She is known for helping women on their journey to motherhood at the University of Michigan Center for Reproductive Medicine, but Dr. Senait Fisseha has been plagued by the plight of women in other parts of the world – the ones with the least access to quality care.
The reproductive endocrinology and infertility specialist and mother of four knows all too well about the health challenges of the developing world. Born in Ethiopia – which has one of the highest maternal mortality ratios in the world – Fisseha has long dreamt of being able to use her medical expertise to give back to the global community.
Now, a $25 million grant from an anonymous donor will give Fisseha that opportunity.
The money will allow Fisseha to start the new Center for International Reproductive Health Training, which will focus on increasing the number of health professionals equipped to provide life-saving reproductive health care in low-income countries.
The ultimate goal: To reduce the number of deaths among women across the globe.
More from Dr. Fisseha on the new center:
As the director for the Center for International Reproductive Health Training, you will obviously be devoting a lot of time to building this new program, including travelling abroad and spending time away from your regular job and family. Why is leading this center so important to you?
This work is extremely important to me both on a professional and personal level because I come from that part of the world.
I have four healthy children. Here in the U.S., I was able to get outstanding care during my own pregnancy, was able to deliver in a facility with highly-trained doctors and nurses, had access to adequate pain control and had a safe birth experience. To be able to live a life like this and then go to part of the world where women are dying because they don’t have access to safe delivery, comprehensive reproductive health services or skilled birth attendants during childbirth is something that doesn’t sit very well with me.
How has your connection to Ethiopia helped shape your career?
I will always share a deep bond with Ethiopia and care immensely about its people. Despite significant improvements in maternal and child mortality, it’s incredibly painful and hard to reconcile with the fact that too many mothers and children die from preventable causes and from a lack of skilled birth attendants who are so accessible in other countries. I always knew that no matter where my medical path took me, I’d find a way to go back and be engaged in advancing training, service and research for women’s healthcare in the global south.
When I interviewed with U-M’s Ob/Gyn chair Tim Johnson as a resident, it didn’t take long to realize that U-M would give me the opportunity to do the global work I believed so strongly in. Dr. Johnson – who has led maternal health initiatives in Ghana – is an avid champion of women’s health both in the U.S. and abroad. It was clear he shared my deep commitment to improving the state of women’s health around the world. This department’s philosophy is that the fate of a woman’s health should not depend on where she was born or where she lives. After meeting with him, I didn’t need to look any further.
How would you describe the state of women’s health in Ethiopia?
Ethiopia was among six countries that accounted for about half of maternal mortality in the world. The others include India, Pakistan, Nigeria, the Democratic Republic of Congo and Afghanistan. There has been remarkable improvement in the last decade in maternal-child health in Ethiopia. The maternal mortality ratio has declined significantly from 871 for every 100,000 live birth to 420 for every 100,000 live birth. But to put it into perspective, that number is 28 for every 100,000 live birth in the United States. These maternal deaths are often preventable if health care providers were well-trained in critical lifesaving skills and women could deliver in health care facilities. The ratio of OBGYNs to women in Ethiopia is 1 to 1.8 million. As a physician committed to public health, I see this is a crisis we should all be concerned about.
What steps have been taken to address the alarming number of maternal rates in Ethiopia?
Ethiopia has made tremendous strides over the last 15 years by increasing the number of healthcare providers and health facilities in rural areas to make health services more available. The government has worked hard to increase medical training, going from just a handful of medical schools to having over 30 in the country. Although there has been significant increase in the quantity of providers, there is still a significant need to improve the quality of training and access to high-quality health care.
What is the goal of the Center for International Reproductive Health Training or CIRT?
Globally, reproductive health issues are a leading cause of poor health and death of women of childbearing age. Women in developing countries suffer disproportionately from reproductive health issues, including unintended pregnancies, unsafe abortions, maternal death and disability and sexually transmitted infections.
This generous, $25 million grant will allow us to do serious work addressing the global reproductive health crisis. This center is going to be critical in ensuring that comprehensive reproductive health care training becomes integrated into medical education for incoming doctors, nurses and midwives to strengthen the cadre of highly-trained health providers in the country. The center will focus on comprehensive family planning services as well as timing and spacing of pregnancies for safe deliveries since we know that unintended pregnancies among Ethiopian women are linked to a higher-than-global-average of deaths and disability.
