Ethiopia

OVERVIEW

In Ethiopia, you can purchase birth control without a prescription. While birth control is readily available and rather affordable in cities like Addis Ababa, it is not widely used by women. However, the rate of usage has certainly increased in the past decade, due to government emphasis on family planning. You can access emergency contraception (the morning after pill) without a prescription. There are facilities for STI/STD testing and support, but PrEP is not yet available in Ethiopia. In Addis Ababa, you can find pads and tampons (there appears to be no sellers of menstrual cups). Abortion is legal in certain circumstances and, since 2005, has generally covered many more scenarios. However, underground and unsafe abortions remain very common, and it is the hope of NGOs and many health organizations in Ethiopia that more women can obtain safe abortions in the future instead.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Ethiopia, you can purchase birth control without a prescription. While many contraceptive options are available to Ethiopian women, and some are entirely free, the rate of usage is not supremely high. It is estimated that about 36% of Ethiopian women (of reproductive age) use some form of contraception. The most popular methods are injectables (25.1%), implants (7.6%), pills (4.2%) and other traditional methods (3.2%). When young women (ages 15-24) engage in unprotected or "high-risk" sex, about 17% use condoms.

This can be partially attributed to the fact that many Ethiopian women live in rural areas, where the nearest access to a health center can be a full day's walk. Furthermore, religion plays a critical role in Ethiopian society, with the most predominant religions being Ethiopian Orthodoxy (43.5%), Islam (33.9%) and Pentay Protestantism (20.6%). The Ethiopian Orthodox Church prohibits any form of contraception, while women of many religious backgrounds feel social, cultural and religious pressure to avoid contraception. This means that, even for urban women, where they may have health care facilities in their own neighborhoods, they may not seek out contraceptive methods. Some women may even choose to have secret occasional abortions rather than engage in a regular contraceptive plan.

However, the Ethiopian government has worked to improve family planning options. As reported by Buzzfeed, "The push has been part of Ethiopia’s efforts to achieve the eight UN Millennium Development Goals — two of which include reducing child and maternal mortality — by 2015. In exchange, groups like the World Bank have agreed to cancel Ethiopia’s debt." From 2008-2011, the rate of hormonal contraceptive use for married women jumped from 8% to 29%. The government built 3500 health centers, many of them in rural areas, which staff midwives.

You can check out this photojournalism essay about family planning in Ethiopia from 2014.

What to Get & Where to Get It

If you need basic consultation on birth control and your options, here are some resources:

• You can visit Henry van Ameringen Health and Community Development Center in Shola Market of Addis Ababa for services related to reproductive health and family planning, including contraception, in partnership with DKT Ethiopia.
• Marie Stopes Ethiopia: "The services we provide across Ethiopia include general medical consultation, short, long-acting and permanent methods of contraception, family planning counselling, pre- and post-natal care, child health checks, free condom provision, voluntary testing and counselling on HIV, and STI screening and treatment." Call: 8044 (toll free on certain networks). You can contact them on Facebook: click here. info@mariestopes.org.et.

Here are some of your options for contraception in Addis Ababa:

• You can get male and female condoms at pharmacies. For a 3-pack of Sensation condoms, you can expect to pay 3 Ethiopian birr. There are also many free or low-cost places to obtain condoms in Ethiopia, which are geared toward Ethiopian nationals.
• You can get birth control pills at pharmacies and you don't need a prescription. If you want the combined pill (estrogen-progestin), you can ask for " “Estrogen/ progestin pill ifeligallehu” (Amharic) or "“Estrogen/ progestin pill ideli iye” (Tigrigna), which both mean "I want the estrogen-progestin pill." The pills are typically sold in 3-month supplies. Some brands you may see are Microlut, Microval, Eugynon, Neogynon, Ovidon, Lo-Femenal, Microgynon-30 and Nordette. For a 3-month supply of pills, you can expect to 20 to 30 birr. If you're an Ethiopian national, you can probably get birth control pills for free.
• You can get the implant (Impanon) in Ethiopia at health centers. You'll be asked to consult with a nurse first. If you're an Ethiopian national, you can probably get the implant for free.
• You can get an IUD in Ethiopia at health centers. You'll be asked to consult with a nurse first. The IUD has to be implanted by a Maternal and Child Health nurse. If you're an Ethiopian national, you can probably get the IUD for free.

Costs

If you're an Ethiopian national, you can get birth control (condoms, birth control pills, shots, the IUD, etc) for free. If you're not an Ethiopian national, you will need to pay standard market prices, based on the rates set by the pharmacy, clinic or hospital.

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Ethiopia, you can purchase emergency contraception (the morning after pill) over-the-counter at pharmacies. No prescription is needed.

What to Get & Where to Get It

• You can obtain dedicated emergency contraception in Ethiopia at pharmacies or health clinics. Some brands you can expect to see are Postinor 2 and Postpill (take 2 pills within 120 hours after unprotected sex). Take the pills as soon as possible to prevent pregnancy.
• You can have an IUD inserted to prevent pregnancy. Please refer to the "Contraception" section for details.
• If you can't access dedicated emergency contraception, you can use regular oral contraceptives (birth control pills) as emergency contraception. For progestin-only pills, you can take Microlut or Microval (take 50 pills within 120 hours after unprotected sex). For combined (progestin-estrogen) pills, you'll need to remember that, in 28-day packs, only the first 21 pills can be used. You can take Eugynon, Neogynon or Ovidon (take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later). You can also take Lo-Femenal, Microgynon-30 or Nordette (take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

There are no travel or residency restrictions related to HIV or STI status. You can enter the country as a tourist or live in the country as a resident, no matter your HIV status. You can also import antiretroviral medication for personal use.

