Family Planning in Ethiopia & Zanzibar
A recent BBC article described a large decrease in Ethiopia’s fertility rate, stating a drop from 7 to 4.6 since the 1990’s[1]. A UNFPA official in Ethiopia, one of the world’s fastest growing economies, attributes the drop to a variety of factors including improved standard of living in the country and women staying in school longer. The most important factor noted is the increased popularity of family planning. The Government health extension program providing improved access to family planning information, the increase of women’s education and child survival rates, and increased urbanization have contributed to the increase in contraceptive use in rural and urban areas and across all socio-economic classes[2]. Contraceptive prevalence rates increased from 8.2% in 2000 to 28.6% 2011[2].
The major religions in Ethiopia are Muslim and Orthodox, neither of which openly supports family planning[2]. Although it initially faced objections in Ethiopia from the government, religious groups, and the community, the country has seen the economic benefits that result from successful family planning, and the administration is now trying to expand services and reach its 2015 target prevalence rate of 44%2. It is encouraging to see not only the increased prevalence of contraceptives in Ethiopia, but also the support of the government.
Zanzibar could benefit from increased focus on similar initiatives. Several of the providers and women interviewed last summer in Zanzibar, where the population is 99% Muslim, stated family planning was not popular due to religious and cultural objections. As of 2010 Unguja North and Pemba North had modern contraceptive prevalence rates of only 7%, the lowest in the country[3]. Among other benefits, better family planning programs could help women avoid numerous, closely spaced births and control family size. Though not uncommon, limited spacing between births and multiple pregnancies (>5) are risk factors associated with PPH, the leading cause of maternal death in Zanzibar.
Ethiopia’s model for reaching rural women has the potential to work well in Zanzibar where there is a large community health worker presence. In Ethiopia, community health workers are now educating women in rural areas on family planning, but also trying to educate and involve the men, who are often the decision makers when it comes to family planning yet often have misconceptions on effective family planning methods. In some rural areas in Ethiopia, women also discuss family planning in depth when they meet for coffee, educating not only each other, but also the younger generation[1].
[1] http://www.bbc.com/news/world-africa-34732609
[2] http://countryoffice.unfpa.org/ethiopia/drive/DHSIn-depthAnalysisonFamilyPlanning.pdf
[3] http://dhsprogram.com/pubs/pdf/SR183/SR183.pdf
