Written by Tamrat Assefa

A recent expert forum in Washington, chaired by Mary Robinson, advocated more contraception aid  for poor countries, for example. So we invited Tamrat Assefa, Emerging Voice from Ethiopia, to give his perspective on this important issue.

Humanity welcomes the 7 billionth individual at the end of this month. Nicolas Sarkozy and his wife did their best, but Giulia just arrived too early to be a contender. The arrival of the 7 billionth person is cause for profound global concern (and not just because he or she will be born around Halloween). A rising population puts enormous pressure on a planet already plunging into environmental catastrophe. Providing food, clothing, shelter, and energy for 7 billion people is a task of startling complexity.

As is well known, population growth rates vary greatly among regions and even among countries within the same region. The population of less developed regions is currently estimated at 4.6 billion and is growing at a rate of 1.6 per cent annually. Over the next 30 years, almost 98 per cent of global population growth is projected to take place in developing countries. Africa’s high rate of population growth also masks variations within the continent. Rates of growth fluctuate from 2.0 and 1.6 per cent in Northern and Southern Africa to 2.5 and 2.7 per cent in Western and Middle Africa, while the average for the continent is about 2.4 per cent. Fertility is highest in Niger, Malawi, Uganda and Angola, where women have, on average, about 7 children. Africa’s population of nearly 900 million could reach 2 billion in 40 years at current rates. Extreme poverty and large families tend to reinforce each other, in a vicious cycle. The challenge the world faces is to stop this vicious cycle and accelerate the shift to smaller families.

With a population of eighty million (in 2011), Ethiopia is the second largest country in Africa (just in case Michelle Bachman stumbles upon this guest editorial J) with an average annual growth rate of 2.6%. The population of Ethiopia is expected to double in 30 years time. The total fertility rate is 5.3 children per women and the average household size is 4.8 persons. Major determinants for the high fertility rate include early marriage, the low level of girls’ education, the low rate of women employment and empowerment, the traditional family structure and lack of access to family planning services.

Well aware of this daunting challenge, the Ethiopian government has been undertaking various policy reform measures and made substantial progress towards achieving the MDGs. The improved policy environment and a shift in government priorities towards the social sector have significantly improved access to and quality of health services. With the formulation of the national population policy in 1993 and subsequent policy measures the government clearly considers the rapid population growth as a high priority. The health service extension program (HEP) is the biggest venture of the government and flagship program of the ministry. In this program, two government paid female health extension workers are assigned at kebele level (the lowest administrative level with an average population of 5000). The health extension workers started to provide contraceptive information and services in the community. Use of modern methods more than doubled in the last decade, from 6 percent in 2000 to 14 percent in 2005 and 32 percent in 2009. Even better, the rate of increase in the use of modern contraceptive methods by currently married women was more rapid in rural areas than in urban areas, so the gap between urban and rural women narrowed. There was also a dramatic increase among the poorest SES categories. This increased access to family planning and reproductive health (RH) services for underprivileged segments of the population  clearly demonstrates the possibility of universal access to the whole population through community based health extension programs.

Total RH expenditure in Ethiopia accounts for 13 percent of total spending in health. This amounts to a per capita spending per woman of reproductive age (15-49 years) of about US$8. The share of government financing of RH substantially increased, but donors still contribute most.

One of the keys to sustainable development is the stabilization of the global population. The reduction of fertility rates should be encouraged in poorer countries, as has been the case in higher-income countries. Rapid and  voluntary reductions of fertility have been and can be achieved in poor countries. Success at reducing high fertility rates depends on keeping girls in school, ensuring that children survive, and providing access to modern family planning and contraceptives. Undoubtedly, improved access to family planning and other reproductive health services in poor countries like Ethiopia can significantly combat the incidence of maternal mortality and improve the state of women. Comprehensive, high-quality sexual reproductive services can help to prevent the unnecessary deaths of women.

Family planning should become a global and an African priority. Soon.

Tamrat Assefa

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