Case Study Non Birth Control Population Policy Of Ethiopia

Population policies, programmes and the environment

J. Joseph Speidel,1,*Deborah C. Weiss,2Sally A. Ethelston,3 and Sarah M. Gilbert1

1Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 335, PO Box 0744, San Francisco, CA 94143-0744, USA

2Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, USA

3PATH Malaria Vaccine Initiative, 7500 Old Georgetown Road, Suite 1200, Bethesda, MD 20814, USA

*Author for correspondence (ude.fscu.nygbo@jledieps).

Author information ►Copyright and License information ►

Copyright © 2009 The Royal Society

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Human consumption is depleting the Earth's natural resources and impairing the capacity of life-supporting ecosystems. Humans have changed ecosystems more rapidly and extensively over the past 50 years than during any other period, primarily to meet increasing demands for food, fresh water, timber, fibre and fuel. Such consumption, together with world population increasing from 2.6 billion in 1950 to 6.8 billion in 2009, are major contributors to environmental damage. Strengthening family-planning services is crucial to slowing population growth, now 78 million annually, and limiting population size to 9.2 billion by 2050. Otherwise, birth rates could remain unchanged, and world population would grow to 11 billion. Of particular concern are the 80 million annual pregnancies (38% of all pregnancies) that are unintended. More than 200 million women in developing countries prefer to delay their pregnancy, or stop bearing children altogether, but rely on traditional, less-effective methods of contraception or use no method because they lack access or face other barriers to using contraception. Family-planning programmes have a successful track record of reducing unintended pregnancies, thereby slowing population growth. An estimated $15 billion per year is needed for family-planning programmes in developing countries and donors should provide at least $5 billion of the total, however, current donor assistance is less than a quarter of this funding target.

Keywords: population, environment, family planning, natural resources, reproductive health

1. Overview

Population gained acceptance as an environmental issue in the late 1960s and early 1970s, following the publication of Paul Erlich's book The Population Bomb (Ehrlich 1968) and the celebration of the first ‘Earth Day’. Yet, more than 30 years later, population seems to have largely dropped off the environmental movement's agenda, owing at least in part to three factors: (i) uncertainty and controversy around population and reproductive health and rights issues, such as those relating to family planning, abortion and various governmental population policies; (ii) the political dominance of a largely anti-environmental White House and Congress in the USA; and (iii) a shifting of priorities within the US environmental movement in response to immediate threats such as loss of biodiversity and climate change.

Parallel to these developments, activists and foreign-aid donors concerned about population policies and programmes increasingly have focused their attention on reproductive health, especially HIV/AIDS, and on ensuring that family planning and other reproductive health programmes respond to the individual needs of women and men and are fully voluntary (Germain & Kyte 1995). Less attention has been focused on the demographic rationale or consequences of population programmes and, consequently, their environmental implications. Like their environmentalist colleagues, family planning and reproductive health advocates in the USA face determined opposition from social and other ideological conservatives, who try to minimize the significance of continued population growth or to limit the medical options of those seeking to avoid pregnancy and sexually transmitted infections (STIs).

Although preservation of natural systems through reduction of the degradation and consumption of natural resources is urgently needed, this paper seeks to refocus attention on the importance of population trends to environmental sustainability. It identifies prevention of unintended pregnancy as potential common ground for government policy-makers, environmentalists and family planning advocates. The health and other benefits of preventing unintended pregnancy are experienced most directly by individual women, men and their families. At the same time, preventing unwanted pregnancies usually results in smaller family size, an important factor in slowing population growth and, as a result, a source of broader benefits—including those affecting the environment—to society.

2. Population–environment interactions: population growth, consumption and human impact

It is estimated that half of the productivity of the Earth's biosystems has been diverted to human use, with concomitant depletion of our natural resources and impairment of the capacity of life-supporting ecosystems (Ehrlich & Ehrlich 1990; Green 1992; World Resources Institute 1998; United Nations Development Programme, United Nations Environment Programme, World Bank and World Resources Institute 2002; Wilson 2002; Brown 2004; Millennium Ecosystem Assessment 2005). Current size and continuing growth of the world's population adds to this environmental burden and, especially in places where growth is proceeding rapidly, will undermine the prospects for socio-economic development (Kendall 1992; National Academy of Sciences, National Academy of Engineering and Institute of Medicine 1993; Wilson 2002). The United Nations (UN) medium-variant population projection suggests that between 2008 and 2050, the world will have to accommodate 2.3 billion additional people. This growth, along with desperately needed advances in living standards for nearly 3 billion people in poverty will increase pressures on the environment (World Bank 2005; Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2009).

The impact of humans on their environment is related to population size, per capita consumption and the environmental impact of the technology used to produce what is consumed. Although an oversimplification, this relationship has been represented by the ‘IPAT’ equation: ‘I (impact) = P (population) × A (affluence/consumption) × T (technology) (Ehrlich & Holdren 1971). It is an invalid assumption that environmental degradation grows in direct proportion to population size (assuming constant per capita consumption and modes of production). In particular, feedbacks, thresholds and synergies generally amplify risk, causing environmental degradation to grow disproportionally faster than growth in population size (Harte 2007).

