“A hello from a nurse is not just a hello during childbirth,” said Azeb Girma, recounting her childbirth experience.
The mother of two who lives in the outskirts of Addis Abeba gave birth to two of her children in private hospitals.
Azeb says she decided to give birth in private care after visiting a public hospital, and she didn’t like what she saw, a long queue of pregnant women waiting to see a doctor.
She added that her sisters, who are also mothers, also influenced her decision as she proceeded to choose the same private hospitals they gave birth in.
Azeb gave birth to her first daughter at Myung Sung Christian Medical Center, aka Korea Hospital five years ago. Her nine-month-old son was delivered at Grace Maternity Hospital.
For pregnant women, prenatal care, medical checks ups during pregnancy, start at an early stage. Medical professionals recommend regular checkups on the mother’s health and the growing baby starting from the fourth week of the pregnancy.
Azeb also went to see her doctors during both of her pregnancies regularly. Azeb says her doctors were very attentive, and they eventually became close friends to the family.
“I received good health care services with little inconveniences,” Azeb told Addis Insight.
However, things become a little more complicated and inconvenient when the pregnancy is due and is time for delivery.
Azeb, who gave birth to both of her children through C-section, surgical delivery, was required to deposit money before entering the surgery.
Azeb was required to deposit 12,000 during the birth of her daughter five years ago at Korea hospital while the figure raised to 20,000 birr when she gave birth to her son at Grace Hospital this year.
According to the arrangement, the cost of the medical services Azeb would receive during the childbirth was going to be deducted, and the reaming money was to be returned to the new mom.
“However, in both of the deliveries, no money was returned by the hospitals, and the money I deposited was just enough to cover my expenses,” Azeb told Addis Insight.
In Addis Ababa, depending on the type of delivery, private hospitals have made it customary to require parents to pay a “guarantee payment,” ranging from 10,000 to 20,000 birr for child delivery medical service.
Women who give birth through labor are required to deposit between 10,000 birr to 15,000 birr while surgical delivery in private hospitals requires guarantees ranging from 15,000 birr to 20,000 birr.
The hospitals promise to return the rest of the money after service charges and used items are deducted. However, new parents complain that they get nothing in return and that hospitals often take the whole money creating bogus costs and bills.
Another parent who shares such experience is Amanuel Solomon. Amanuel became a father two months ago after his wife decided to give birth through surgical delivery at Grace Hospital.
When Amanuel was asked to deposit 20,000 birr, he requested the list of the services his wife needed and their respective prices.
“However, the hospital claimed that they didn’t have it and stated the bill would be calculated after the surgery’, Amanuel told Addis Insight.
After his wife gave birth to a healthy son and it was time to settle the cost, the new father was waiting for a return from his initial 20,000 birr deposit.
To his surprise, the hospital told him that the medical treatment his wife received costs an additional 1,860 birr.
Amanuel was who furious at the time demanded to get the bill for his service, which he says left him bewildered. Besides lots of items with medical terms he didn’t know, he was able to identify some charges.
His bill contained 1500 birr attributed to three nurse visits. The doctors’ fee was 2500 birr, and another 1500 birr fee was billed for an “assistant.”
Azeb’s bill also had a similar list. In her case, the doctor was priced at 3000 birr while nurse visits were also billed at 500 birr per visit.
“If the nurse came and said hello, it didn’t matter, that was a visit, and it would cost you 500 birr”, said Azeb in frustration.
Besides overpriced services, Amanuel and Azeb claim that the hospital bill also included unused services and items.
“The bill included a 3000 birr cost for an Intensive Care Unit (ICU), which is insane because the baby was never taken to the ICU”, said Amanuel.
In the case of Azeb, she states the small items such as tissues and temperature measurement, which costs 65 birr per checkup, were overcounted.
“When you start asking questions about the price, the hospitals always reply that having the baby in peace was the main thing,” Amanuel told Addis Insight.
While parents are paying such high prices in private hospitals, the cost of childbirth in public hospitals is affordable and low.
The average cost of childbirth, either through labor or C-section, is around 300 birr in public hospitals as they get subsidies from the government.
While some mothers might end up requiring extra medical care and service, the bill doesn’t exceed 1000 birr.
Mihret Bihonu is one of the mothers that chose to give birth in a public hospital. Mihret delivered her son a year and a half ago at St. Paul’s Hospital Millennium Medical College.
“I received round the clock medical care, and I knew I was in good hands,” said the 27-year-old.
She says that except for a few things that made her uncomfortable, such as sharing a room with other women in labor, giving childbirth in a public hospital in Addis Abeba is safe and encourages other women to do so.
The Ethiopian public health care strategy places maternal, newborn, and child health as a priority.
The Federal Ministry of Health, in cooperation with institutions like the World Health Organization (WHO) and UNICEF, has been working to ensure that pregnant women and newborns receive good quality care throughout pregnancy, childbirth, and the postnatal period.
As a result, the country is seeing advancements in these areas. The current infant mortality rate for Ethiopia in 2020 stands at 34.010 deaths per 1000 live births, with a 4.21% decline from 2019.
The country has also seen a massive cut in fertility rates. The fertility rate in Ethiopia has declined from an average of seven children per woman in the 1990s to 4.1 currently.
Experts say the country has made this turnaround because of a combination of factors. They attribute the decline to women staying longer in school, increasing living standards, and expanding the use of contraceptives and family planning.
In the capital, Addis Ababa, the fertility rate is estimated to be 1.7 – lower than the rate needed to keep the population steady.
More educated women and a higher cost of living often mean fertility rates are lower in urban areas.
Gandhi Hospital is one of the known public hospitals in the capital under the supervision of Addis Ababa City Administration Health Bureau. 12,600 women have given birth at the hospital in this Ethiopian year so far.
74 percent of the women who gave birth at the hospital delivered their babies through labor” said Tariku Tassew (MD) Medical Director at the hospital,
“It is the doctor that decides whether the mother should deliver through labor or surgery following scientific procedures,” added Tariku.
However, in private hospitals, the percentage of mothers that give birth through surgery is much higher, as mothers can choose the form of delivery they want in private care.
“A growing number of women in the capital are opting for surgery delivery to avoid complications and risks of labor,” said Bethel Dereje (MD) Gynecology-oncology fellow at St. Paul’s Hospital Millennium Medical College.
“Labor delivery could take several hours with some involved risks, while delivery through surgery takes 30 minutes or less” added Bethel
Though it is declining, the maternal mortality rate is still high in Ethiopia. According to WHO, 810 women died each day in Ethiopia due to complications during and following pregnancy and childbirth in 2017.
Bethel, who moonlights at a private hospital, also does not agree with the statement that childbirth medical service is expensive in a private hospital.
She believes that the medical professionals that offer the service deserve the price they are asking.
“People spend more money on luxury,” said Bethel “child delivery is a complex process that requires time, skill, and energy, with a risk to the medical professionals,” said Bethel.
She also supports the practice of requesting deposit and argues its necessity.
“People usually have a hard time paying the bill after the service, and it gets worse when there is unsuccessful delivery,” she added.
The Ministry of Health also backs Bethel and claim that it’s a free market.
We can’t control the price private hospitals charge”, an official from the Ministry of Health told Addis Insight.
However, he added that they accept complaints and investigate if people are charged for the service they didn’t use.
Both Amanuel and Azeb did not take their complaint to authorities as they found the hustle of lodging complaints after going through child labor too much to deal with.
After all, what mattered the most was that they gave birth to a healthy baby.
Both Myung Sung Christian Medical Center (Korea Hospital) and Grace Maternity Hospital have declined to comment on the issue.