What’s your vision for the center 10 or 15 years from now?
Our goal for the center is to take an active part in scaling up training in Ethiopia first and then eventually expand efforts to other countries with the highest need for this type of training. We are committed to taking an active role in creating quality, respectful, patient-centered reproductive health services in the developing world while also raising awareness for the benefits of reproductive health services. We also hope to support outreach efforts within the country to ensure these reproductive health services will be accessible not only in areas that are close to big cities and training institutions but in remote areas as well.
Why is U-M committed to this effort?
As a large public institution, we feel that addressing health inequities is a moral imperative and we have to play an active role working for the public good. Developing bilateral relationships with global partners will help improve health worldwide. As a department, under the leadership of Dr. Tim Johnson, we’ve committed to taking a very active part in improving women’s health with the philosophy that whether you live or die or whether you have good care or not shouldn’t depend on what part of the world you’re from.
There is a significant difference in how medicine is practiced in the western world versus in the global south, and it’s especially poignant for physicians like me who go back and forth between both worlds. Here, we practice medicine at a tertiary care center where we use very complex technology, where we have medication at our disposal, where we have a large number of highly-trained health care providers and where we are able to offer patients the best healthcare options available. The differences are stark.
It is not a one way street but rather a mutually beneficial relationship. We get out of it as much as we put in. We have a tremendous opportunity to take our trainees with us where they see diseases in very advanced stages and see different types of disease pathology they don’t see in the west. It also provides an opportunity to collaborate in research and other areas.
How do you ensure that the work you do fits with the country’s goals for improving health?
When we go abroad, we establish deep, meaningful and sustaining relationships that are driven by the country’s agenda and not by that of the University of Michigan.
We have developed very deep relationships with our colleagues in Ethiopia and other countries we work with, such as Ghana. This includes close collaboration and partnerships with ministries of health, medical institutions, professional associations, civil societies and many others. These relationships are critical in determining how our work fits with the country’s health goals and of course ensuring success in any programs we engage in.
How does the reproductive health of women impact the country’s health socially and economically?
Reproductive health services are extremely important, not only to women but to society as a whole. It is usually poor women and girls from poor families who suffer the most. Although women generally are not the primary breadwinners, women tend to be the primary keeper of homes. When you have strong, healthy girls and women, you have a strong, healthy community. In most cultures, women are the core of the family so maternal deaths really break up families – especially in the global south – the whole family is shattered.
So, access to quality reproductive services will not only allow women to live healthier lives but also make families stronger. When women have the freedom to be able to control their reproductive destiny, it also empowers them to improve their economic status and take care of their family.
How long will it take to make a dent in these health issues?
The World Health Organization recommends at least one doctor to 10,000 people in developing countries, and Ethiopia is lagging behind those numbers. We also recognize that we are up against many challenges. More than three quarters of women still deliver at home, not at a health facility, which underlies the need to train midwives and other mid and low-level community-based providers that are culturally common there but considered non-traditional here in the U.S.
There are many government-led initiatives in Ethiopia that have already significantly increased the number of physicians and other health care cadres, and now we are committed to helping improve the quality of the medical education and work in integrating comprehensive reproductive health training the providers receive. I can’t tell you how long it will take before Ethiopia has produced an adequate number of obstetricians. It certainly won’t be in the immediate near future, but I know we are heading in the right direction. We know we have a long way to go but we will continue to partner with our Ethiopian colleagues until that goal is achieved.
Take the next step:
- Read the full story about how the $25 million grant will help U-M’s role in shaping healthcare in low-resource countries.
- Read more about U-M’s work in Africa.
- See more stories at the Michigan in Ethiopia blog.
Senait Fisseha, MD, JD, is the medical director for the University of Michigan Health System’s Center for Reproductive Medicine. Her areas of specialty cover all aspects of infertility including: polycystic ovary syndrome, recurrent pregnancy loss, other endocrine disorders resulting in infertility; as well as assisted reproductive technologies such as IVF/ICSI, and gamete and embryo cryopreservation.
The University of Michigan Center for Reproductive Medicine uses a multidisciplinary approach that brings the expertise of endocrinology and infertility specialists, OB-GYN’s, urologists, lab technicians and research scientists together to help each of our clients have access to the latest expertise and technology available – through one convenient center.