Between 1950 and 2000, the world's population more than doubled, from 2.5 billion to 6.1 billion (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2007). At the same time, the gross world product expanded nearly sevenfold, from approximately $7 trillion to $46 trillion of annual output (Assadourian 2003). If per capita consumption were to grow at a modest rate of just 2 per cent annually, it would result in a fourfold increase in per capita consumption by 2075. Combined with a projected 52 per cent increase in population size over the same period (United Nations Department of Economic and Social Affairs Population Division 2004), this level of consumption could require economic production to increase sixfold. To achieve this without further degradation of important ecosystems presents a daunting challenge.

Although it received little attention, the recent UN-sponsored Millennium Ecosystem Assessment, conducted by more than 1300 experts in 95 countries, was an important and comprehensive study of the effects of ecosystem change on human health and well-being (Millennium Ecosystem Assessment 2005). It found that humans have changed ecosystems more rapidly and extensively over the past 50 years than during any other period, primarily to meet increasing demands for food, fresh water, timber, fibre and fuel. For instance, more land was converted to cropland in the 30 years after 1950 than in the 150 years between 1700 and 1850. It also estimated that 60 per cent of ecosystem services—the benefits people obtain from ecosystems—are being degraded or used unsustainably (Millennium Ecosystem Assessment 2005).

Other examples of ongoing environmental degradation include the following.

  1. Forests are dwindling: global forest cover has declined by 50 per cent since pre-agricultural times (United Nations Development Programme, United Nations Environment Programme, World Bank and World Resources Institute 2002). Rising use of forest products for paper, lumber and fuel is accelerating the process. Since the beginning of the twentieth century, 22 per cent of forest cover has been lost (Food and Agriculture Organization of the United Nations 2001), and in the Amazonian rainforest the decline is even steeper with a 20 per cent loss since 1970 (Kingstone 2005; Palermo 2005).

  2. Fisheries are endangered: with more than 2.9 billion people dependent on fish as a source of protein, 80 per cent of global fisheries have been over-fished or fished to their biological limit (Food and Agriculture Organization of the United Nations 2009).

  3. Cropland is shrinking because of soil erosion and desertification, and crop yields are threatened by rising temperatures and inadequate water supply (Brown 2006). Furthermore, between 1950 and 2007, the growth of world population has halved grainland per person from 0.23 ha to 0.10 ha (Brown 2008). Increasing diversion of grains to biodiesel, ethanol, and meat production additionally decreases supplies available for human consumption (Brown 2008).

  4. Water tables are falling as 15 countries containing half of the world's people, a total of 3.26 billion, are over pumping aquifers (Brown 2006). Depletion of aquifers threatens production of grains in the three largest producers—China, India and the USA—placing 175 million Indians and 120 million Chinese at risk of water shortage. Aquifer depletion threatens India with a 25 per cent decline in grain production during the next 50 years, when India's population is projected to increase by some 500 million, or 45 per cent (Worldwatch Institute 1999; Brown 2000, 2008). By 2025, three out of four people will face some degree of water scarcity (United Nations Environment Programme 2006).

  5. Global warming has doubled the percentage of the Earth's land area affected by drought from 15 per cent in 1970 to 30 per cent in 2002 (Brown 2006). The loss of glaciers that supply South America, China, India and many other countries with water threatens irrigation. Global warming has also reduced the snow pack that feeds irrigation and rivers in summer months in Afghanistan, Central Asia, Iran and the western USA (Brown 2008). Past record temperatures may become the norm by 2100, and a 1°C increase in mean temperatures will probably cause a 2.5–16% decline in crop yields, as already occurred in the 2003 European heat wave (Battisti & Naylor 2009). Warming is also slowing ocean circulation, causing more destructive storms, melting Arctic ice and bringing about rising sea levels (Brown 2006, 2008). A 10 m rise in sea level could displace more than 600 million people and flood large areas of cropland (McGranahan et al. 2007).

Brown has described the interaction between life-supporting ecosystems and population growth as follows: ‘as land and water become scarce, competition for these vital resources intensifies within societies, particularly between the wealthy and those who are poor and dispossessed. The shrinkage of life-supporting resources per person that comes with population growth is threatening to drop the living standards of millions of people below the survival level, leading to potentially unmanageable social tensions' (Brown 2008).

Living standards are already abysmally low for the more than 900 million people that the UN Food and Agriculture Organization estimates are chronically hungry. This situation is the worst among children and in Africa, where in 15 countries 35 per cent of the population is chronically hungry. It is estimated that malnutrition causes one in three children in developing countries to suffer physical and/or mental stunting (Black et al. 2008; Food and Agriculture Organization of the United Nations 2008).

The Sahelian region of Africa, which includes Darfur, is both rife with conflicts and has one of the world's fastest growing populations. In the northern Sahel, grassland is turning to desert, forcing herders southward into the farming areas. Declining rainfall and overgrazing are combining to destroy the grasslands (Brown 2008).

The population of sub-Saharan Africa is projected to increase from 809 million in 2008 to 1.7 billion in 2050 (Population Reference Bureau 2008a). Undoubtedly this will further intensify the competition for land, water, and food and increase the potential for conflict, social unrest and failed states.

