Overcoming Barriers to SRHR in Ethiopia 

Girl showing something to a crowd of people

Ethiopia continues to face a major humanitarian crisis due to climate disasters, disease outbreaks, and conflict, which are exacerbated by economic insecurity. During times of crisis, women and girls often face outsized impacts. However, strategic support for sexual and reproductive health and rights (SRHR) and maternal, newborn, and child health (MNCH) helps to mitigate these effects for individual girls and women and for their families, communities, and the country overall. In a recent study, we found that women and girls in rural areas of Ethiopia face major barriers that impede their access to health services. 

The Reach, Expand, and Access Community Health (REACH) program in Ethiopia’s Jimma and Borena zones aims to ensure access to information and services for integrated sexual and reproductive health and rights, menstrual hygiene management, and water, sanitation, and hygiene (WaSH) services for women and young people. Through program initiatives, we are addressing barriers to services faced by women and young people in underserved areas and fostering an environment where they can access high-quality care.

Yesuf’s Story: Contraceptive Training Supports Midwives 

(Story Authors: Gashaw Abebe Alemu, Mohammed Ahmed Mohammed, Wondimu Chirfa Tolera, Gizachew Balew Jembere, Kate O’Connell, Danielle Garfinkel) 

Gubidora is one of the health centers found in Yallo Woreda of the Afar Region. It has faced numerous challenges since the onset of the northern Ethiopia conflict in November 2020, through November 2022 when the conflict subsided. Internal displacement and casualties created a significant burden on health service provision, and looting decimated the facility’s medical equipment, drugs, supplies, furniture, and documents. Furthermore, most SRH services, particularly comprehensive contraceptive services, were interrupted, resulting in unintended pregnancy in many women, which can lead to unsafe abortion. 

Yesuf is a midwife working in the maternal and child health department at the Gubidora health center.  After EngenderHealth provided Yesuf with comprehensive contraceptive counseling training, he met with the health center management team and discussed the training he took, how to revitalize the family planning (FP) services in their center, and how to ensure access to services. He also helped establish a separate room for FP services in the facility to maintain clients’ privacy and quality of services.  

Yesuf also initiated a regular health education program at the health center for clients and patients. The health center used an outreach campaign twice a week in hard-to-reach kebeles like Wekredi and Rekrek, where they provided health education about the benefits of contraceptives and how to manage unintended pregnancy among the community and provided contraceptive options.  

Yesuf said “I was happy when EngenderHealth visited our health center to conduct baseline assessments to support us and initiate Family Planning, Post Partum Family Planning, and Post Abortion Family Planning services. During the visit, I remember the service being provided to clients in previous years was interrupted before the assessment. The training helped me gain the necessary knowledge, attitude, and skills. I oriented all staff members, including medical and paramedical staff, on the comprehensive abortion care service, which is given free in our health center.” 

Chichale’s Story: Happy with Her Family Planning Method 

(Story Authors: Olifan Degabas Olkeba, Amina Kanpise Arero, Wondimu Chirfa Tolera, Gizachew Balew Jembere, Kate O’Connell, Danielle Garfinkel) 

Chichale is a 30-year-old mother of five children. She is a pastoralist living at Har-Wayu Kebele, a rural village in Borena Zone where access to transportation is challenging because of the hilly topography and rocky road of the kebele. Due to the prolonged drought, her livelihood deteriorated, and she faced difficulty in feeding her family and sending her children to school. She decided to limit her family size and consulted a nearby health facility, where they discussed available FP methods. She wanted an intrauterine contraceptive device (IUCD), but none were available. Since the nearby health facility had no trained service provider and lacked her method of choice, Chichale was worried about becoming pregnant. 

Shortly after Chichale’s experience, the REACH project trained the health facility providers on comprehensive contraception methods and also distributed equipment, commodities, and other supplies. Additionally, the project conducted social behavioral change communication training for health extension workers and started demand-creation activities, including community dialogue, and home-to-home visits at the village level which improved referral linkage between the health post and the health center. 

After these capacity-building interventions, the trained Health Extension Workers were able to provide Chichale with IUCD services. When we met her 11 months later, she was excited and leading a healthy and happy life. As a satisfied client, she has been sharing her experience with nearby mothers. As a result of her peer counseling, 19 clients in Chichale’s area adopted an IUCD as the FP method of their choice. 

Smiling woman in a red sweater and colorful scarf with a baby on her back in Ethiopia

“I was trying to space my children by using different contraceptive methods like three-months injectable, Implanon, and oral pills but none of them suited my needs, as I live in a kebele where transport service and access to the road is challenging. Through community dialogue, health extension workers told us the availability IUCD service at Har-Wayu health center and linked me by referral paper to consult providers in the health center. The health care providers in the facility welcomed and provided me with appropriate information about the methods, its follow-up, and to come back to the health center if there is any problem with it.  I decided on IUCD and have been using it for nearly a year. I am healthy and very happy with it. I keep on telling my neighbors about the method and I think many of them took it,” said Chichale

Photo caption: Chichale, a 30-year-old mother of five children, living in Har-Wayu Kebele, a rural pastoral village in Borena Zone. She is a satisfied client with an IUCD. Photo by Olifan, EngenderHealth Staff.

