The ground floor of Betsegah Mother’s and Children’s Hospital was teeming with pregnant women, who came for their checkup appointments last Thursday. Most mothers were chattering excitedly about their pregnancies and swapping advice with each other, as they waited for their names to be called.

However, for most of the women lying in the hospital rooms on the second floor, the anticipation was over; they had delivered their babies and were now resting, while family and well wishers gathered around during the lunch time visiting hours.

In one of these rooms, Zerihun Damtew was attending to his wife Tigist Tadesse, who gave birth to a 3.5 kg baby boy on Wednesday night. He is a teacher at a private school, earning 3,000 Br per month, while his wife, who works as a language and culture facilitator and is paid on a contractual basis, brings 2,000 Br a month on average, according to Zerihun. 

This is the couple’s first born and they have prepared as best possible for their newborn’s needs, according to Zerihun.

But a child’s needs are many, as Zerihun is finding out. He said he had already spent 1, 500 Br buying some clothes for his child. In addition, both parents expect the total medical costs from the time Tigist was pregnant to the time she will be discharged from the hospital to reach around 10,000 Br. Tigist delivered the baby via Cesarean section (C-section), which costs around 7,000 Br, at Betsegah, according to information from the Hospital administration.

There is also the cost of a baby washing basin, a bed, diapers and food to consider aside from hospital bills and clothing costs.

“Even though I have not gone about calculating every expense in a scientific manner, me and my wife have put our capacity in consideration and are willing to work hard to provide for our child, like most other parents,” Zerihun said.

On the other hand Fetiha Temesgen, who became the mother of baby boy Salamudin, on Tuesday last week at Zewditu memorial hospital, says that she has not bought any clothes nor made any preparations for her boy. Fetiha who came from Wolkite, the rural side of the country, considers it a taboo to buy anything for a child before it is born.

“The child might not make it to delivery, and in such cases preparation may cause sadness,” Fetiha, who speaks from her experience of losing a one year-old girl previously, told Fortune.

Fetiha who trades vegetables on the black market while her husband trades shoes in the same manner, claims that she lives a hand-to-mouth existence. She does not know what her daily income is. However, she says that parents can raise a child with the capacity they have.

“I do not necessarily have to buy food or clothing from the same place that somebody richer may shop at, however I will provide him with basic necessities and raise my child without spoiling him,” Fetiha says.   

However much the services and products that parents use to raise a child vary, a simple survey of the market reveals that costs are increasing across the board. 

Despite the exorbitant costs, the number of pregnant mothers and deliveries has increased in hospitals and health care centres over the past year. In the month of Meskerem alone, from September 12 to October 11, 2011, 164 mothers delivered at Betsegah’s, according to information from the hospital administration.

A rough count from the delivery register at Zewditu Memorial Hospital reveals that during Meskerem around 327 mothers gave birth, while the number of children delivered in the same month the previous year was around 274.  Similarly, in the Ethiopian month of Hamle, from July 8, 2011 to April 7, 2011, roughly 292 children were born at Zewditu, while around 159 children were born in the same month last year.    

The cost of raising a child starts from the moment of conception when pregnant mothers need regular medical attention. Betsegah’s Hulagersh Gualu, a midwife of 30 years, says a pregnant woman needs to visit a health care centre at least four times during her pregnancy, according to WHO convention. This is because she needs to get blood work done, get HIV/AIDS testing and counselling, RH blood tests and ultrasounds, according to sister Hulageresh. 

However, this is the minimum amount and most mothers come to Betsegah’s monthly during early months of pregnancy, then every 15 days when their due date is near. A registration card, which is valid for 10 days, costs 60 Br at Betsegah’s. Ultrasound examinations cost 100 Br, and laboratory fees can total up to 200 Br maximum.

These costs are only pre-delivery expenses. If a mother delivers her baby naturally, it will cost between 1,200 to 3,000 Br, depending on medications and utilities used. If a mother encounters complications such as mal presentation, high BPR or multiple births and has to have a C-section, costs can go upwards of 7,000 Br, says Hulageresh.

Usually new mothers are monitored by doctors for a couple of days at Betsegah’s, where room costs range from 200-400 Br depending on whether they are private or semi-private rooms.

In government hospitals the costs are less. However, there are people that cannot even afford these costs and need to ask for free service, which hospitals provide upon receiving proper documentation, according to Aynalem Mersha, an antenatal care midwife nurse at Zewditu Hospital.

A card which is valid for 15 days costs five Br at Zewditu, according to Aynalem. Delivery costs range from 50 Br for normal delivery, 70 Br for delivery with complications and 140 Br for C-sections, in keeping with the price list posted on the wall of the maternity ward corridor. 

New mothers are monitored for six hours before they are sent home from Zewditu, barring complications, according to Hanna, a midwife nurse at Zewditu. A room in the maternity ward costs 100 Br, 200 Br or 400 Br, depending on whether there are wards, semi-private or private rooms, respectively.

After handling these costs, parents still have to shop for clothes for the newborn. Like medical costs, these prices also vary from store to store.  But price increases appear across the board.

Bezawit Abdelah, who sells baby clothes, near Betsegah hospital, says that prices have increased by almost 100pc in the past few years.  The prices that Bezawit gives are similar to Merkato’s, where she gets her supply from. “Babies need wrapping blankets right after they are born and socks and a hat, and other clothing materials a little bit later,” Bezawit says.

