Addis Ababa — "Unmet need", in the context of family planning, is a rather mundane term that masks an urgent social justice and human rights issue. An estimated 220 million women in the world who want to manage their fertility, and plan their lives, do not have it, because they lack access to contraceptives. Some wish to decide whether to have children, while others want to delay parenthood for months or years, or want to space births for health and financial reasons.
All of these choices are acceptable, and moreover they are personal. Yet too many people cannot make them, because for a range of complicated reasons, they do not have the knowledge and tools to do so. Policymakers, public health professionals and donors must provide the necessary leadership, commitment and resources to enable these choices.
Ethiopia is the second-most populous nation in Africa, with vast stretches of difficult terrain where citizens live with limited access to modern resources or services. The bulk of our unmet need for family planning is in rural, hard-to-reach areas, among women with little to no education, and among young people.
Our road to ensuring full access and full choice to family planning, an essential part of ensuring the health and well-being of all our people, has been long and tough. We have worked hard to address lack of information through social marketing and community-awareness activities.
To make health care, including family planning services, a reality where it was not before, we have trained, equipped and relied on more than 38,000 government salaried health extension workers who fan out into the farthest villages across the country. To complement the health extension program, to increase the uptake of available services, we have introduced a home-grown innovative strategy called the Health Development Army. Through this initiative, currently we are trying to mobilize 3 million women volunteers across the country.
We have had major victories as a result of these efforts. As women learn about family planning, and where to get it, their demand for it rises. In 1991, just 3% of women in Ethiopia were using modern contraception. By 2011, this had risen to 29%—still too low, but double the rate of just five years prior. Based on the current trends, we expect to see this dramatic progress continue.
Addressing unmet need is critical not just because access to family planning is a social justice and human rights issue, but because it is a key to economic development. When people can determine the number and timing of their children, the toll of maternal mortality lessens. Parents can better ensure their families' well-being and invest in health and education. The demographic transition that results allows and in fact promotes sustained economic growth. Ethiopia has its sights set on becoming a middle-income country in about a decade and we know that family planning is critical to getting there.
In November, we will proudly host the third International Conference on Family Planning (ICFP) in the capital city of Africa, Addis Ababa. Thousands of policymakers, advocates and family planning experts will join us to collectively strategize how we can continue pushing forward toward full access and full choice.
This meeting takes place just over a year after the landmark London Summit on Family Planning, where Ethiopia and other countries pledged to their citizens and the international community to take meaningful action to expand voluntary family planning access. We are more committed to meeting these goals than ever. As we prepare to host ICFP, our focus in addressing unmet need revolves around three challenges.
First, childbearing among very young women remains a major cause of maternal deaths in our country. It is difficult for adolescents to access reproductive health services because of limited opportunity for youth-friendly services, and the fact that most available services are not well-tailored to the particular needs of young people. Problems related to the skills and attitudes of service providers are also limit the use of reproductive health services by adolescents. We are focusing specifically on reaching girls aged 15 to 19 with family planning information and services by addressing these challenges.
Second, those who seek contraceptives at times find them out of stock at local clinics. We are strengthening delivery systems to ensure that the contraceptive methods people want are available when and where they want them.
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Finally, we are working to fill a 50% gap in domestic funding for family planning commodities as we aim to take fiscal responsibility for contraceptive access in our country.
These are not easy challenges that will be solved readily. There is no "one-size-fits-all" approach to addressing unmet need, but a solution is possible. To be successful, we must take bold action, and never shy away. We will do so because it's a cause worth fighting for.
We look forward to meeting with our fellow advocates from around the world in Addis Ababa in November, where we will again embrace the opportunity to transform the lives of millions of women and men by ensuring universal access to family planning. When people are able to plan their families, we will have societies where health systems are stronger, economies more productive, and rights more realized.
Dr Kesetebirhan Admasu is the minister of health in Ethiopia.
