Overcoming Barriers in Ethiopia

In remote regions of Ethiopia, women and families can face extreme difficulties when trying to access health care. I saw this firsthand. A few months ago, some colleagues and I travelled to rural communities in the Oromia and Amhara districts to document Pathfinder's programmatic work. There, I met health extension workers (HEW)*—amazing women who, as part of the Integrated Family Health Program (IFHP), provide a range of preventative health care to their neighboring families.

The health post I am visiting today is a simple cinder block building with three small rooms. Aminaa and her fellow HEW, Jamila, show us the private examination room, the secure storage area for medicines and supplies. Together, they point to the walls in the counseling area, which are covered with colorful health education posters and charts tracking the health data of the community. The rooms are very clean and welcoming. They have large windows, through which the light flows inside.

Aminaa spoke with us first. "I was born and raised here. I completed my secondary education, but when I took the national exam seven years ago, I did not pass. I was looking for a job and heard about the 'health extension training' course and decided to enroll. I completed the one year training and was posted to a very remote location. I worked there as an HEW for three years before being transferred here nearly four years ago.

"When I first came here, the concept of preventative care was difficult. People only understood 'getting medicines,' but did not understand that there were things they could do to stay healthier. We would try to teach people new things, but at first they were not very open. Now, it is much better. Before, people had no idea about vaccines, sanitation, maternal and child health, and family planning, but we began to work with them—to educate them— and now it is so different. I counsel all women between the ages of 15-49 on family planning."

"I see the women are happier and so are the men. The women have more time for themselves to take care of their families and to earn an income. She becomes empowered economically, which helps the family to have school for their children or buy medicines for them if they become ill."

Women in Aminaa's community never knew they had family planning options.

"Now," Aminaa says, "I see mothers spacing their pregnancies. To help them understand, I compare them to being a farmer who tills the land one year and leaves it fallow the next to make sure that the ground is more fertile and will grow better crops. Women can give their husbands more attention and then the love blossoms within the household. This is a big change for the husbands as well. When I go to their homes and talk about family planning, they participate. In some cases the wife will refuse contraception because she is afraid of the side effects. The husband will come to me and ask me to convince his wife to use a method."

Aminaa tells us how much more she is able to offer the people in the community now.

"I learned how to insert Implanon [a long-acting method of contraception] under supervision from the Health Center Director. She worked with me for a year and four months. For the past six months, I have been inserting it on my own. The greatest advantage to the implants is the length of time that they provide women with contraception."

A young woman arrives for family planning and agrees to let us stay and record her visit. Aminaa appears confident while interacting with the woman. She talks with her for a while, making her comfortable, and explains each of the methods of contraception available at the health post. The client asks a number of questions and then she decides that she wants to have Implanon inserted. She already has several children and does not want any more right now.

As I watch Aminaa provide services—explain how each contraceptive works, check her client's blood pressure and weight—I think back to the beginning of my own career when I worked as a counselor for Planned Parenthood.

I recall those exchanges with clients, when I felt so excited to be able to help women make a choice about contraception.

I see that same satisfaction in Aminaa's face.

I am also acutely aware of some of the differences between my experience and what I see here. The women in this community have had to overcome so many obstacles to make it here, to be receiving these services. They may not have even known about contraception before they became sexually active. The hour and a half they may have to walk each way to come to the health post may mean, should they miss a visit, they may face an unintended pregnancy. Or, they might make the journey and discover that the health post is out of the contraceptive they are using—something that never happened for the women I saw at Planned Parenthood.

Aminaa tells us, "In the beginning, there was a problem of running out of contraceptives at the Health Post. Since IFHP has been here, we now have a reliable supply of contraceptives for our clients. More than 300 women are using the implants."

It is clear that Aminaa is very proud to be serving her community and helping so many women and their families with improved health. I feel honored to be part of it, too.


*Having trained for her position for over a year, an HEW is ready to join her team at a community health post. Usually two-person teams, HEWS have a unique, effective system: one stays at the health post, while the other makes house- to- house visits, walking from one end of her village to the other.

Linda Suttenfield

Linda Suttenfield

Linda Suttenfield is Pathfinder International's Director of Communications.

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