What to Expect When You’re Expecting, in Ethiopia


Sara is 22 years old and in her ninth month of pregnancy, evidenced by an extremely swollen belly and a shirt whose buttons barely fasten. We’re standing together a few steps from her home in one of Addis Ababa’s improvised urban settlements, tucked into a back corner of Ethiopia’s capital city. It’s not often that I find myself speechless, but Sara’s response to my last question — where and how she plans to deliver her baby — has me at a loss for words.

My team and I came to Ethiopia with the Amplify program, a partnership between the nonprofit design organization IDEO.org and the UK’s Department for International Development. Our goal is to research the challenges facing low-income parents in East Africa when it comes to supporting their children’s growth and development. My interview with Sara, whom we met by chance on the street, is one of more than 20 conversations we’ve had over the past three weeks with mothers, fathers, prospective parents, nurses, teachers and community leaders.

In 15 minutes, I’ve learned quite a bit. This baby will be Sara’s third (her two older children are currently living with her mother in the rural north). Like many young Ethiopians we met, Sara recently returned from the Middle East, where she worked for years as a housemaid.

Sara in her neighborhood of Addis Ababa, 2014

Back in Addis Ababa, she now depends on daily work to support herself, having been abandoned by her boyfriend when she became pregnant. Despite the obstacles she’s facing, Sara is warm, welcoming, and — after a tentative first few minutes — candidly answers my questions. When I ask where she plans to give birth she replies without hesitation: At home.

“I know that it could kill me or the baby to do it alone,” she says, “but I do not have money to pay a birth attendant and I have no family here.” Like all mothers, she wants to give her child the best possible start in life, but she has also prepared for the worst.

My shock at Sara’s response isn’t about the risk this delivery will bring to her and her baby — I’m aware that Ethiopia is among the most dangerous countries in the world to give birth. I’m shocked because I came to Sara’s neighborhood directly after visiting a nearby clinic where her baby could be safely delivered under the care of a professional midwife, free of charge.

My team spent the morning conducting research at that clinic, less than 50 yards away from the one-room shack where Sara lives.

Despite being an outsider in this neighborhood — having spent less than a week in Addis Ababa — I know all about the clinic’s free delivery services and vaccination program for children. Sara has no idea it even exists.

Sara’s lack of knowledge of the resources available to her speaks to a larger theme that came up several times during our design research. Without reliable information channels, many mothers living in poverty are unable to make choices that support their children’s health and development during the most crucial window: from conception to age five. Despite what we might think, the most pressing need for mothers in the developing world isn’t always new hospitals, fancy tools or more advanced technology. It’s better access to information.

In the world’s more affluent cities, information for prospective parents is everywhere. What to Expect When You’re Expecting has sold tens of millions of copies in the United States alone, “mommy and me” groups are ubiquitous, and a pediatrician is only a phone call away. My own Facebook news feed is full of the byproducts of this information: pregnant friends posting photos of themselves holding fruits and vegetables in front of their growing bellies, each of which corresponds to the current size of their baby. These photos are artifacts of the knowledge that parenting books, reliable health care, and even high school biology classes have enabled — allowing the women in my life to make informed choices that support the health and wellbeing of their children and track progress week by week.

For women at the top of the economic pyramid, there is a ritual around preparing for parenthood, built on a foundation of complete and reliable information about what children need to thrive. Designing a way to get that same information into the hands of mothers like Sara is about more than fairness. It just might save a life.

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