Adolescent Reproductive Health in Ethiopia: Commitment Versus Reality
The Ethiopian Government has focused more closely in the last decade on the reproductive health outcomes of young people by committing to improve and increase access to health services, including family planning. In the early 2000s, a Health Extension Program was initiated aimed at bringing health care workers and services to the most rural populations, including adolescents. Following that in 2007, the government launched the National Adolescent and Youth Reproductive Health Strategy which specifically recognized the need for quality reproductive health services tailored for young people in Ethiopia. Most recently, these efforts have expanded reproductive, maternal, newborn, and child health interventions to include adolescents (RMNCH+A). The Ethiopian Government has also pledged to improve adolescent reproductive health at the global level, as evidenced by Ethiopia’s Family Planning 2020 (FP2020) commitment to expand youth-friendly services throughout the country.
Unfortunately, despite increased commitments and improved policies, young people in Ethiopia still encounter both structural and social barriers to accessing family planning and reproductive health information, care, and services. For example, Ethiopian women aged 15-19 still have a high unmet need for contraception whether they are unmarried and sexually active (37%) or are married (33%). Formal sexuality education is often not provided to young people, particularly girls, in school, and discussions on reproductive health rarely happen between young people and their parents. For adolescents in Ethiopia, information on reproductive health is largely shared through friends, but this information is often inaccurate and perpetuates myths.
Earlier this year, I had the opportunity to speak with a health care worker in Sendafa, a rural town about 40 kilometers outside of Addis Ababa. She confirmed that young people travel to the next community to access contraceptives out of fear of being recognized and stigmatized in their own communities. The burden of travel means that as a result, fewer young people can access accurate information and contraceptives from a trained health care provider. If a young person is able to scrounge together the resources to travel to receive these services, their choice of methods is very limited—Health Extension workers can only offer oral contraceptive pills and condoms.
Ethiopia’s experience with the Health Extension Program illustrates that the hardest-to-reach populations are not necessarily the most distant and that expanded care without the guarantee of quality, non-judgmental services means little in the case of youth. More must be done to reduce the stigma around young people accessing contraceptive commodities in their own community and to ensure that, if they choose, they can access a broader range of methods.
The Ethiopian Government has made commitments to increasing reproductive health information, care, and services to adolescents at the global level and has begun to translate those commitments to national-level policies. However, it must ensure that policies address not only physical access to contraceptives but also societal norms that restrict young people’s access to contraceptives. Ensuring that correct information from a trusted source and quality services are readily available to young people is essential to meeting their reproductive health needs.