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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, according to the latest UN report on world population released on July 11. The Horn of Africa nation, however, stood more than a quarter of a century ago as a pioneer in reducing fertility on the African continent, thanks to a broader family planning policy, including this still slowly urbanized rural country.
The country may be the second most populous in Africa, but it does not know the actual size of its population. The last census in Ethiopia was in 2007. Since then, Ethiopian authorities have relied on general assumptions. The UN population estimate is 122 million. Despite the steadily declining fertility rate, Ethiopia’s population is expected to reach 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,” Dr. Mengistu, director of the Ethiopian NGO Pathfinder, told Asna. In the capital, Addis Ababa, the average female fertility rate is less than two children: a rarity on the continent.
Away from the authoritarian approach
For three decades, sexual and reproductive health experts, doctors have followed the evolution of the Ethiopian method. It was in 1993 that the challenges of demographic change made their presence felt in national policies. The Ethiopian government then set its national population policy on stone. Its priority is already “Reduce the fertility rate from 7.7 in 1993 to 4 in 2015.”
The objective will not be fully achieved – the national fertility rate is still 4.2 today – but the program will enable the integration and popularity of family planning across this deep rural country. “It was not about birth control in a repressive way, but about aligning our population growth with our economy and doing it on a voluntary basis.” Says Mengistu Asana.
In 1993, Ethiopia gradually emerged from a fifteen-year civil war under the communist military dictatorship of Darg. Institutions are bloodless, no government institution offers family planning opportunities. Only one private clinic in the capital has provided this facility. Only 4% of women then use contraception. A hole. The arrival of many donors and international NGOs coincided with the growth of the clinic.
Away from the Chinese authoritarian system, Addis Ababa is betting on education. One primary school has been built in each of them qebele (“District”), the school enrollment rate for young girls has increased from 21% in 1995 to 95% today. This pool of schoolgirls promotes family planning strategies. “Since 2005, a flagship health extension program will train high school girls to become reproductive health workers.” Explained by Dr. Mengistu Asana. Thousands of young women go through a year of training before being deployed to their native areas.
“Regional and socio-demographic inequalities”
Ethiopia now has about 40,000 ambassadors in the four corners of its territory, responsible for spreading contraceptive knowledge. Five methods recommended: pill, injection, condom, implant and IUD. One in four women use it. “It was an innovation on the continent, organizing women volunteers directly from the local community.” Mengistu adds Asnake. Public health experts then came from Nigeria, Tanzania, Mozambique or Uganda to study the Ethiopian model.
But is this method satisfactory in a country where 60% of women still do not use contraception? Can we talk about equity when more than 50% of women in Addis Ababa use contraception as opposed to 3.5% in the Somali region? And that fertility rate is three times higher than the capital in the Oromia region (large Ethiopian region)?
Health Minister Leah Tades has pointed the finger “Regional and socio-demographic inequality” and “poor quality of government service delivery” As a barrier to controlling fertility in Ethiopia. In reality, all Ethiopian women need to triple the budget allocated by the government to meet their needs. In fact, more than 20% of them, willing to benefit from family planning, do not currently have access to it.
The ambitions of the Ethiopian authorities may come against a critical political context. The civil war in Tigris and the drought in the eastern part of the country displaced more than 5 million Ethiopians in 2021: a world record. Also, the conflict has destroyed more than two thousand health centers in northern Ethiopia, as well as hundreds of schools.