It's Not About Choice; It's About Choices

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What if your best option for contraception was off limits, simple because of your age? This is the reality for many young people who want to use contraceptive implants. But it doesn't have to be this way.

Birhan Gebre, a young woman from the city of Adigrat, Ethiopia, grew up one of six children. When she was married at eighteen, Birhan and her husband agreed to wait a while before having kids of their own.

"But pills had some side effects on me," says Birhan, who is now twenty. She remembers the monthly trips to the health center being a real expense, costing her family time and money. There had to be a better option.

One in three women in Ethiopia have had their first child by the time they are 18 years old. But when Birhan was married at 18, she decided to wait.

"I heard about long-acting methods on television," Birhan remembers. Then, with the help of the Integrated Family Health Program, led by Pathfinder, she received knowledge and counseling on a variety of contraceptive methods. "We received education at the health center and in the kebele (community) during women's meetings."

In Ethiopia, only five percent of young women (ages 15-19) report using a contraceptive of any type. One in three women have had their first child by the time they are 18 years old. But Birhan and her peers learned they don't have to become statistics. They have options.

Implants and Adolescents, a Good Match?

Young people face particular obstacles that make them less likely to use short-acting methods, such as pills or condoms, consistently, or to use contraception at all. These include a lack of information on how to use contraception effectively, unpredictable sexual activity among those that are unmarried, and community norms that don't support adolescents' use of contraception.

Given these factors, implants are particularly suitable for many young people who want to delay pregnancy for a couple of years, or space their next birth. After a small contraceptive rod is inserted under the skin of a young woman's arm, the implant lasts for 3-5 years. It does not interfere with sex, and no daily action is required.

So What's the Problem?

Restrictive policies, misconceptions, and stigma—on the part of both providers and the community—often limit young people's access to highly effective long-acting methods. Here's where Pathfinder comes in.

"Before the training, we wrongly assumed that this type of contraceptive was relevant only for older women and those who have started giving birth," says Genet Desta, a clinical nurse at Adigrat Health Center.

Since 2009, Pathfinder has supported the Ethiopian Ministry of Health by training clinical care providers in long-acting contraception across six regions of Ethiopia. We have trained them to provide quality counseling services—to help dispel common myths about contraception, and long-acting methods in particular, and to deliver information and services adolescents and youth need, free from judgment and bias.

"As I got special training on implants and IUDs," says Genet, "I became aware that long-acting methods are appropriate for adolescent girls. More girls, especially the ones who go to the university, prefer these options. They can avoid the burden of traveling to the health centers again and again. I think the adolescent girls choose this method because they believe it doesn't affect the probability of pregnancy in the future."

Implants are not only effective, they are completely reversible. As soon as the implant is removed, a woman's fertility returns. When Birhan heard this—that she has the ability to get pregnant when she and her husband decide they are ready—she made her choice.

"My husband is very happy, and we have decided together to use this method. Our families even know we use an implant and they are all supportive."

This Is Change

Pathfinder was one of the first organizations to address the unique sexual and reproductive health needs and interests of young people. We have implemented project in more than 30 countries, guided by the core belief that sexual and reproductive health is fundamental for young people to realize their full potential and lead healthy, free, productive lives. Always, this means they must have information on and access to a full range of contraceptive options.

We are not alone in this belief. Women like Genet and Birhan in Ethiopia are sharing their powerful experiences. National governments are taking action. Young people across the world are shaping the sexual and reproductive health programs they want and need. These are our partners, and their words speak for themselves.

"I believe the availability of different types of contraceptive methods is an advantage," Birhan says. "So you can choose the method that is comfortable for you and make your own decision."

Read more about how Pathfinder is changing the family planning landscape in Ethiopia through our Integrated Family Health Program.

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