Kabale’s Story: Healthcare Facility Delivery Saved Lives 

(Story Authors: Amina Kanpise Arero, Wondimu Chirfa Tolera, Gizachew Balew Jembere, Kate O’Connell, Danielle Garfinkel) 

Kabale is a thirty-year-old, married woman from Bokosa kebele of Dubuluk woreda, Borena zone. She was displaced from her village following a devastating drought that extended for more than three years and has been living in a site for Internally Displaced Persons (IDPs). 

Kabale became pregnant and, like many women in Ethiopia, she was not planning to give birth at a health facility. After she received information about the risks of home delivery, she went to the IDP health post for antenatal care (ANC). The health extension workers there referred Kabale to the Dubluk health center, where Kabale was deemed high risk and referred to Yabelo General Hospital. At the hospital, the obstetrician informed Kabale that both her twins were in a footling breech position. The medical teams closely monitored Kabale, providing her with the care she needed to safely deliver a baby boy and baby girl.

Woman holding a baby in Ethiopia

“If I had not been informed about the benefits of ANC follow-up and delivering at a health facility, I would have continued with my usual practice of delivering at home. Unfortunately, this could have led to life-threatening complications, as I was informed by the health professionals,” Kabale said. “The advantages of delivering at a health facility became abundantly clear to me. I would like to extend my heartfelt thanks to the healthcare professionals who played a pivotal role in my safe delivery. I urge all pregnant women to embrace ANC follow-up and give birth at health facilities under the care of skilled professionals.

Photo caption: Kibale, a 30-year-old, married, internally displaced woman from Bokosa kebele of Dubuluk woreda, Borena zone. She is a beneficiary of skilled birth. Photo by Amina Kanpise, EngenderHealth staff.

Fatuma’s Story: Family Planning Integration helps reach more women to  Plan Healthy Family 

(Story Authors: Firewein Yilma Gezahegn, Mohammed Ahmed Mohammed, Wondimu Chirfa Tolera, Gizachew Balew Jembere, Kate O’Connell, Danielle Garfinkel) 

Fatuma is a 30-year-old mother of five children living in the rural pastoralist village of Dichoto Kebele in Afar region. She supports her family by collecting and selling wooden charcoal. 

Fatuma didn’t know about family planning methods and didn’t space her pregnancies. She faced many difficulties raising her children. Two of her children were admitted for malnutrition treatment at the Dichoto health center. While she was there with her children, a health provider counseled Fatuma about family planning and its benefits. 

When she got home, Fatuma consulted her husband about different contraceptive methods. Fatuma and her husband chose for her to use the three-year implant method.  

Tesfaye, a healthcare provider at Dichoto Health Center said, “Fatuma came to me after hearing about different FP methods from the nutrition unit. She asked me to give her additional information about different methods, I counseled her about all methods, and she decided to take an Implant. EngenderHealth does a lot of work in FP and abortion services in the Afar Region; including providing competency-based training for service providers that increased service uptake. Currently, FP counseling is being given to all clients in the waiting area and across all the departments in Dichoto Health Center. This has helped us strengthen internal referrals and provide services for clients like Fatuma.” 

Fatuma’s last child is four years old, and after four years with her implant, Fatuma is very happy. She said “I am excited about my situation because my children’s health is improved, and I have avoided unplanned pregnancy. If I want to have children, I know that I can remove the implant and get pregnant. I have been telling local mothers about my experience and linking them to the health center myself so that they can benefit from FP services and live happy lives.” 

In addition to Fatuma, facility reports show that more than 196 women were informed about FP through an internal integration approach across different service units and adopted contraceptive methods of their choice. This approach is practical and advantageous to pastoralist women who rarely visit health facilities. It provides one stop for information and access to services or referrals to all available services. 

Commitment to SRHR is Crucial for a Better Future for All 

Yesuf, Chichale, Kabale, and Fatuma’s stories show us that while the ongoing conflict, drought, and humanitarian crisis in Ethiopia disproportionately affects women and girls; strategic and ongoing support for SRHR and MNCH is a beacon of hope for community members. EngenderHealth’s contributions have led to life-changing, positive outcomes not only for individual women and girls but also for their families, communities, and the nation at large. As Ethiopia continues to navigate its complex challenges, sustained commitment to SRHR efforts is crucial for fostering resilience and building a healthier, more equitable future for all Ethiopians.