Public knowledge of STI prevention methods can be improved. According to a 2014 study, "Two-thirds of Ethiopian women aged 15–24 are aware that condom use and having one uninfected partner reduces the risk of HIV infection (62% and 68%, respectively), but only 24% have a comprehensive knowledge of HIV/AIDS, defined as knowing both of these HIV-prevention methods, knowing that a healthy personal can be HIV positive and being able to reject two common misconceptions about HIV transmission."

What to Get & Where to Get It

Testing Facilities

• Henry van Ameringen Health and Community Development Center: Services include: Full laboratory including HIV, STI, and TB counseling and testing, CD4 monitoring, hematology, chemistry and microscopy services. "The Henry van Ameringen Health and Community Development Center, located in the Shola Market in Addis Ababa, was the first location established upon ASC’s return to Ethiopia in September 2003. Located in the largest open-air market in Addis, this clinic provides free services to over 6,000 of the most vulnerable people in this community, each year."
• Bethzatha Medical Center: Provides Confidential HIV Antibody Testing, Counseling, HIV Antibody Testing, Hospital Services, Laboratory Services, STD Testing, STD Treatment, TB Prevention & TB Testing. "Mission: Provide quality and efficient health service to Ethiopian public Objective: 1-Provide services, 2-Involvement in research, 3-Training Established: 1995"

Support

• Henry van Ameringen Health and Community Development Center: "Services include:Community outreach and HIV prevention education, Antiretroviral treatment, TB and STI treatment, and treatment to prevent opportunistic infections, Treatment adherence support & Pediatric HIV/AIDS case management.

Medications & Vaccines

What to Get & Where to Get It

• Ethiopia has an HPV vaccination pilot program in place (as of 2016).
• There appears to be no Pre-exposure prophylaxis, or PrEP, available in Ethiopia.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

In Addis Ababa, you can find pads in most grocery stores. Outside of Addis Ababa (and especially in rural areas), it's much more difficult to find menstrual products. There appears to be no official sellers of menstrual cup brands, like DivaCup, MoonCup, Lunette and LadyCup, in Ethiopia, so those brands should be purchased online.

Gynecological Exams

What to Get & Where to Get It

For local recommendations, visit the city pages, like the [[Addis Ababa}} page.

Pregnancy

What to Get & Where to Get It

For local recommendations, visit the city pages, like the [[Addis Ababa}} page.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

Since 2005, abortion in Ethiopia has been permitted under certain circumstances, which include: if the pregnancy endangers the life of the woman, if pregnancy is the result of rape or incest, if there is risk of fetal defect, or if the pregnant woman cannot take care of the child due to her age (i.e. under 18 years old) or due to mental infirmity. Abortion is also decriminalized, meaning that women who seek out abortions or health care personnel who provide abortions will not be punished. This is a huge update from previous laws, which only allowed abortion if the woman's life or health was endangered by the pregnancy.

Generally, about half of the medical facilities in Ethiopia provide abortion. The breakdown in 2010 was as follows: public hospitals (76% provide abortion services), nongovernmental organizations/NGOs (63% provide abortion services) and public health centers (41% provide abortion services). By the second trimester, however, only 9-10% of facilities provide abortion services. Overall, private and NGO facilities provided the most actual induced abortion procedures per year.

Unfortunately, many Ethiopian women still continue to receive obtain unsafe abortions. In 2008, only 27% of abortions were safe abortions performed in medical facilities. It's very common for Ethiopian women to have unintended pregnancies, with 42% of all pregnancies unintended in 2008. According to a 2010 study, 49 per 1000 women had received abortions in Addis Ababa, and 184 out of 1000 women had received abortions in smaller rural regions. While the abortion rate is not especially high in Ethiopia, many women have received more than one abortion, with 35% of women obtaining induced abortion care and 27% of women obtaining post-abortion care reporting that they had received a previous abortion. This can be partially attributed to the low rate of contraceptive use, and the fact that conservative religious and cultural views may sway some women away from contraception. Considering the high maternal mortality rate in Ethiopia and the fact that these clandestine abortion services are certainly not all safe and equipped to provide services for women, it is critical that more women are directed to safe and legitimate abortion services in the years to come.

For more information on abortion in Ethiopia, check out this fact sheet.

What to Get & Where to Get It

• Marie Stopes International - Ethiopia: They can direct you to the appropriate clinic and services. They will also be able to consult you and help you find the information you need. "We provide comprehensive sexual and reproductive health services through a network of centres. These facilities provide a wide range of services including: general medical consultation, comprehensive family planning; pre- and post-natal care; child health checks; free condom provision; voluntary testing and counseling on HIV; and STI screening and treatment." Address: Marie Stopes International Ethiopia, P.O. BOX 5775, Addis Ababa, Ethiopia

List of Additional Resources

• Ethiopian Society of Obstetricians and Gynecologists: Address: PO Box 8731, Addis Ababa. Ethiopia. Tel: +251 11 5506068/69. Fax: +251 11 5506070. E-mail: esog-eth@gmail.com.
• Ethiopian Public Health Association: "The Ethiopian Public Health Association (EPHA) is a health professionals association established in 1991 G.C. that envisions the attainment of an optimal standard of health for the people of Ethiopia. It promotes better health services to the public and high professional standards through advocacy, professional competence, relevant policies, and effective networking."
• Ethiopian Ministry of Health: The official website of the Ministry of Health.
• Tigray Trek 242: "Tigray Trek 242 is 242 kilometer run through the Tigray region of Ethiopia designed to be an attention-getting way of raising awareness of HIV and teaching dynamic and interactive approaches to HIV prevention to over 1000 Tigrawa people by Peace Corps Ethiopia volunteers and their community counterparts."