Home to over 79 million people, Ethiopia is Sub-Saharan Africa’s second most populous country. It is a young nation: 43% of its population is below the age of 15. It also is a place where marriage comes early: the median age at marriage is 18, and in some regions of the country half are married by age 15.

Girls who are married are expected to bear children as soon as possible, contributing to the epidemic of pregnancy complications in Ethiopia, where rates of maternal mortality and morbidity are among the world’s worst. At the same time, the number of HIV infections is high and in Ethiopia women represent the majority of the 980,000 people with HIV.

Since 1987, EngenderHealth has played a critical role in improving sexual and reproductive health care services in Ethiopia. With over 20 years of experience collaborating with the government and local partners, EngenderHealth currently reaches more than 150 sites in the regions of: Addis Ababa, Afar, Amhara, Bene Shangul Gumuz, Dire Dawa, Gambella, Harrari, Oromiya, and the Southern Nations, Nationalities, and People's Region (SNNPR), and our programs are expanding. We are:

• Providing HIV and AIDS services for at-risk populations
• Improving the quality of and access to reproductive health care
• Challenging traditional gender norms
• Expanding contraceptive choice
• Addressing the needs of young people, including girls at risk of early marriage and those already married
• Promoting an integrated approach to population, health, and the environment

Providing HIV and AIDS Services for At-Risk Populations
EngenderHealth reaches the most at-risk groups, including adults and young people engaged in transactional sex, with HIV information and prevention services in 42 major urban centers throughout the country. The project increases their access to voluntary testing and counseling, prevention methods like condoms, as well as care and treatment. EngenderHealth aims to improve the capacity of local groups to sustain HIV prevention programs for those engaged in transactional sex and others most-at risk of infection.

Improving the Quality of and Access to Reproductive Health Care
In partnership with government offices, such as the Addis Ababa Regional Health Bureau, and nongovernmental partners, EngenderHealth continues to advance its mission to make quality reproductive health care available to all Ethiopians. Efforts include:

• Upgrading health care providers’ clinical skills through training courses
• Dispatching mobile family planning clinics to reach clients in underserved areas of Amhara and Oromiya
• Initiating continuous quality improvement monitoring and follow-up systems
• Developing guidelines on infection prevention at health clinics
• Training staff to use EngenderHealth’s COPE® methodology, which enables health care workers to identify problems, find the root causes, and develop effective solutions for improving their clinical services.

 
Expanding Contraceptive Choice
A shortage of skilled and trained providers, inadequate commodities and supplies, and lack of accurate information about methods have hindered men’s and women’s access to modern contraception and other reproductive health services in Ethiopia. Through ABRI (Access to Better Reproductive Health Initiative), EngenderHealth aims to:

• Enhance comprehensive abortion care services
• Improve health care professionals’ knowledge and skills in providing quality sterilization
• Spread the word about long-acting contraceptives such as hormonal implants and intrauterine devices (IUDs) and permanent methods (tubal ligation and vasectomy) and eliminate rumors and misinformation
• Ensure that supplies and equipment are available
• Advocate for more attention to reproductive health among policymakers 

 
Challenging Traditional Gender Norms
Through an initiative funded by the President’s Emergency Plan for AIDS Relief (PEPFAR), EngenderHealth addresses gender norms and related behaviors that contribute to the spread of HIV. Collaborating with Ethiopia’s Ministry of Health and other organizations, EngenderHealth helped establish a Men Engage Network to get men more involved in reproductive health. The network will develop a national strategy and guidelines on male involvement. Other activities include:

• Conducting a study on HIV prevention for high-risk youth in Addis Ababa
• Assisting local groups to address male gender norms and HIV
• Providing ongoing mentoring and support to local partners

 
Addressing the Needs of Young People
EngenderHealth’s program in Ethiopia focuses on reaching adolescents, particularly young married girls. Activities are designed to reduce the medical and social barriers that young people face when trying to access sexual and reproductive health services. Additionally, EngenderHealth employs strategies to delay marriage and childbearing, promote gender equity, and improve the status of girls and young women. The program works with young people, ages 10—14, engages their parents and communities, and builds their skills to protect their health and livelihoods.

 
Promoting an Integrated Approach to Population, Health, and the Environment
Recognizing that Ethiopia’s growing population strains its natural resources and economy and limits opportunities for its citizens, EngenderHealth is taking a leading role in addressing population, health, and environmental concerns. Bringing all sectors together to work on issues such as poverty reduction, food security, and gender equity, EngenderHealth provides assistance to the Consortium for the Integration of Population, Health and Environment and works with a local association, the Movement for Ecological Learning and Community Action, which is working to preserve the bio-diversity in Dinsho Woreda, Bale. These activities are funded by the Packard Foundation.