Over 1,100 women in Amhara, Ethiopia worked together to improve their sexual and reproductive health. This is thanks to the pilot of community health groups focussed on these issues, run in partnership with MSI Reproductive Choices.
1 in 5 Ethiopian women are unable to get access to the contraception they need. Good sexual and reproductive health saves lives by reducing unsafe abortions and deliveries. It helps women meet their potential, and builds stronger, healthier, wealthier communities.
Through community-led action, supported by expert family planning promoters working for MSI health clinics, women worked together to break down barriers around knowledge, attitudes, finance, and access to services.
The groups collectively talk through their biggest issues and problems, and work together to find the appropriate solution to mitigate or overcome them.
Women are finding them to be a safe space to talk about issues and openly share stories and concerns. Members and leaders of the community were interviewed over the groups’ feasibility and the difference they made.
Gaining crucial knowledge
Adult women became more knowledgeable on family planning. This includes the ability to name different contraceptives, how long they are effective for, and their common side effects.
Misconceptions around family planning causing infertility were addressed. This was crucial. It meant services were used widely, not just among families who no longer wanted more children.
More newlywed couples are now visiting family planning clinics to postpone their first pregnancy. One woman reveals, "I freely discuss family planning with my husband. We have been married for two years. But we don’t want to have a child right now, so I'm using contraception."
The groups also discussed HIV and other sexually transmitted diseases.
Improving community support
Women said the groups improved community communication and interaction. Members have been helping each other to access family planning information and services.
When a woman from a group faced unwanted pregnancy, her group supported her financially and emotionally to obtain abortion care at a health facility.
Getting buy-in from respected leaders
The project engaged local leaders through workshops to talk through the benefits of family planning services. It encouraged leaders to be champions of family planning. Some started using contraception themselves.
One religious leader says, “There shouldn’t be any barrier to contraception, including religion. Our economy doesn’t allow us to have more children; couples discuss it and decide.”
A community elder adds, “The mother's health will improve, her children will receive better care and love. The father will not be overburdened."
Another community group meet to discuss sexual and reproductive health (Source: MSI Reproductive Choices)
Confronting Gender Based Violence
The groups have given women the opportunity to discuss issues in a safe environment, especially when sexual violence has been used in the recent armed conflict in Tigray.
A religious leader tells of the impact, “There was sexual harassment. It was difficult to support victims. During the war, women were not allowed to meet in health care facilities. Many daily activities and social interactions were stopped.”
The project trained Gender Activists in kebeles (wards) to refer women for support services, as well as to educate their communities on the issue and how it needs to be stopped.
Overcoming Financial Barriers
Some groups created funds which can be used by members to cover health related costs. One group established a small shop selling basic foods. Others started poultry farms, raising chickens and producing eggs. The produce was used by families, helping to reduce malnutrition, which also plays a role in reproductive health.
The leftover produce was sold at the market, raising funds for people to access healthcare they could not otherwise afford. The profit is prioritised for pregnant women and mothers who cannot afford to cover out of pocket medical costs.
Surmounting Access Barriers
A group, which did not have access to ambulance services, approached their village leaders and local taxi drivers for help. They agreed to offer free transport for mothers and babies needing urgent access to health clinics.
Advocating for health services
One group was concerned about the risks of cervical cancer and requested screening from health workers. This grass-roots advocacy played a role in MSI Reproductive Choices introducing this service at their clinic. Since this successful lobbying, 40 women have been referred and 2 have been diagnosed with cervical cancer. They are now getting the treatment and support they need.
Encouraging male involvement
It can be challenging to involve men in family planning, due to societal pressures to have big families, or that it’s only a ‘women’s concern’.
The groups felt it was beneficial for men to join groups and discussions. This benefitted couples and encouraged more women to be able to use services.
As one man said "Discussing is beneficial for the household. If we have a similar understanding, we can make decisions together."
Addressing adolescent participation
Adolescent sexual health is sometimes a taboo, due to prevailing social norms and values. Many interviewed adult participants changed their attitudes through discussions. One woman said, “Those who have a boyfriend should use contraception."
Yet teenage girls themselves still feel they cannot freely use services. While the shift in attitude is encouraging, in future projects more focus needs to be placed on addressing adolescents.
As one young woman said: “If a girl goes to a health facility, people think she went to get abortion. Adolescents fear going due to the stigma and social pressure. I suggest awareness creation activities can solve the problem.”
What’s Next
As well as our work in Ethiopia, Women and Children First will be working in the months ahead in Kenya to set up more community health groups. These will be aimed specifically at teenage girls and young women, to address access to sexual and reproductive health care services.
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Ethiopian women discuss sexual and reproductive health issues (Source: MSI Reproductive Choices)