Mainstreaming EC in Ethiopia’s Public Sector: Project Results and Implications for Scale-up

Abstract

Abstract
Background: Building on nearly a decade of momentum, the Federal Ministry of Health (FMOH), the Ethiopian Society of
Obstetricians and Gynecologists (ESOG) and Population Council (EC Afrique) launched a two-year project in 2004 to mainstream
emergency contraception (EC) in the public sector.
Objective: The project aimed at improving reproductive health (RH) care among young women and to reduce the abortion rate by
expanding access to EC in the country. Its overall goal was to demonstrate the feasibility of integrating EC within the public sector’s
broader contraceptive mix.
Methods: The project undertook a set of activities aimed at improving provider competency, increasing public demand and ensuring
commodity security. The final evaluation drew on service statistics from 33 intervention sites, and knowledge, attitude and
practice surveys conducted with family planning service providers and clients in the health facilities involved in the project.
Results: EC users were primarily unmarried women between the ages of 20-24, although male partners were increasingly involved
in EC decision-making and procurement. This runs counter to predominant perceptions of EC users as adolescent girls. Sexual
assault was the least commonly cited reason for EC use, reflecting its current position as primarily a family planning method. Television
advertisements and clinic-based health education were the most commonly sited forms of communication on EC, while print
media reached the fewest respondents. Both clients and providers believe that pharmacy provision of EC is socially acceptable, and
agree that one Birr is the optimal price for sale in the private sector.
Conclusion: Scaling up EC mainstreaming activities in Ethiopia will effectively position EC as a core component in the national
family planning program and post-rape care services. Furthermore, there is need to strengthen the capacity of providers so as to
encourage EC users to seek HIV/STI counseling and testing services. To ensure that EC serves as a gateway to more comprehensive
RH care, it is critical to stress “bridging” as a key element of the services.
Keywords: Emergency contraception, family planning, adolescents, levenorgestrel