Wrapping and holding blankets that used to cost 45 Br four years before now sell for 230-250 Br according to Bezawit. Local flannel wrapping blankets sell for 65 Br whereas four years ago they used to sell for 25 Br. Costs for socks and hats range from 8 to 15 Br, while the cheapest outfit, which includes five pieces, costs 130 to 150 Br.

This outfit used to cost 45 to 50 Br, according to Bezawit. Other outfits in Mercato can range from 250 to 300 Br. Shoes cost 60 to 120 Br and locally made diaper t-shirts cost 12 Br in shops and boutiques around Merkato.

Pricier boutiques and shops in malls sell wrapping and holding blankets from 350 to 550 Br. Tiny shoes can sell for up to 400 Br and small pants and t-shirts cost 250 and 170 Br respectively. These boutiques say their products come from the United States, the United Kingdom (UK) or the United Arab Emirates (UAE) and prices are affected by the current foreign exchange rate.

But more than clothing expenses, new parents say they are most affected by the cost of diapers and food. Usually people bring clothes for newborn babies in different sizes which can last up to a year, Fetiha told Fortune. Fetiha also has a sister in Qatar, who provided her clothes for the first daughter before she died. If they have children with similar gender parents are also likely to cloth  babies with hand-me down clothes.

Most parents use cloth diapers that are reusable. One ready-made diaper with four corners, made from Debela, a thick cotton material, sells for 11 Br in Merkato. Prices are cheaper in Lideta, where diapers with three corners cost 2.50 Br a piece in cooperative shops. 

Lemlem Shumye, who has been selling small clothing items on the streets of Merkato since the King’s time, remembers when the 11 Br diapers used to sell for three Br.  These diapers are cost-friendly aside from expenses incurred for soap and water to wash them.

Disposable diapers on the other hand, which are available in supermarkets and stores, are a pricier option but save time and energy. In supermarkets the small eight-piece disposable diapers sell for 48 Br and large 32-piece disposable diapers sell for 110 Br. Disposable diapers bought in bulk ranging from 48 pieces to 64 pieces sell for 216 and 319 Br, respectively. One disposable diaper can be used for four hours and most mothers say that small babies use up to four diapers a day, while kids a year old and above use fewer.

When it comes to feeding their babies, mothers are advised to feed breast milk to their babies exclusively for six months. However, most mothers may be employees and can only have maternity leave for 2-3 months. Increasingly therefore mothers rely on formula milk to feed their babies.

Currently in supermarkets, formula milk brands like Infacare, Promil, Mother’s Milk, and S-26, at 400gm per volume, sell for prices ranging from 122 to 152 Br. Instant cereals like Cerelac and the local Cerefam, which can be supplementary food after six months, sell for 40 Br and 18 Br respectively at supermarkets. 

Some mothers like Fetiha, however, plan to prepare porridge material out of mixed ground cereals containing 15 or so cereal varieties called mitin and use cow’s milk which can be purchased by the litre daily and can cost up to 360 to 400 Br a month. The price for such homemade ground cereals is also increasing. Barley, a major ingredient in the mixes, now sells for 17 Br per kilogram.

Despite all these basic and necessary costs, the birth rate in the country is increasing. The current crude birth rate in Ethiopia is 34.5 births per 1000 population according to the Ethiopian Demographic and Health Survey 2011 preliminary report. However other data from the CIA world factbook 2011 estimates the birth rate to be 43 births per 1000 population. Ethiopia ranks at number six in the birth rate list according to the factbook, preceded by five other African countries.

Hulageresh and Aynalem, the nurses at Betsegah and Zewditu respectively, would like to see more done in the area of family-planning and maternal health. Hulageresh, who has worked for five years at Betsega’s and 25 years rotating through government hospitals, says that more attention needs to be given especially to homeless mothers, who often use their kids for begging on the streets.

Aynalem says she encounters a lot of homeless mothers who have had unplanned pregnancies come to Zewditu. “We try to teach them as much as we can to care for their child when they are pregnant and also give them training for family planning, but in most cases it is to no avail,” she told Fortune.

“Our focus should not be on the number of children we have but our capability of raising children that will be active citizens,” Hulageresh explains.

The total population of Ethiopia is 80.4 million according to the 2010 population projection of the Central Statistics Agency (CSA); however CIA estimates that in 2011 the population has reached 90 million people. The fertility rate is five children born to every woman according to the 2010 Ethiopian Demographic and Health Survey preliminary report.

Meanwhile the maternal mortality rate is 600 deaths per 100,000 live births and infant mortality is 77.12 deaths of 1000 live births, according to the Ethiopian Demographic and Health Survey preliminary report.

Ethiopia will have to reduce the maternal mortality rate to 267 per 100,000 live births and the child mortality rate to 31 deaths per 1000 live births in order to meet the millennium development goals according to Ministry of Finance and Economic Development, indicating that a lot should be done. CIA world fact book 2011 which estimates the maternal mortality rate to be 470 deaths per 100,000 live births, ranks Ethiopia at number 29 for maternal mortality rate and number 17 for infant mortality rates respectively.

Expenses and mortality rates, however, fade into the background for parents like Fetiha and Zerihun who are revelling in the experience of having newborns. As Zerihun tries to explain to Fortune how he plans to care for his child, his mother-in-law Negatua Tsegay, who has 20 children and grandchildren combined, interjects repeatedly the age-old saying, “My child, it does not matter how expensive raising a child gets, Lij Tsega new; a child is a gift.”

By ELLENI ARAYA,
FORTUNE STAFF WRITER.