3. World population growth

(a) Demographic projections

Twentieth century advances in agriculture, public health and transportation, most markedly in the latter half of the century, yielded significant declines in death rates worldwide. Yet in many poor countries, the persistence of high birth rates resulted in rapid population growth. The century began with a world population of 1.6 billion and ended with 6.1 billion (McFalls 2007). World population has now reached 6.8 billion and is still increasing. Almost all current growth—about 1.5 million a week—occurs in developing countries and is most pronounced in Africa, a region projected to double in size, from the current 967 million to 1.93 billion in 2050 (Population Reference Bureau 2008a).

By contrast, with the exception of the USA, the 1.2 billion people living in wealthy developed countries are on the other side of a ‘demographic divide’—are characterized by birth rates so low that population decline and rapid ageing are almost inevitable.

In 1950, the world's population was 2.6 billion, the average number of children per woman over her lifetime (total fertility rate or TFR) was 5.3, and annual population growth was 48 million (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2007). Widespread use of contraception has decreased the world's average TFR to 2.6 in 2008, but because death rates have also declined, about 78 million people are now added to the world's population each year (figure 1) (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2009). Developing countries are projected to account for 98 per cent of world population growth between 2007 and 2050 (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2009).

Figure 1.

Estimated world population growth: 1750–2050 (McDevitt 1999). Black line, total world population; grey bars, population increase during the preceeding decade.

It took only 12 years, from 1987 to 1999, for world population to grow from five billion to six billion (United Nations Department of Economic and Social Affairs Population Division 1999). This is the shortest time ever to add one billion people—almost equivalent to the combined population of Europe and North America (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2007). Although the UN medium-variant projection suggests that the TFR worldwide will decline to 2.02 by 2050, population would still increase to 9.15 billion (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2009). The UN also produces alternative demographic scenarios: the low-variant, with fertility declining rapidly, projects a 2050 population size of 7.96 billion, whereas the high-variant projects a slower decline in fertility and a population of 10.46 billion (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2009).

If current family planning efforts are not strengthened and current levels of fertility were to remain unchanged, then world population is projected to reach 11.0 billion by 2050, rather than the 9.2 billion that is projected in the medium-variant (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2009).

Even if projected declines in fertility occur, the annual number of births worldwide is expected to remain high (McDevitt 1999). Previously high fertility rates have left many poor countries with large numbers of women of reproductive age; their numbers are projected to increase from 1.4 to 1.8 billion between 2005 and 2050 (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2007). As these increasing numbers of women have children, population size will increase even if fertility rates decline, a phenomenon known as population momentum. For example, although China's TFR has fallen below the replacement level of 2.1, the large number of couples of reproductive age has kept the country's population growing by about eight million annually (Population Reference Bureau 2008a).

Although fertility is low in Europe, Japan and a number of developing countries, high fertility persists in much of the developing world, ensuring that rapid population growth will continue. In 2008, TFR among the 4.2 billion people living in less-developed countries outside of China was estimated at 3.2 children, with an annual population growth rate of 1.8 per cent (Population Reference Bureau 2008a). At this rate, the population of these countries would double in just 39 years. Even taking projected declines in fertility in these regions into account, the number of people living in less-developed countries outside China is projected to increase by 60 per cent by 2050, to 6.6 billion (Population Reference Bureau 2008a).

(b) Sources of world population growth

It might be assumed that future population growth will result primarily from the desire for large families in developing countries—but this is not the case. Bongaarts has estimated that most of the projected population increase in developing countries will result from population momentum (49%), followed by unwanted pregnancies (33%), and high desired family size (18%) (Bongaarts 1994, 2009).

The significance of unintended and unwanted pregnancies for population growth can be seen in the high proportion of pregnancies that are unplanned each year: out of 210 million pregnancies worldwide, 80 million (38%) are unplanned, and 42 million (20% of all pregnancies) end in abortion (Alan Guttmacher Institute 1999; Ahman & Shah 2007).

Reducing unintended pregnancy is the factor in continued population growth that is most amenable to programme and policy intervention. Organized family-planning programmes have a 40-year track record of success in helping hundreds of millions of couples choose the number and timing of their pregnancies.

Based on survey research, the Guttmacher Institute estimates that more than 200 million women in developing countries would like to delay their next pregnancy, or stop bearing children altogether, but rely on traditional, less-effective methods of contraception (64 million) or use no method (137 million) because they lack access to family-planning services; mistakenly believe that they are not at risk of getting pregnant because they were not fecund, were breastfeeding, or not having sex frequently; or face other barriers to using contraception (Singh et al. 2003). These barriers include cultural values that support high fertility, opposition to use of contraception by family members and others, fears about health risks or side effects of contraception, and access to only a few contraceptive options (Carr & Khan 2004; Sedgh et al. 2007).

4. US population growth

(a) US demography

The US population size is important because of the country's high level of consumption and because, in contrast to almost all other developed countries, the US is experiencing rapid population growth (Perry & Mackun 2001). Now the world's third largest country, the US is projected to grow from 305 million in 2008 to 356 million in 2025, and to 438 million by 2050 (Population Reference Bureau 2008a). As a result, the US has a disproportionately large environmental impact.

(b) Sources of US population growth

Natural increase (births exceeding deaths) accounts for 58 per cent of population growth in the USA, with 4.15 million births and 2.46 million deaths in 2006; net immigration of 1.2 million people accounts for the remaining 42 per cent of the annual growth of 2.9 million people (Kent & Mather 2002; US Census Bureau 2006).

