CSIS Delegation Examines Family Planning in Ethiopia

Alisha Kramer, Program Manager and Research Assistant
Global Health Policy Center, Center for Strategic and International Studies


Meheret was given for an arranged marriage at age 12. By age 17, she had given birth to her first child. 

Meheret, a health extension worker, is interviewed by a CSIS film crew.

Meheret's story is not unique; one in five Ethiopian girls are married by the time they turn 15, and 50% of these young girls have given birth to their first child by age 18.

The Government of Ethiopia has recognized the importance of family planning for women's health and empowerment and for achieving broader health and development goals for the country. Political commitment is high and significant progress has been made, but Ethiopia faces complex challenges in reaching their ambitious goal to expand contraceptive prevalence to 66% by 2015.

For these reasons, the CSIS Global Health Policy Center chose to take a U.S. delegation to Ethiopia to examine family planning as a cross-cutting development issue.

The delegation included:
- Gretchan Blum, from the Office of Senator Mark Kirk;
- Kristin Dini Hernandez, from the Office of Congressman Charlie Dent;
- Sara Nitz, from the Office of Congresswoman Karen Bass;
- Jennifer Dyer, Executive Director, Hope Through Healing Hands;
- Tom Walsh, Senior Program Officer with the Bill & Melinda Gates Foundation; and
- Janet Fleischman, CSIS Senior Associate led the delegation.

Young Ethiopian girls in Tigray.

The CSIS delegation met with Meheret in Gemad Kebele in the Tigray region of northern Ethiopia. We spoke with her at the health post where she now works as a health extension worker.

Meheret provides information on and services for family planning, and she knows first hand the wide-ranging benefits of timing and spacing pregnancies. After delivering her first child, she was educated on and began to use family planning methods herself. She waited over a decade before having her second child. She continues to use family planning methods today; as she told us, "Two is enough for me."

Over the past decade, the Government of Ethiopia has trained over 38,000 health extension workers like Meheret and stationed them at 15,000 rural health posts across the country. This fast-tracked mobilization has produced impressive results: contraceptive prevalence in Ethiopia has increased from 8.2% in 2000 to 28.6% in 2011.

Yet large and complex challenges remain to further expand access and availability of family planning services, including the strength of the health care system and plans for long-term sustainability. 

Ethiopian terrain is mountainous and rural,
like you see in this photo taken in Tigray.


Social, cultural, and religious barriers also impede progress. We were told that in some parts of the country, such as in the Amhara region, many communities believe that women who are unmarried, divorced, or widowed should not be sexually active and therefore do not need family planning. Married women--regardless of age--are often expected to prove their fertility, giving birth to many children during their reproductive years. Their communities do not believe that they need family planning either.

The CSIS delegation was able to hear about these challenges at all levels of Ethiopia's health care system--from a health post to a rural health center to an urban hospital.

There is a lot to be hopeful about and the delegation will have inspiring stories to take home--like Meheret's--of how family planning can change lives, strengthening and empowering women. But they also returned home with the reality of the challenges ahead, both for women in Ethiopia and for U.S. investments in family planning. 


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