While IUDs have become a course of controversy and new restrictions in the US, the Government of Ethiopia is actively trying to expand access to IUDs and other long term birth controls to women all over the country. In 2005 the Ministry of Health in Ethiopia began a Health Expansion Program that created paid and trained health extension workers to provide care at the community level. In 2009, the Implanon implant was expanded by specifically training the extension workers to insert the implant. In 2011, the Ministry added IUD training to this expansion.
This summer I am working with FHI360, specifically on project that helps the Ministry of Health with monitoring and evaluating the IUD expansion. FHI360 helps build the Ministry’s capacity by evaluating training, as well as provides measurement and evaluation training and coaching for health center staff and Ministry of Health staff. The Ministry of Health has the support of not only FHI360 for measurement and evaluation, but also Pathfinder and John Snow Inc. for the actual trainings of the health extension workers.
Currently, the birth control most commonly used in Ethiopia are oral contraceptives, at 21% of married women and 32% of single women. The Ministry’s project focuses on underserved rural areas whose health centers may not have a trained health worker to administer the IUD or implant. As a 2001 Demographic Health Survey points out, one of the problems is the inconsistency of birth control access between health centers. This past week, I visited many rural health centers in southern Ethiopia. They all had varying access to medicines, electricity, water, trained health workers and location to the nearest hospital. It was and eye opening experience traveling through Ethiopia and talking with all the different healthcare workers and seeing the centers. The health centers were surrounded by beautiful Ethiopian landscape, from jungle-like to flat and dry. While driving, my eyes would follow the abundant power lines, but they either did not quite reach the health centers or were not functional. One health center said they would have to deliver a baby by candlelight if labor went into night because they did not have power in the maternity building, but did in the building across the way. Another did not have running water, and seemed to carry their water in from a nearby stream, leading to their number one disease (at that center) being intestinal parasites. From my observation, most of the health centers have separate rooms for family planning, staffed by a trained health worker who could insert and extract an IUD or implant. While there were negative aspects to the centers, we were greeted at every center with friendly and cooperative health workers and administrative staff. Due to unforeseen circumstances, I was unable to travel and observe as much as I would have liked to. However, my one trip into the field did allow me to see the positivity that surrounds the health centers despite daily difficulties.
There is still an unmet need for family planning within underserved areas. I am thrilled to have been a part of a project and organization that is working to address this need for more family planning. FHI360 and the Ethiopian Ministry of Health are not only expanding access but also ensuring women are provided safe, comprehensive and consistent family planning advice and treatment.