Unintended pregnancy is a major contributing factor to the relatively high birth rate in the US. Of 6.4 million pregnancies in 2001—the most recent year for which data is available—almost half (3.1 million) were unintended (as were 82% of the 811 000 annual teenage pregnancies). These pregnancies resulted in 1.1 million miscarriages, 1.3 million abortions, and four million births, of which 1.4 million were unintended (Finer & Henshaw 2006). Without these 1.4 million unintended births, the natural increase of the US population would be about 300 000 per year, less than 20 per cent of current natural increase. In other words, unintended pregnancy accounts for roughly half of the current increase of 2.9 million people to the US population each year (US Census Bureau and Population Division 2006).

The contribution of immigration to US population growth is also important. Between 2000 and 2004, 4.3 million immigrants, including an estimated two million undocumented immigrants, arrived in the country (Camarota 2004). Passel estimates that there are 11.5–12 million undocumented immigrants in the US (Passel 2006). There is also an important relationship between immigration and natural increase: nearly one-quarter of babies born in 2002 had a foreign-born mother, an increase from six per cent in 1970 (Camarota 2005).

(c) US environmental trends

The US already has the world's largest ‘environmental footprint’, i.e. the greatest per capita consumption compared with the productivity of US ecosystems and natural resources. A recent study has documented the deleterious synergies between US population growth and the rapidly increasing per capita consumption of resources (Markham & Steinzor 2006). Among the report's findings are the following.

  1. Land-use: US land is converted for development at about twice the rate of population growth. The most predominant form of land use change is ‘sprawl’—low-density development spread into suburban and rural areas, with high vehicle use and new roads, shops and other infrastructures.

  2. Water: Use by Americans is three times the world's average. More than half of the nation's wetlands are gone and more than 40 per cent of the nation's rivers, lakes and estuaries are too polluted for fishing and swimming.

  3. Biodiversity: About 6700 known plant and animal species are considered at risk of extinction, mainly (85%) from habitat loss and alteration attributed primarily to human activity. About one-third of America's freshwater animal species are at risk.

  4. Forests: The US is the world's largest consumer of forest products, increasing by 50 per cent in the past 40 years.

  5. Fisheries and aquatic resources: Thirty per cent of assessed fish populations in the US coastal waters are either over fished or fished unsustainably. A high proportion of fish caught in US rivers, lakes and coastal areas present health risks because of contamination by mercury and other pollutants.

  6. Agriculture: Nearly 3000 acres of US farmland are lost every day to development.

  7. Energy: With only 5 per cent of the global population, the US consumes almost 25 per cent of the world's energy. America has the highest oil consumption worldwide, and is projected to use 43 per cent more oil than the current levels by 2025. Transportation is the nation's fastest growing energy use sector.

  8. Climate change: The US is the second largest carbon dioxide greenhouse gas emitter in the world, accounting for nearly one-quarter of all global emissions. The nation's average temperature increase during the next 100 years is projected to be 2.8–5°C. Sea level rise and more severe weather events that will impact coastal areas are predicted, particularly in the US Mid-Atlantic and Gulf Coasts.

  9. Waste: Each American produces about five pounds of rubbish daily, five times the average amount in developing countries.

5. Policies to address population growth

(a) International agreements

The 1994 International Conference on Population and Development (ICPD) set a broad agenda for population work (UNFPA 1995). In addition to the provision of basic family planning and other reproductive health services, it emphasized poverty eradication, women's empowerment, gender equity, human rights, environmental protection, male responsibility in sexual behaviour and family welfare, adolescent reproductive health and safe abortion (Germain & Kyte 1995).

In 2000, the UN Summit issued a Millennium Declaration and shortly thereafter Millennium Development Goals (MDGs), though these did not explicitly address the broad array of reproductive health issues from the ICPD or call for access to family planning. However, in 2005, the UN Millennium Project's report, ‘Investing in Development: A Practical Plan to Achieve the MDGs’, argued that expanding access to sexual and reproductive health information and services is part of a core group of necessary, affordable and effective actions that can speed progress towards achieving the larger MDGs (UN Millennium Project 2005). The 2005 UN World Summit took the additional step of explicitly incorporating the ICPD goal of universal access to reproductive health as a target under the fifth MDG on improving maternal health. This action was approved by the UN General Assembly in 2006.

(b) Strengthening family planning deserves high priority

Reproductive health problems related to pregnancy, childbirth and STIs including HIV/AIDS represent nearly one-fifth (18%) of the global burden of disease (GBD).1 For women of reproductive age, such problems account for one-third of the disease burden, and an even higher share among women in developing countries (Vlassoff et al. 2004). Thus, it is easy to see why improving reproductive health—especially as it relates to avoiding unintended births, ensuring safe childbirth and HIV/AIDS prevention, treatment and care—is intrinsically desirable. Family planning, in particular, is not only important to improving reproductive health, but also to enabling women and men to choose the number and timing of childbirth—a basic human right. Provision of family-planning services is also the most direct intervention to slow population growth and assist environmental preservation (Potts 1997; Vlassoff et al. 2004).

