Song aims to reduce maternal deaths in Ethiopia

U of A professors enlist country's biggest pop stars to save lives through music.

Roger Turnell had his doubts after seeing the lyrics for "Lib Yaleh" for the first time.

"How the hell is a song about a man singing about the death of his wife and child going to sell?" wondered the director of the University of Alberta's Ethiopia-Canada Maternal, Newborn and Child Health Project.

And how will such a depressing sentiment have any effect in reducing the high rate of maternal deaths in Ethiopia, the intended audience for the song?

The lyrics are without a doubt heart-wrenching and bleak, but when Turnell showed them to a group of Ethiopian midwives, their reaction surprised him.

"That will go over great," they said. "It will really sell in this country."

The song and video were released today in Addis Ababa, with a national press conference involving UNICEF, Global Affairs Canada and Ethiopia's ministries of education and health.

Along with the tragic story, the song's refrain is blunt and unrelenting: if the father had taken his pregnant wife to the clinic, he wouldn't have lost her and the child.

The accompanying video ends with a scene of expectant mothers seeking care at a clinic, followed by a happy family, smiling baby and a tagline: "Care at the clinic saves lives."

Now that "Lib Yaleh"-which means "If you have heart"-and the video are released, fingers are crossed the message will spread widely and help curtail abnormally high rates of maternal and perinatal mortality and morbidity in Ethiopia. The rates are especially inflated in rural areas where 80 per cent of expectant mothers choose to give birth at home rather than in a health centre.

Promoting public health with music

The idea to tackle maternal mortality in Ethiopia through song started with Michael Frishkopf, the director of the U of A-based Canadian Centre for Ethnomusicology, who has devoted much of his career to spreading positive messages about public health through music.

"When I found out about this project, I thought we should do some music," he said.

"A song is so powerful because it combines ideas and emotion.

"It galvanizes people around an issue and it's repeatable. People actually go home singing and humming it. It's broadcastable and can hit every corner of the country-and it overcomes illiteracy."

The overall maternal mortality rate in Ethiopia is somewhere between 350 to 450 per 100,000 live births, said Turnell. In Canada the rate is six per 100,000.

"However, when you move to a city like Addis Ababa, where 80 to 90 per cent of mothers deliver in health centres, the mortality is closer to 30 (per 100,000)," he said. "You decrease it by over tenfold by delivering in health centres."

Since the maternal health project launched in 2014, the U of A-led team has seen the numbers change dramatically in some places. In the pilot region of two million people, for example, they managed to cut maternal mortality rates in half.

"We do know-have hard data that shows-the mortality rate of small babies in the hospital reduced dramatically," said U of A pediatrics professor Khalid Aziz, who is also involved in the project.

Changing attitudes and behaviour

A crucial goal was getting expectant mothers to deliver in an available health-care facility staffed with trained health-care providers. The goal required changing attitudes and behaviour, not only among mothers-to-be but their entire families as well, especially their husbands. Frishkopf thought that music, tapping into culture and emotion, could offer an effective strategy.

At first he planned to help produce an entire CD for the Ethiopian project, but that quickly grew too expensive and impractical, especially since Ethiopians rarely listen to CDs. So he settled on just one track and found an Ethiopian producer, Thomas Gobena, based in Washington D.C., to find the musicians and help write, arrange and record it. As a UNICEF ambassador, Gobena had just the right connections to make it happen.

"Then over a beer in Addis Ababa," everyone on the project put their heads together to come up with a theme for the song that would direct the writing of lyrics, said Turnell.

Gobena enlisted female Ethiopian pop star Zeritu Kebede to write the lyrics and sing the female part in Amharic. He then found Tadele Gemechu, a male pop star, to sing in Oromo, the second main language of Ethiopia.

"It's important that the song sound local and use local stars singing in local languages," said Frishkopf. "Local singers, musical styles and languages, expressed through local culture, carry a distinctive emotional clout that outsiders can't attain, no matter how famous."

Gobena agrees the song can only work if the public health message isn't laid on too thick.

"It has entertainment value," he said. "I want people to listen to it as a good song. If they like it, the message will hit home."

Turnell helped finance the project and made arrangements with a Saturday morning radio program to air the song and devote an episode to maternal health. The program typically reaches 60 million of the country's 100 million people.

While Turnell admits music is not something he knows a lot about, he is now convinced of its power to touch people.

"The song provides a basis for gaining access to the household," he said. "I would never have thought of it, but I'm all for it now.I think every grant that goes out into rural areas should have a music component to it, because it gets down to the lowest common denominator."

"The idea is that development has to go hand in hand with some sort of change in consciousness, attitude and behaviour," said Frishkopf. "If there's no uptake for whatever you're providing, then you've failed."