program (MCHIP), a project funded by the U.S. Agency for International Development. MCHIP has been supporting Leguama Health Center to improve maternal and newborn health (MNH) services since 2012. As part of a wide-ranging collaboration with the government to build capacity of health workers, Adem and his colleagues were also trained in basic emergency obstetric and newborn care, essential newborn care, and performance and quality improvement to strengthen the quality of comprehensive maternal and child health services in the health center.
In talking with Yeworkwuha, Adem explained to her the high chance of having an HIV-free baby with proper medication and even how to breastfeed exclusively. When he recommended that she bring her husband on her next visit, Yeworkwuha did just that. Adem had a long discussion with the couple about the benefits of HIV testing before Seid finally agreed to take the test. Seid’s result was a surprise—he was negative.
Yeworkwuha remembers that after the news of their discordant result, their relationship began to crumble. “Seid stopped talking to me; I felt so afraid and I didn’t know what to do. I wanted to run away and live alone.” She fled to his brother’s house, but Seid came looking for her. They talked seriously about how they can still live together and with their children and returned home together. Yeworkwuha is grateful that their union still holds strong.
Adem was a big help as Yeworkwuha worked through the issues involving her health, such as giving birth in the health facility and using family planning. “His advice comforted me a lot,” she said.
After introducing PMTCT services in Leguama Health Center, MCHIP provided regular mentoring and coaching for the health workers to ensure the smooth integration of the service into the routine MNH care. MCHIP also provided the facility with essential equipment to improve service delivery. In two years (from 2012–2014), Leguama Health Center has increased skilled birth attendance rates from 13 percent to 25.7 percent and antenatal coverage from 56.4 percent to 87.6 percent. With the support of MCHIP, 834 pregnant and breastfeeding mothers who accessed antenatal and labor and delivery services in the facility were tested and counseled for HIV. Eleven of these women tested HIV-positive and started antiretroviral (ARV) prophylaxis to help prevent transmission of the virus to their infants and to treat their own condition. Moreover, nine HIV-exposed infants were identified and provided with ARV prophylaxis. These babies will be tested again after the age of 12 months to determine their exact result.
MCHIP provided similar support to 43 other health facilities in Amhara, Oromia and SNNP regions of Ethiopia, where the program either introduced or strengthened existing PMTCT services. A few selected health facilities, including Leguama Health Center, received intensive follow-up from MCHIP over nine months. This included on-site visits and regular phone follow-up. Such intensive follow-up and support helped the centers sustain quality service delivery by further minimizing missed opportunities for testing and treating HIV-positive pregnant mothers.
In September 2013, Yeworkwuha gave birth to a baby boy in Leguama Health Center. She received the necessary care during labor. The baby immediately started nevirapine prophylaxis medication, the treatment for HIV-exposed infants to reduce HIV transmission during labor and breastfeeding.
“As instructed, I only give my son breast milk. He is growing healthily and he smiles a lot too. I’m very happy,” the mother said. “My husband and I are using condoms for dual protection, from HIV and pregnancy, and in addition I’m using Implanon, a family planning method inserted in my arm.” The baby’s growth is regularly monitored in the health facility and 45 days after birth, a dried blood spot sample was taken from him for HIV testing. His result was negative. Yeworkwuha gives her son medication and takes her own drugs regularly.
“Even my husband reminds me to take them on time,” she says. “Without all this support, I could have been severely ill or could have even ended up dead. Instead, I was given the chance to see my children grow.”