In Ethiopia, controlling population growth requires education

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Women and children wait for the distribution of food aid in Adi Mehameday, western region of Tigray, Ethiopia, May 28, 2022.

Ethiopia is one of eight countries in the world where more than half of the world’s population growth will be concentrated between 2022 and 2050, shows the latest United Nations report on the world’s population, published on July 11. The Horn of Africa country, however, stood more than a quarter of a century ago as a pioneer on the African continent in terms of reduced productivity thanks to a detailed family planning policy, including already in rural areas of this slowly urbanizing country.

The country may be the second largest population in Africa, but it does not know the true size of its population. The last census in Ethiopia began in 2007. Since then, Ethiopian authorities have relied on simple estimates. The United Nations estimates the population at 122 million. Despite a continuing decline in fertility rate, Ethiopia is expected to have a population of 213 million by 2050, making it the ninth most populous country in the world.

“We have one of the most progressive family planning policies in Africa,” said Dr. Mengistu Asnake, director of the NGO Pathfinder in Ethiopia. In Addis Ababa, the capital, women have the average fertility rate without two children: a rare one on the continent.

Far from authoritarian methods

A specialist in sexual and reproductive health for three decades, the doctor has followed the evolution of the Ethiopian method. It was in 1993 that the challenges of demographic transition reflected in national policies. The Ethiopian government then put its national population policy in stone. Its priority is already “Reduce the fertility rate from 7.7 in 1993 to 4 in 2015.”

The goal was not fully achieved – the national fertility rate is still at 4.2 today – but the program has made it possible to coordinate and popularize family planning throughout this deep rural country. “It’s not about controlling births in a rigid way but about aligning our population growth with our economy, and doing it on a voluntary basis”, said Mengistu Asnake.

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In 1993, Ethiopia slowly emerged from fifteen years of civil war under the communist military dictatorship of Derg. Institutions are bloodless, there is no public institution that provides access to family planning. Only one private clinic offers this privilege in the capital. Only 4% of women use contraceptive methods. A hole. The arrival of many donors and international NGOs coincided with the proliferation of clinics.

Far from the methods of the Chinese authorities, Addis Ababa is betting on education. An elementary school was built in each qebele (“District”), which increased the number of school enrollments for young women from 21% in 1995 to 95% today. This group of female students promoted family planning techniques. “Since 2005, a core health promotion program will train high school girls to become reproductive health activists,” he said. explained Doctor Mengistu Asnake. Thousands of young women go through a year of training before being deployed to their regions of origin.

“Regional and socio-demographic inequality”

Ethiopia now has about 40,000 of these ambassadors in the four corners of its territory, responsible for disseminating contraceptive knowledge. Five methods are suggested: pill, injection, condom, implant and IUD. One in four women uses it. “It’s an innovation on the continent, to directly mobilize women volunteers from local communities,” added Mengistu Asnake. Public health experts then flocked from Nigeria, Tanzania, Mozambique or Uganda to study the Ethiopian model.

But would this approach be satisfying in a country where 60% of women still do not use contraceptives? Can we talk about fairness when more than 50% of women in Addis Ababa use some form of contraception against 3.5% in the Somali region? And that the fertility rate is more than three times higher in the Oromia region (the largest region in Ethiopia) compared to the capital?

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Health Minister Lia Tadesse pointed the finger “regional and socio-demographic inequality” and “poor quality of distribution of public services” as barriers to controlling the fertility rate in Ethiopia. In fact, the budget allocated by the government should be tripled to meet the needs of all women in Ethiopia. In fact, more than 20% of them, who seek to benefit from family planning, currently do not have access to it.

The ambitions of the Ethiopian authorities may be at odds in a critical political context. The civil war in Tigray and the drought in the east of the country displaced more than 5 million Ethiopians by 2021: a world record. In addition, the conflict has destroyed more than two thousand health centers in northern Ethiopia, as well as hundreds of schools.

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