According to Potts: ‘all societies with unconstrained access to fertility regulation, including abortion, experience a rapid decline to replacement levels of fertility, and often lower’ (Potts 1997). Better contraceptives and the establishment of organized family-planning programmes have successfully met the demand for small families and decreased fertility.

  1. Between 1960 and 2008, contraceptive prevalence in less-developed countries increased from 9 per cent (about 30 million users) to 62 per cent (about 630 million users) among married women of reproductive age (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2005; United Nations Department of Economic and Social Affairs Population Division 2007; Population Reference Bureau 2008a,b).

  2. During the same time period, the TFR in developing countries declined by more than half, from 6.0 to 2.8 (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2005; Population Reference Bureau 2008a).

The importance of abortion in child-bearing choices is seldom recognized. Given the high unmet need for family planning and the high failure rates of existing methods of contraception, access to safe abortion is necessary for women to fully control their fertility. It is estimated that about 12 per cent of pregnancies end in abortion in Africa, 23 per cent in Latin America and the Caribbean, and 30 per cent in East Asia (including China and Japan, where abortion is legal) (Alan Guttmacher Institute 1999). Without the 42 million abortions worldwide each year, population growth would be much more rapid (Alan Guttmacher Institute 1999; Ahman & Shah 2007). Unfortunately, in 2003 about 20 million of these abortions were medically unsafe and caused 13 per cent of all maternal deaths—about 67 000 of 529 000 deaths annually. An estimated 97 per cent of unsafe abortions occur in developing countries where, on average, each woman will experience one unsafe abortion during her child-bearing years. This is one reason why the ICPD identified unsafe abortion as a major public health concern (Crane & Hord Smith 2006; Ahman & Shah 2007).

The impact of organized family-planning programmes on population growth is clear: such programmes were responsible for at least 40 per cent of the fertility decline in developing countries from the 1960s through to the 1980s (Vlassoff et al. 2004). At the same time, fewer pregnancies, which are appropriately spaced, result in less exposure to the risks associated with pregnancy and childbirth. Indeed, use of family planning could prevent at least one-quarter of maternal deaths in developing countries (Levine et al. 2006). In Pakistan, for example, preventing all births after the fifth would reduce maternal deaths by half (Eastwood & Lipton 2006).

6. Family-planning programmes slow population growth: three case studies

The experiences of Thailand, Iran and California demonstrate how publicly supported family-planning programmes can successfully curb rapid population growth.

(a) Thailand: slowing population growth through innovative methods

Thailand's government launched its population programme in 1970, making a broad array of contraceptives including injectable and oral contraceptives available without a prescription. Contraceptives were distributed by nurses, midwives and even shopkeepers within communities (Rosenfield et al. 1971). Programme results include the following.

  1. By the late 1980s, Thailand's TFR had dropped below replacement level to fewer than 2 births per woman (bpw) (compared with about 7 bpw just two decades earlier) and currently remains low at 1.7 (Hirschman et al. 1994; Population Reference Bureau 2008a).

  2. Cost–benefit analysis estimates that Thailand's programme will have prevented 16.1 million births between 1972 and 2010, saving the government $11.8 billion in social service costs, or $16 for every dollar invested in the programme (Chao & Allen 1984).

(b) Iran: improving family planning with political and religious support

Recognizing an impending imbalance between available natural resources and population size, the Iranian government, with the support of Muslim religious leaders, restored its national family-planning programme in 1989 with the following results (Hoodfar & Assadpour 2000; Larsen 2001).

  1. Between 1976 and 1997, the proportion of married women of reproductive age using contraception increased from 37 to 73 per cent (Aghajanian & Merhyar 1999).

  2. After reaching 6.8 in 1984, the TFR dropped from 5.5 in 1988 to 2.8 in 1996 and is currently at the replacement level of 2.1 bpw (Abbasi-Shavazi 2002; Population Reference Bureau 2008a).

(c) US: a cost-effective programme for California's low-income residents

Low-income women represent 40 per cent of women in California of reproductive age and account for nearly two-thirds of births in the state (Braveman et al. 1999). An estimated 1.7 million women in California are in need of publicly funded family-planning services (Chabot et al. 2006). In 1997, the California legislature initiated the Family PACT (Planning, Access, Care and Treatment) Programme to provide clinical family planning and reproductive health services at no cost to low-income residents with the following results.

  1. During the programme's first 5 years, the number of clients served more than doubled—from 750 000 to 1.55 million (Bixby Center for Reproductive Health Research & Policy 2005).

  2. The contraceptive services provided by Family PACT in 2002 averted an estimated 205 000 unintended pregnancies (Foster et al. 2006). Every dollar spent on Family PACT avoided public expenditures—for medical care, income support and social services for women and their children—that would have cost $2.76 over 2 years and $5.33 over 5 years (Brindis et al. 2005). An investment of $403.8 million in 2002 therefore saved $1.1 billion over 2 years and saved $2.2 billion over 5 years.

The experience from these diverse settings shows that impressive declines in fertility and population growth are possible in a short period of time through implementation of well-managed, fully voluntary family-planning programmes that meet the needs of individuals and families. Similar programmes could—at relatively low cost—yield a substantial impact on population growth worldwide and help to alleviate the increasing burden it places on the environment.

