Current status of family planning in Ethiopia

In this step we will examine the rapid progress made in relation to family planning outcomes in Ethiopia. Ethiopia is the second most populous country in Sub-Saharan Africa with a population of 99 million in 2015, and during the past twenty years the nation has made considerable progress in improving family planning outcomes. A snapshot of indicators relevant to contraception in Ethiopia is shown below.

Why has Ethiopia been successful

Commentators broadly ascribe this success to four factors, described briefly below. These are adapted from: Olson D and Piller A. Ethiopia: An emerging family planning success story. Studies in Family Planning. 2013;44(4):445-459.[5]

Political will

The Ethiopian government has set ambitious targets for the country’s development, and in doing so has recognised the challenges that population growth poses for poverty reduction, and high fertility poses to the health of women and families. In 1995 it committed to put in place policies that would support women’s right to access family planning information, education, and services, and has now set the goals of increasing the contraceptive prevalence rate to 55% and reducing the total fertility rate to 3.1 children per woman by 2020. In line with these commitments, the government has also increased spending on health, including on improving health service provision and commodity supply.

Ethiopia’s Health Extension Programme

Launched in 2003, the Health Extension Programme (HEP) was designed to increase access to and use of preventive and curative health services across Ethiopia, including family planning services. Since its launch, the HEP has trained and deployed almost 40,000 health extension workers: trained, salaried community health workers who work in almost 20,000 health posts, each of which is designed to have strong linkages with a primary health facility. The duties of these health extension workers include provision of family planning counselling in communities, and the administration of some contraceptive products and services – while providing links and referrals to health facilities when necessary.

Non-governmental Organisations and Public-private partnerships

Non-governmental organisations (NGOs) have worked together with the government’s Health Extension Programme as major contributors to Ethiopia’s family planning success. In particular, NGOs have been able to help the government meet the population demand for services by focusing on procurement, management and distribution of commodities, and by implementing social-marketing innovations that strengthen private sector engagement.

Donor Support

During the same time period, multiple donors have provided consistent support to purchasing contraceptive commodities, strengthening government capacity, and improving research, policy and training. Notably, from 2000-2010, Ethiopia was the largest recipient of family planning donor assistance in Sub-Saharan Africa, partly encouraged by strong political will, but also by strong integration of family planning within the broader Ethiopian health agenda.

Equity Issues

While the contraceptive prevalence rate has increased, the improvements have not been equal for everybody. For example, pastoralist communities continue to have much lower awareness or demand for family planning, and fewer points of access, than other communities do. Both outreach and referral mechanisms are particularly important for women in these communities. This means making full use of the rural penetration that the Health Extension Programme offers, making sure that women are not required to travel long distances to reach services. It also builds a functioning referral network from health posts, to health centres, to district hospitals where more long-term family planning options are available.

In the next step we will reflect on two equity dilemmas for the Ethiopian government to consider.