Ethiopia: An emerging family planning success story

Delegates at the International Conference on Family Planning pose for a photo in front of DKT Ethiopia's coffee ceremony tent.

This was co-written with Andrew Piller and originally published on Impatient Optimists on Dec. 10, 2013.

When global family planning practitioners gathered in November for the Third International Conference on Family Planning, there was a timely relevance for meeting in Ethiopia. Over the last two decades, Ethiopia has become a family planning success story, one of only a handful of countries in Africa to achieve that status.

 Positioning of population and family planning at the center of development is critical.In 2000, Ethiopia’s contraceptive prevalence rate for modern methods was only 6.3 percent, which, at that time, was lower than any other country in Eastern and Southern Africa except Eritrea. By 2011, the rate had increased to 27.3 percent. Over the same period, the total fertility rate (the average number of children born to a woman in her lifetime) had decreased from 5.5 to 4.8.

Our article, "Ethiopia: An Emerging Family Planning Success Story," is available in the December 2013 issue ofStudies in Family Planning, published by the Population Council. This new report chronicles the history of that success, identifies four key factors that produced those successes, and details how these factors interacted to expand access and desire to use contraceptives.

 The presence of a large and active social marketing program can contribute substantially to higher contraceptive prevalence.In our article, we build the case for four determinants of success:

Political Will:  In setting its development policies, the Government of Ethiopia paid increasing attention to demographic factors, recognizing population growth as one of the main obstacles to reducing poverty. The government set ambitious goals for family planning and started using its own resources to procure contraceptives.

Generous Donor Support: From 2000 to 2010, Ethiopia was the largest recipient of international family planning assistance in sub-Saharan Africa. International donors have provided continuous support for purchasing products, strengthening government capacity, and improving policy, research, and training.

Nongovernmental Organizations and Public-Private Partnerships:  A number of national and international NGOs have supported the government’s efforts and employed strategies such as social marketing, behavior change communications, mobile clinics, and social franchising as ways of providing access to contraceptives for more and more people in low-resource settings.

Health Extension Program (HEP): Many analysts believe that the biggest factor in Ethiopia’s success was HEP, the government’s flagship health program. The program invested in a network of 38,000 frontline health extension workers (HEWs) based at 17,000 health posts to bring education and contraceptive products and services to rural areas that previously lacked trained health personnel and high-quality facilities.

For the government, the biggest challenges to sustaining and improving family planning services in Ethiopia relate to addressing remaining unmet need, maintaining sufficient supply of products, high turnover of health workers, shortage of staff, uneven distribution of health professionals, training of HEWs in the provision of Implanonimplants, and constraints associated with the monitoring and evaluation system.

Our article in Studies in Family Planning highlights lessons learned in Ethiopia that we believe can help other countries emulate the Ethiopian success, including:

• Political commitment, though not indispensable, is one of the most important ingredients for success
• Positioning of population and family planning at the center of development is critical
• African countries should invest a greater proportion of their own funds in health care, as Ethiopia is starting to do
• More progress must be made in integrating the response to HIV/AIDS with family planning
• More efforts must be made to diversify the modern contraceptive mix to satisfy the still high unmet need of 26.3% of married women
• The presence of a large and active social marketing program can contribute substantially to higher contraceptive prevalence
• Governments should fully engage civil society – including NGOS, the private sector, and faith-based organizations – so they can also contribute to family planning success

Read the full report in the December issue of Studies in Family Planning.