7. International population challenges

(a) Unmet need

Of the 201 million women in developing countries with an unmet need for contraception, 64 million rely on high-failure, traditional methods, often owing to lack of access to modern methods (Singh et al. 2003). A survey of 89 developing countries found that only 57 per cent of couples had reasonable access to five modern contraceptive methods (pills, intrauterine devices, condoms, and male and female sterilization) (Ross & Stover 2001). In 35 countries including Afghanistan, the Democratic Republic of Congo, Ethiopia and Nigeria, modern contraceptive use among married women is less than 15 per cent (Population Reference Bureau 2008b). Unfortunately, many countries, including Kenya, Nigeria and Tanzania, are experiencing contraceptive shortfalls resulting from increasing demand for services and decreasing donor funds to support them (Finkle 2003).

(b) Discontinuation and failure rates

Many couples do not use contraception even when it is available because of concerns about side effects or unrealistic fears that contraceptives are dangerous. Other couples are limited to a modern method that is unsuitable to their circumstances, leading to high discontinuation rates. In some countries, particularly those in which contraceptive use is already high, efforts to improve contraceptive continuation may therefore be more appropriate than efforts to reduce unmet need (Westoff & Bankole 2000). Modern contraceptives also fail frequently, mainly because of incorrect use; even for the most effective methods, such as the pill, a failure rate of 8 per cent is typical (Trussell 2004). A study of 15 diverse developing countries found that contraceptive failure increased the TFR by 4–29% (Blanc et al. 2001).

(c) Unintended pregnancies

Of the 5.5 billion people living in developing countries in 2008, one in four (1.4 billion) were women of reproductive age (Singh et al. 2003; Population Reference Bureau 2008a,b). More than half were at risk for unintended pregnancy because they were sexually active, able to become pregnant, and had either completed their childbearing or did not want children in the near future (Singh et al. 2003). Nevertheless, according to Demographic and Health Survey estimates for 51 developing countries, almost one-half of pregnancies and one-third of births in the developing world are ill-timed or unwanted (Westoff 2001).

(e) Abortion

Given the high unmet need and failure rates for the existing methods of contraception, access to safe abortion is necessary for women to fully control their fertility. Also, without the 42 million abortions worldwide each year, population growth would be much more rapid (Ahman & Shah 2007).

(f) Assisting the transition to low fertility in developing countries

Unlike the long-term demographic transitions in Europe and the USA, which involved minimal government intervention, developing countries require substantial government and donor investment to hasten their demographic transitions. This investment includes financing of resources that otherwise are not available (e.g. contraceptive supplies and training) and supporting policies that indirectly affect fertility rates (e.g. promoting female education) (Cross et al. 2002). New development priorities, such as general debt relief and support of broad sectors rather than specific programmes have diverted funds from family planning. These new approaches to development assistance, combined with conservative policies that cater to religious groups and anti-abortion activists, threaten government-sponsored population programmes both in the developing countries and in donor nations.

(g) Meeting the growing need for financial resources

Increased financial resources are needed not only to maintain current levels of contraceptive use, but also to meet the unmet and growing demand for family planning. According to the UN Population Division's medium-variant projection, the number of women aged 15–49 in less-developed regions is projected to increase from 1.38 billion in 2005 to 1.75 billion in 2030 (Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat 2007). This increase of 370 million women, most of whom will need family-planning services, is in addition to the 200 million women in developing countries who already lack quality family-planning services. Even if the proportion of couples using contraceptives were to remain level between 2000 and 2015, because of population growth, developing countries would still have to serve 125 million additional couples (Ethelston et al. 2004). However, the global community has failed to provide the funds to satisfy the current unmet demand for family planning, let alone fulfil the ICPD goal of universal access to family planning, maternal health and other basic reproductive health services.

(i) Funding targets

Various estimates of funding needs are shown in table 1. In 1994, the ICPD estimated the cost of programmes for family planning, safe childbirth and STI/HIV prevention at $18.5 billion for 2005 ($27.2 billion in 2008 dollars when adjusted for inflation), of which two-thirds was to come from developing countries and one-third from donor countries (UNFPA 1995). These ICPD estimates included all delivery system costs in the figure for family planning. The estimate for reproductive health only included funds for safe childbirth services and the estimate for STI/HIV/AIDS only included preventive services.

Table 1.

Funding targets for family planning (FP), reproductive health (RH), and STI/HIV/AIDS programmes in developing countries (in $ billions).

The Guttmacher Institute and the UNFPA revised the cost estimates for family planning in 2003, calling for $12.7 billion (in 2008 dollars) for family planning, a figure that includes health system costs (Singh et al. 2003).

Revised cost estimates by Speidel in 2005 called for $15.9 billion in annual spending for family planning and basic research and $15 billion for reproductive health; the same year UNAIDS called for $14.9 billion for the full range of HIV/AIDS prevention, treatment, care and support services. UNAIDS also called on donors to provide two-thirds of the total for STI/HIV/AIDS programmes ($10 billion) (Speidel 2005; UNAIDS 2005).

Adjustments for inflation and the increased price tag for a broader array of reproductive health and STI/HIV/AIDS services bring the revised annual funding target for 2005 to $45.8 billion ($49.2 billion in 2008 dollars) rather than the original $18.5 billion.

