Joining the Conversation

I have just returned from a week-long trip to Ethiopia, where I traveled with a group of incredible women to learn more about the reproductive health options available for women and their families throughout the country. Our week was filled with visits to local health centers and rural hospitals, and we even had an opportunity to meet with the Minister of Health. Out of the many things we experienced, one particular day stood out most for me: In a remote agrarian village in Amhara, a community dialogue among 30 local women left a big impression on me. The sights, sounds, and lessons from that day have been on my mind ever since.

I remember distinctly how on my way to join the discussion, I walked down a rocky dirt path and approached the group who had already assembled. The women I met rose in unison and welcomed me with a swell of festive drums and lively dancing. As we sat down together, the greeting continued with a traditional Ethiopian coffee ceremony, complete with steaming hot cups of rich coffee, Dabo (bread baked over firewood), sweet popcorn and savory incense. And then the conversation began. Led by Fantu, a community health extension worker -- a young woman certified by the government, and trained by EngenderHealth to facilitate the conversation -- the group shared stories about their own family planning experiences and choices. Women of all ages discussed the great lengths they would go to ensure that more women in their community understood the benefits of family planning. Chief among them, the women described how family planning provided an opportunity for them to earn an income and helped them send their children to school.

I couldn't help but wonder why this discussion worked so well. What was it that made everyone feel comfortable enough to speak candidly about very personal decisions? The answer was actually right in front of us: The discussion flowed freely as a result of the relationship between the women and Fantu, their health extension worker. And the strong connection between them meant that trust ran deep, ideas were exchanged openly, and more women and their families were able to make informed decisions about family planning.

Today, a majority of the 84 million people in Ethiopia live in rural areas like the village I visited in Amhara, and they have limited access to reproductive health care. But that is changing. Since the introduction of the Community Health Extension Workers Program 10 years ago, the Ethiopian government has trained and deployed 38,000 salaried health extension workers -- including the woman who led our group discussion -- to help improve maternal and child health and expand access to family planning. The reasons for the program's success are simple: All health extension workers are educated, and all are equipped with the requisite training and tools to actively involve their communities in making informed reproductive health decisions.

Two health extension workers per village live in the communities they serve, and as a result, they understand firsthand the challenges that rural women face. Health extension workers knock on each door to educate families and promote dialogue among women, men, and communities. They provide basic preventive health care that was once traditionally provided by physicians, including providing vaccinations and offering basic family planning services.

The health extension workers who participate in EngenderHealth-led training are equipped with the tools they need to engage communities in ongoing dialogue about making informed reproductive health decisions. The community dialogue approach was designed to catalyze discussion in peer groups and among couples. The underlying idea is simple: When more women are educated about their options, and when they discuss reproductive health with their partners, they are more likely to go to a clinic or health center to access prenatal services and to use family planning methods.

Since the health extension workers program began, the contraceptive prevalence rate in Ethiopia has increased five-fold. In the last two years, the Ethiopian government has also built a health development army of 3 million volunteers, composed of community members who work alongside health extension workers to educate their peers and help people lead healthier lives.

At the close of the community conversation I joined, we listened as women described how the regular dialogue has impacted their lives, noting, "even though we are not educated, the program gave us the opportunity to ensure that our children get an education." Through engagement, education, and outreach, the power of family planning is in the hands of people who need it most, demonstrating the kind of commitment at every level -- from government to community leaders -- that sets the country apart and places Ethiopia at the forefront of change in Africa.