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Diplomacy in Action

Ethiopia's Investments in Family Planning


Remarks
Anne C. Richard
Assistant Secretary, Bureau of Population, Refugees, and Migration
Center for Strategic and International Studies
Washington, DC
April 23, 2014

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Let me start by thanking you for organizing this event.

And thank you for preparing this video. It is inspiring to see how enlightened family planning policies can transform the lives of women like Mihret who was a child bride and young mother and is now proudly helping others make their own choices about when to bear children.

I would also like to thank CSIS and Janet Fleischman and Alisha Kramer for producing this excellent report. The fact that it grew out of a bipartisan trip is encouraging. So is your astute analysis of what Ethiopia is attempting to do in the area of reproductive health, the strategies that have worked, the obstacles to be overcome, and what donors and governments, including our own can do to help.

And finally I would like to thank many of you in the audience who have dedicated your careers and lives to bringing family planning services to women who desperately need them. As Assistant Secretary, I have had the chance to witness first-hand how important this work is, and what it means to those who benefit from it. This past fall I attended the Third International Family Conference in Addis. On this trip, I toured our implementing partners’ facilities, including projects run by Pathfinder and Marie Stopes International.

I visited the home of a family involved in Pathfinder’s “model families” effort. In this program, families are encouraged to adopt 16 measures to improve the overall health of the household, such as using family planning, vaccinating children, sleeping under mosquito bed nets and building hygienic latrines. These families are then celebrated as “trendsetters” for the community so that others will copy their behavior. I also visited a Marie Stopes “Blue Star” franchise effort where pharmacists receive special training in the use of long-term contraception and sexual and reproductive health services. They then agree to provide high quality longer-term family planning methods like implants and IUDs at affordable prices, and they get to use the Blue Star logo on their clinic or pharmacy. This brings customers to them who end up also using their other services.

Ethiopia’s enlightened health policies and quest for sustainable development are incredibly important – not just for Ethiopia but as an example to other nations grappling with similar problems.

Today, we share the planet with seven billion people. We added a billion in just the past twelve years. And by 2050 there could be nine or even ten billion of us. Virtually all of this growth will occur in developing countries. Birthrates elsewhere have plummeted, but in some of the world’s poorest nations they are rising.

It would be one thing if women were simply choosing to have large families. But we know that many become pregnant as early and as often as they do because they have no means to prevent it. Globally, surveys indicate that hundreds of millions of women want to avoid getting pregnant but have no access to modern methods of contraception. The gap between what is needed and what is available is widest in sub-Saharan Africa, where according to the Guttmacher Institute, 28 percent of married women aged 15 to 49 lack access to modern and effective forms of birth control.

Young girls face the most acute unmet need. Like Mihret in the video we’ve seen, many are expected, even compelled to marry and bear children when they are still in their teens. Every year, more than 60 million girls get married before they turn 19. Throughout the developing world, less than one-third of married adolescents are using modern contraceptives, although many more want to avoid or delay pregnancy. More than two thirds of the married adolescents in sub-Saharan Africa aged 15-19 want modern contraception and do not have it.

And, I find this particularly shocking –around the world two million girls aged 10-14 give birth every year, and over 90% of these girls are married. These marriages and pregnancies can have devastating, life-long consequences. We see them as a form of gender based violence and an abuse of these girls’ human rights.

But adult women who cannot access modern contraceptives or adequate healthcare also can experience life-threatening problems. One in 22 women in sub-Saharan Africa dies during pregnancy or childbirth. That’s compared to roughly one in 6000 in wealthy countries. Babies face heightened risk as well. When mothers have babies spaced closely together, survival rates fall. These are preventable deaths.

In addition to saving lives, sexual and reproductive health and reproductive rights can promote human rights, gender equality and health, economic empowerment and prosperity. Ethiopian government and health officials spoke forcefully and eloquently about this in the video. And we in the U.S. Government could not agree more.

The evidence is overwhelming. Women’s equality, empowerment, and human rights are inexorably tied to their ability to control when they bear children. And empowering women to make these decisions is one of the best ways to fight poverty. Girls who can delay pregnancies can become educated, productive, healthy adults, and raise more educated, productive, healthy children. This virtuous cycle can propel families and whole nations out of poverty. Research has provided compelling, concrete examples of how family planning unleashes economic growth. Falling fertility rates in parts of East Asia and Latin America have raised the share of the population in the workforce, driven up output, and created a so-called “demographic dividend.” A UN study has also documented the opposite: when early pregnancy truncates girls’ educations, it derails their careers, reduces their lifelong earnings and hampers their ability to invest in their children. The researchers estimate that the United States loses one percent of GDP due to adolescent pregnancy. Uganda loses 30 percent. The countries that pay the steepest price for these early pregnancies are the countries that can least afford it.

Finally, I was recently surprised to learn that simply providing family planning services to all women who want them would cut global carbon emissions by between 8 and 15 percent. That is the same reduction we would achieve by stopping all deforestation or by multiplying the world’s use of wind power by forty fold…more proof that voluntary family planning can fuel sustainable development.