In 2007, UNAIDS revised their target, calling for donor and developing country expenditures of $22.5 billion for HIV/AIDS in 2009, reaching $49.5 billion annually by 2015 (UNAIDS 2007).

Stover uses another approach, estimating that for each client family-planning services average $17.24 per year. If it is assumed that in 2008 there were 1.4 billion women of reproductive age; 70 per cent of these women were married or in union; and ideally 85 per cent would use contraception, then the family planning funding target would become $14.8 billion (Gillespie et al. 2009).

In 2009, the UNFPA, working with the World Health Organization and a group of expert advisors, conducted a new analysis of funding needs for each of the ICPD categories. These estimates grouped all programme- and system-related costs for family planning and maternal health into a single category, with estimated funding needs of $15 billion in 2009. Funds for direct family-planning costs were estimated at an additional $2.3 billion and for direct maternal health costs were estimated at an additional $6.1 billion, for a total of $23.5 billion. With the inclusion of $1.55 billion for research, data collection, and policy activities and $23.98 billion for HIV/AIDS, the revised ICPD annual cost estimates total $48.98 billion for 2009 (United Nations Economic and Social Council 2009).

Taken together these estimates suggest that annually about $15 billion is needed for family planning and related service delivery systems, and close to $50 billion is needed for the comprehensive ICPD programme that includes family planning, other reproductive health services, research, training, data collection and addressing HIV/AIDS.

(ii) Progress in meeting funding goals

The revised UNFPA target of nearly $49 billion called for donors to provide about $24.3 billion and the developing countries about $24.7 billion (table 2). These targets can be compared with provisional figures for 2007 of $8.13 billion being provided by donors, $7.7 billion by developing country governments and non-government organizations, and $10.8 billion spent by consumers for a total of $18.5 billion from domestic sources (United Nations Economic and Social Council 2009).

Table 2.

Revised 2009 ICPD funding targets for family planning, reproductive health and HIV/AIDS compared with provisional 2007 population assistance and domestic expenditures (in $ billions and per cent). Donor share of total is one-third, except share for STI/HIV/AIDS,...

It should be recognized that the apparent good performance of developing countries with regard to domestic expenditures shown in table 2 is misleading in many instances. The generous support of reproductive health programmes in a few large countries, including China, India and Indonesia, obscures the dismal performance of the governments of many other countries, particularly those in Africa. Furthermore, the estimates of consumer spending, the source of more than half of domestic expenditures, are imprecise, and the quality of services offered is likely to be sub-standard in many settings.

An analysis of donor funding by area of activity shows great divergence in priorities. The most recent increases in donor outlays for population assistance have been for HIV/AIDS, while donor funds specifically allocated for family planning have decreased during the past 12 years. Between 1995 and 2007, the most recent year with provisional data (United Nations Economic and Social Council 2005; United Nations Economic and Social Council 2009):

  1. funding for STI/HIV/AIDS activities has increased from 9 to 75 per cent of the $8.13 billion provisional total for population assistance;

  2. the proportion of funding for basic reproductive health services has changed a little, from 18 to 17 per cent;

  3. funding explicitly for family-planning services decreased, from 55 per cent to just 5 per cent; however, some family planning is now funded from within the reproductive health category; and

  4. funding for family-planning activities decreased in absolute dollar amounts from $723 million to $407 million.

In addition, funding for basic research activities accounted for only 3 per cent of expenditures in 2007.

If the revised targets for donor funding in 2009 are compared with the provisional 2007 donor contributions, family planning plus reproductive health assistance reached only 16 to 23 per cent of the two annual outlays targets shown in table 3. Donor assistance for STI/HIV/AIDS in 2007 reached 38 per cent of the UNFPA/UNAIDS target for 2009.

Table 3.

2008 and 2009 ICPD funding category targets for donors for family planning (FP), reproductive health (RH) and STI/HIV/AIDS services compared with estimated 2007 donor population assistance by category targets (in $ billions and per cent). Donor targets...

Clearly, population programme assistance provided by donors, particularly for family planning, is insufficient to achieve the goals of the ICPD and the MDGs. Many developing country governments, especially in the least developed countries, provide almost no domestic funds for population programmes and rely almost entirely on development assistance. Since more funds are available to address HIV/AIDS activities, less priority is given to other health needs including family planning, maternal health and other reproductive health activities.

8. US population challenges

Despite progress in states such as California, as well as nationwide reductions in teenage pregnancy and birth rates, unintended pregnancy remains a major problem for the US and significantly contributes to population growth in the country. Challenges to addressing unintended pregnancy include the following.

  1. Comprehensive sexuality education—which could help prevent pregnancy and is favoured by a majority of parents and educational experts—has been replaced by ‘abstinence unless married’ programmes, which since 1982 have received major increases in federal funding with total expenditures of $1.5 billion through 2008 (National Family Planning and Reproductive Health Association 2009). Given that 62 per cent of male and 70 per cent of female teenagers become sexually active, these programmes leave many teenagers unprepared to make informed decisions regarding their sexual and reproductive health (Mosher et al. 2005).

  2. Efforts are also underway to eliminate confidentiality and requiring parental consent for teenagers seeking family-planning services, even though research shows that if confidentiality were lost, teenagers would stop attending clinics, but would not stop having sex (Jones et al. 2005).

