When Senait Fisseha left her native Ethiopia at age 18 to attend college in the United States, she dedicated herself to improving women’s reproductive health in her home country.
“The poverty is so pervasive. It was something that was palpable around me,” Fisseha, MDRES’03, said of a country where women have little access to prenatal or health care. She has witnessed many young women in Ethiopia getting married at a young age and having children at 15 and 16, and some end up having large families that negatively affect their health and quality of life.
“I had grown up watching the suffering of women all around me, knowing the high rate of maternal mortality and infant mortality, and always said ‘I’m going to medical school and try to bring the impact home.’”
Fisseha’s work eventually led to the Center for International Reproductive Health Training (CIRHT), a groundbreaking initiative that launched at the University in February 2015 with $25 million from an anonymous donor.
“The magnitude of the impact we had in Ethiopia was unanticipated.” – Janet Hall
CIRHT aims to increase the number of medical professionals in Ethiopia who are trained in providing comprehensive, compassionate reproductive health care, especially in rural areas. The country does not have enough doctors who specialize in this field, Fisseha said, and many leave Ethiopia to train and never return.
The program started after Fisseha completed medical school at Southern Illinois University and headed for her residency to U-M, where she met Tim Johnson, chair of the University’s Department of Obstetrics and Gynecology. Johnson helped establish an OBGYN practice in Ghana that is considered to be the most advanced of any in the country. Since 1989, the program has succeeded in training 142 OB-GYNs; 141 still practice in the country.
“We demonstrated that there are substantial downstream public health benefits to training OB-GYNs,” he said, adding that having students globally engaged is a priority of the University. Fisseha told Johnson of her plan to contribute in a meaningful way in Ethiopia.
“He gave me incredible support, from mentoring and advising to connecting me to global health leaders,” she said. The program fell into place when Tedros Adhanom, then minister of health in Ethiopia, asked U-M to replicate the Ghana program. Johnson said he could take on only one country and was pleased to have Fisseha lead the effort.
Fisseha established the first OB-GYN residency program at St. Paul’s Hospital Millennial Medical College in Ethiopia in 2012. In July 2016, the first residents graduated; 60 residents will graduate within the next three years. The center works with 10 universities in Ethiopia to integrate comprehensive reproductive health training, including family planning and abortion, into medical and nursing education and help expand access to reproductive health services. Coincidentally called Michu clinics—“Michu” is the Amharic word for “comfortable, suitable, and friendly”— they are decked out in Maize and Blue.
The impact of CIRHT’s work is to build capacity so reproductive services will become a mainstay, “not something siloed on the side,” Fisseha said. A part of that is providing family planning information, including ways to space babies so women can have the number of children they desire and access to safe abortions for unplanned pregnancies. Gaining acceptance for abortion was no easy task because of a religious stigma around the practice.
“We are integrating all reproductive health services and mainstreaming it into routine medical care,” said Fisseha.” So it’s not stigmatizing for providers or patients.”
Fisseha, who left Michigan in fall 2015 to become director of international programs at the Buffett Foundation, remains an adjunct professor of obstetrics and gynecology at U-M and is still very involved in CIRHT’s implementation.
“The magnitude of the impact we had in Ethiopia was unanticipated,” said Janet Hall, CIRHT executive director and chief department administrator for the OB-GYN Department. She added that CIRHT hopes to increase capacity and train doctors in other countries where women’s reproductive health services are lacking, applying lessons learned from the Ethiopian experience. It’s set its sights next on sub-Saharan Africa and Southeast Asia and eventually hopes to expand to Latin America.
Johnson said Fisseha has accomplished in just three years in Ethiopia what it took him 12 years to achieve in Ghana. He’s visited the CIRHT centers and said the progress has been remarkable. Fisseha said the experience in Ethiopia has been successful largely because of the strong support of local partners, including Tedros, the former health minister who is a staunch advocate for women’s health, and the current health minister, Kesete Admasu.
“We may face greater challenges in other countries,” she said. “But that won’t stop us.”
Signs of Progress
The efforts of the Center for International Reproductive Health Training are bearing fruit. Along with factors such as the government’s commitment to reproductive health care, more women now have access to services.
Until 2004, Ethiopia had only one OB-GYN residency program; now, 10 programs train more than 100 OB-GYNs a year. According to a 2015 World Health Organization report, the percentage of women making four or more health visits during pregnancy tripled between 2000 and 2014, while contraceptive coverage for modern methods grew from 6 percent to 40 percent over the same period. The maternal mortality rate declined from 743 deaths per 100,000 live births in 2005 to 353 per 100,000 live births in 2015, an average annual rate of reduction of 7.4 percent.
Julie Halpert, ’84, is a freelance journalist who has written for several publications, including The New York Times, Newsweek, The Wall Street Journal, Family Circle, and CNBC. She also teaches a journalism class in U-M’s Program in the Environment.
Correction: The print version of this article (Winter 2016) misstated the maternal mortality rate statistics from the World Health Organization, and has been updated with the accurate data.
