Home to over 77 million people, Ethiopia is Sub-Saharan Africa’s second most populous country.  It is a young nation: 44% of its population is below the age of 15.  It also is a place where marriage comes early: 49% of women are married by age 18, and in some regions of the country half are married by age 15. Girls who are married are expected to bear children as soon as possible, contributing to the epidemic of pregnancy complications in Ethiopia, where rates of maternal mortality and morbidity are among the world’s worst. At the same time, the number of HIV infections is high and rising, and in Ethiopia young women represent the majority of the 1.3 million people with HIV.

Since 1987, EngenderHealth has played a critical role in improving sexual and reproductive health care services in Ethiopia.  With over 20 years of experience collaborating with the government and local partners, EngenderHealth currently reaches 69 sites in the Addis Ababa, Oromiya, Amhara, and Afar regions, and our programs are expanding. We are:

• Providing HIV and AIDS prevention and treatment
• Improving the quality of reproductive health care
• Challenging traditional gender norms
• Expanding contraceptive choice
• Addressing the needs of young people, including girls at risk of early marriage and those already married

Providing HIV and AIDS Prevention and Treatment
Preventing HIV among pregnant and postpartum mothers and responding to the sexual and reproductive health needs of HIV-positive women form the core of EngenderHealth’s work around HIV and AIDS in Ethiopia. Specific efforts address:

• Promoting voluntary counseling and testing for HIV
• Encouraging sound infection control practices at health clinics
• Integrating HIV prevention with maternal health services
• Providing antiretroviral drug therapies for HIV-positive pregnant women
• Reducing stigma and discrimination against people living with HIV
  

 
Improving the Quality of Reproductive  Health Care
In partnership with government offices, such as the Addis Ababa Regional Health Bureau, and nongovernmental partners, EngenderHealth continues to advance its mission to make quality reproductive health care available to all Ethiopians. Efforts include:

• Upgrading health care providers’ clinical skills through training courses
• Dispatching mobile family planning clinics to reach clients in underserved areas of Amhara and Oromiya
• Initiating continuous quality improvement monitoring and follow-up systems
• Developing guidelines on infection prevention at health clinics
• Training staff to use EngenderHealth’s COPE® methodology, which enables health care workers to identify problems, find the root causes, and develop effective solutions for improving their clinical services.

 
Challenging Traditional Gender Norms
Through an initiative funded by the President’s Emergency Plan for AIDS Relief (PEPFAR), EngenderHealth addresses gender norms and related behaviors that contribute to the spread of HIV. Collaborating with Ethiopia’s Ministry of Health and other organizations, EngenderHealth is:

• Developing a national strategy and guidelines on male involvement
• Conducting a study on HIV prevention for high-risk youth in Addis Ababa
• Assisting local groups to address male gender norms and HIV
• Providing ongoing mentoring and support to local partners

 
Expanding Contraceptive Options
A shortage of skilled and trained providers, inadequate commodities and supplies, and lack of accurate information about the methods have hindered men’s and women’s access to modern contraception in Ethiopia. Through the ACQUIRE Project, funded by USAID, EngenderHealth collaborates with Ethiopia's Ministry of Health, Pathfinder International, and other agencies on the following initiatives:

• Improving health care professionals’ knowledge and skills in providing quality sterilization services
• Promoting the use of long-acting contraceptives such as hormonal implants and intrauterine devices (IUDs);
• Ensuring that supplies and equipment are available;
• Eliminating barriers to demand, including misconceptions and lack of information about the IUD.

 
Addressing the Needs of Young People
EngenderHealth’s program in Ethiopia focuses on reaching adolescents, particularly young married girls. Activities are designed to reduce the medical and social barriers that young people face when trying to access sexual and reproductive health services. Additionally, EngenderHealth employs strategies to delay marriage and childbearing, promote gender equity, and improve the status of girls and young women. The program works with young people, ages 10—14, engages their parents and communities, and builds their skills to protect their health and livelihoods.

 
New Directions
Ethiopia’s growing population strains its natural resources and economy and limits opportunities for its citizens. EngenderHealth is taking a leading role in promoting an integrated approach to sustainable development that addresses population, health, and environmental concerns. Bringing all sectors together to work on issues such as poverty reduction, food security, and gender equity, EngenderHealth is forming a national network that will increase collaboration.