Against this backdrop, what Ethiopia is attempting is all the more impressive and urgent. Ethiopia is the second most populous nation in Africa, with a high birthrate and 65 percent of its population is under the age of 30. It faces the same array of challenges that many of its neighbors do: child, early, and forced marriage and maternal mortality are far too prevalent, and the vast majority of the population is rural and poor and hard to reach. Yet Ethiopia has placed family planning at the center of its development agenda, has pioneered an effective health extension program and dedicated funds to pay health extension workers. In fact, I met one of these impressive women during my visit. It is a potent combination. In the past decade years, Ethiopia has quadrupled the use of modern contraception. Today in Ethiopia contraceptive prevalence is 28.6 percent; the government aims to more than double contraceptive prevalence to 66 percent by 2015.

And in a span of five years, Ethiopia has cut the mortality rate for children under five in half. At the same time, it has nearly doubled literacy rates, approached nearly universal primary school enrollment and strengthened education for women and girls.

Together with other these measures intended to spur entrepreneurship and improve fiscal and labor policies Ethiopia has begun to reap its own “demographic dividend.”

How is Ethiopia succeeding in this regard where others have failed? As your report notes, changing attitudes toward contraception has been key. Engaging traditional and religious leaders as allies is good. I commend the government’s willingness to invest real resources, including providing contraceptive services for free. And I also credit the government’s partnerships with organizations such as those represented in the room today. The question is whether these achievements can be replicated. Will other developing countries that face daunting immediate needs make the same critical investments and choices?

We, in the U.S. Government are committed to doing what we can to help. The United States, through the US Agency for International Development, is the largest bilateral provider of family planning assistance, providing approximately $610 million in 2013. As a global leader in support of family planning and sexual and reproductive health for nearly 50 years, the United States government has provided over $3 billion in family planning assistance and support since 2009.

With expert colleagues, the Bureau of Population, Refugees and Migration also works in international fora to highlight the links between family planning services and development. In planning meetings that will shape the post-2015 Development Agenda, the United States is making the case that sexual and reproductive health and reproductive rights are essential to empowering women, eradicating extreme poverty and fostering sustainable development.

During the recent UN Commission on Population and Development (CPD) our Population team led by Margaret Pollack called on delegates to fulfill the commitments made back in Cairo in 1994 under the ICPD Program of Action: namely universal access to quality, comprehensive sexual and reproductive health information, education and services. Governments promised to promote and protect reproductive rights; reduce infant, child, and maternal mortality; and achieve gender equality and the empowerment of women and girls so that all individuals, and all nations, have the opportunity to realize their full potential.

Our delegation pointed out that we are not there yet. We called for an end to the scourge of violence against women and girls and to practices like as child, early and forced marriage and female genital mutilation and cutting, and for integrated, quality sexual and reproductive health services. We stated that these should include maternal health care and access to a broad range of safe and effective modern forms of contraception. We also called for services to prevent and treat sexually transmitted infections, including HIV and AIDS and provide access to safe abortion.

We also drew attention to the special needs of the largest-ever generation of adolescents and youth. The majority of these young people live in developing countries, have limited access to sexual and reproductive health services and crave information. They need it to help them make wise decisions about their health, now and in future.

Another priority for us is the plight of people affected by conflicts and crises. Reproductive health needs do not disappear when people are driven from their communities by conflicts or natural disasters. In fact the can become more acute. Displacement can heighten the need for contraception while raising barriers to access – both for women who cannot care for or protect newborns, and adolescents who may be torn away from family and social support structures and exposed to sexual violence and coercion.

Comprehensive family planning programs should begin as soon as a situation allows. This involves training staff, offering community education, establishing client follow-up, providing a wide range of methods, and maintaining a contraceptive supply chain system. We will continue to actively support the UN Population Fund (UNFPA), the UN High Commissioner for Refugees (UNHCR), and many other development and humanitarian organizations to respond to the challenges of providing predictable access to reproductive health services in crisis settings.

We also recognize that we have more to learn about what it is that women want and need from sexual and reproductive health services. To that end, we applaud Family Planning 2020’s research going beyond numbers and metrics so collectively we can improve our understanding of why some women stop using particular types of birth control. These efforts will help us to better provide the range of modern contraceptive methods individual women want, and empower them to understand, ask for and receive specific products that suit their needs. The objective is to enable an additional 120 million women and adolescent girls in the world’s poorest countries to access and use voluntary family planning information, contraceptives and services by 2020.

In closing, we know that being able to plan one’s family is pivotal. It can spell the difference between life and death, opportunity and helplessness, hope and despair. And, as Ethiopia’s government has recognized, it is one of the best weapons against poverty.

So keep doing what you’re doing. You make the case every day for why it is so important. It’s you and your organizations that are in the field who can tell the most compelling stories of people whose lives have been directly affected by our joint initiatives and programs. These stories remind us of why consistent U.S. government support for sexual and reproductive health and reproductive rights are so vital.

Your continued support and commitment is essential to fighting for a sustainable future – one that empowers children to grow up healthy and pursue their dreams, and help their communities and nations thrive.

Thank you.



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