The Birth Control Trust of The Galton Institute

The generous donation from the Galton Institute has greatly contributed to the first year of this project: To increase access to quality reproductive health and family planning services to low income working women in the town of Bahir Dar. This support has contributed to Marie Stopes International (MSI) and Partner, Marie Stopes International Ethiopia’s (MSIE) ability to make sustained improvements in the health of the Ethiopian population by combining the provision of services through and outreach services with a comprehensive information education and communication (IEC) component.

Ethiopia's population size and growth rate are among the highest in Africa. The population is estimated at more than 67.7 million, making it the second most populous Sub-Saharan African country after Nigeria. With an annual growth rate estimated at 2.9%, Ethiopia's population will approach 110 million before 2020. Nearly 2 million people are added to the country's population each year. This rapid population growth is the result of continuing high fertility and is a fundamental constraint to sustainable development in Ethiopia.

Approximately 44% of Ethiopia's largely rural population is under the age of 15. Contraceptive prevalence is very low – only 8% of women of reproductive age use any method of family planning – although studies indicate that half of Ethiopian women would like to prevent or delay pregnancy. However, cultural and social norms encourage childbearing and large families. In addition, reproductive health services are not widely accessible to the population. When available, the quality of services, including availability of contraceptive supplies, is very inadequate. One tragic consequence of limited contraceptive supplies has been a high abortion rate, among the highest in Sub-Saharan Africa despite it being illegal, which in turn has contributed to high rates of maternal mortality. Collectively Ethiopia has among the highest fertility, infant mortality, and maternal death rates in the world.

Purpose: To increase access to quality reproductive health and family planning services to low income working women in the town of Bahir Dar.

Improved access to quality reproductive health and family planning services provided by a skilled team in the Bahir Dar centre. It is estimated that the project provide 14,826 individuals with services in 2003 of which 7,248 will be family planning clients generating 8,458 couple years of protection (CYP). CYP is the internationally recognised form of measurement for family planning. One CYP is the amount of contraceptive required to protect a couple from unwanted pregnancy for one year.

The project is located in Bahir Dar in the North West of Ethiopia. Bahir Dar is the seventh largest city in Ethiopia. Bahir Dar’s population is estimated at 131,000 rising from 96,000 in 1994 and 54,000 in 1984. This is equates to the city’s population doubling in less than 20 years.

The main project beneficiaries are women of reproductive age and their families in the four project areas specifically;

The project beneficiaries are women, men and young people of low income.

The centre provides a full range of reproductive health services (please see below) and from May 2003 – April 2004 14,410 individuals visited the centre for services. Of these 6,309 sought family planning services and of these 3,196 were new family planning clients meaning that it was the first time they had ever used modern methods to control their fertility. In total in the reporting period 7,120 couple years of protection were generated. Although these results were slightly less than anticipated for the year they still represent an increase of 5% on the previous year’s results.

Ensuring an individual has access to accurate and sensitive information regarding family planning and reproductive health services is key to increasing the uptake of services. The MSIE team have developed targeted IEC programmes designed and implemented in collaboration with the local community to ensure that messages are appropriate and meet the specific needs of the target group. The aim of these programmes is to raise awareness of family planning, reproductive health and general health care issues, and to promote the uptake of service.

Promotional activities were undertaken by 10 centre team members, 15 peer group leaders in 3 schools, 6 peer group leaders at 3 work places and 6 community based distribution agents operating in 7 Kebels (local administration units). The intervention enabled the target groups to make informed decisions about family planning and reproductive health. The recruitment of an information education and communication programme officer at the head office level has also helped to streamline the service and to provide the necessary support.

The Bahir Dar centre operates a principle of cost-recovery, in line with MSI and MSIE’s operating philosophy. Clients pay locally determined and affordable fees for services, to contribute towards the cost of service provision, in order to enable the centre to become financially self-sustaining. However, no client is turned away on the basis of ability to pay, and services are provided at a subsidised rate or free of charge where appropriate. During the reporting period Bahir Dar has increased its income to cost from 55% to 65%, which is extremely encouraging.

The grant from the Galton Institute has been invaluable in ensuring that women, men and young people in Ethiopia have access to essential, life saving reproductive and family planning information and services.

Ensuring women men and young people have knowledge of, and access to, quality family planning services is not only key to improving their health but central to alleviating poverty. The ability to control one's fertility is one of the key conditions enabling women to pursue educational and economic opportunities, protect themselves from contracting STIs including HIV/AIDS and improve their own and their children’s health, thereby reducing maternal and infant/child mortality rates.

There are very few areas in the world that require these services more than Ethiopia. Access to family planning and reproductive health services are among the lowest in the world contributing to a high fertility rate and a devastatingly high level of maternal and infant mortality. Thanks to your support MSI and MSIE will continue to strive to meet this need for quality RH information and services.