  3. Public funding for family-planning services is not keeping pace with demands. At $307.5 million in 2009, inflation-adjusted funding for Title X, the nation's only distinct, federally funded family planning programme, has declined by more than half since 1980 (Alan Guttmacher Institute 2000).

A recent study estimates the annual cost of family planning per client at between $124 and $487 with a mid-range estimate of $203 (Frost et al. 2006). In 2005, California's Family PACT Programme spent $236 per client. With 17 million US women reliant on public funding for contraceptive services, an annual expenditure of about $3.5 billion is needed (Sonfield 2003). This can be compared with public outlays of $1.85 billion for contraceptive services in 2006—about one-half of the total needed (Sonfield & Gold 2005).

Through the Medicaid ‘waiver’ programme, the federal government pays up to 90 per cent of states' family planning programme costs for expanded eligibility for family-planning services. Yet, only 27 states have taken advantage of this option, and stringent income and other eligibility requirements for the programme exclude a significant proportion of low-income women and men in need of services (Alan Guttmacher Institute 2005). To address US family planning needs, Title X funding must be markedly increased, and all states should capitalize on the substantial health and fiscal resources available through Medicaid waivers. If the need for waivers were eliminated, and coverage of family planning through Medicaid were required of all states, an additional 3.5 million women a year would be eligible for services; an estimated 500 000 unintended pregnancies would be averted; and states and federal government would save about $1.5 billion a year (Frost et al. 2006).

9. Addressing population: why the neglect?

Reasons why attention to population issues, and especially abortion, has waned include:

  1. the success of family planning and attention to declining birth rates;

  2. UN projections of population growth ending around 2050;

  3. low fertility in most developed (and a few developing) countries;

  4. criticism at the ICPD of past population work and advocacy for a less focused, ‘ICPD new paradigm’ of reproductive health;

  5. the influence of vocal anti-abortion activists, conservative religious leaders and conservative think tanks;

  6. shifting attention and resources—both human and financial—away from population growth in response to the AIDS crisis; and

  7. ‘donor fatigue’—the tendency to move on to emerging new issues at the expense of continuing problems.

As population issues in general have received decreased attention, so has the interaction between population growth and environmental sustainability. This problem is compounded by the fact that the relationship between population and the environment is a complex and often controversial one. Wilson and Kehoe (2000) have summarized the reasons of why environmental organizations have failed to advocate around population:

… environmental organizations have found it difficult to frame population issues in ways that appeal to the concerns of American environmentalists yet avoid causing internal dissension, raising ethical dilemmas or implicating politically problematic issues. Factors inhibiting unequivocal commitment to population by environmental groups have included: difficulty in applying environmental groups' legal or scientific expertise to the global population issue; the perception that opportunities for success on this issue are limited; domestic controversies, especially debates over the extent to which the groups should address U.S. immigration policies; and sensitivities surrounding North/South dynamics in international relations and the moral dilemmas stemming from America's high rate of consumption relative to the rest of the world (Wilson & Kehoe 2000).

Academic scholarship infrequently addresses the population–environment relationship. Environmental scientists often use UN statistics for their population projections, but may not recognize that these could be too optimistic, especially if population programmes continue to be neglected (Bongaarts et al. 1990; Bongaarts 2005). There is also a tendency to focus on the ‘good news’ of declining birth rates, rather than the continuing large increases in world population size.

Understandably, scientists concerned about the broad array of environmental issues look within their own disciplines for solutions, often through development and implementation of new, eco-friendly technology. Similarly, some influential economists, business leaders and conservative government policy-makers downplay the importance of the population–environment connection in favour of market-based economies and scientific progress as solutions. Also, the cost-effectiveness of investing in population and family-planning programmes compared with many other investments to protect the environment is not well understood (Bongaarts 1994; Bongaarts et al. 1997).

Some environmental activists and organizations do have a long history of concern about population. They include the National Audubon Society, the Sierra Club, the National Wildlife Federation, the Worldwatch Institute, the Earth Policy Institute, the Izaak Walton League of America and the World Wildlife Fund. Other organizations have decreased their emphasis on the link between population and the environment in response to concerns about population programmes that have focused narrowly on reducing growth rates, and programmes with coercive components such as China's ‘one-child’ policy. Finally, there are groups that will not tackle population issues because they consider the subject to be too controversial for their boards, their members, their donors or those they seek to influence.

A number of influential groups that focus more broadly on women's health and welfare have adopted the ideological stand that ‘numbers do not matter’. Since concern about the environment inevitably must consider population numbers, addressing population–environment relationships has been given little attention by these reproductive health advocates. Their prominent presence at the ICPD strengthened the conference's emphasis on broad policies that give high priority to women's education, welfare and health. Clearly, these issues deserve increased attention, but to some extent this emphasis resulted in neglect of population, family planning and environmental issues (McIntosh & Finkle 1995).

Conservative religious activists, who are often opposed to contraception as well as abortion, indirectly influence environmental policy by denigrating concerns about population issues. Family planning and reproductive rights are often at odds with religious views on family structure and morality, especially regarding the sexual behaviour of teenagers and abortion. Thus, some religious groups will not support a rationale for environmental preservation that requires strong family-planning policies and programmes.

Finally, many governments avoid attention to links between population and environment. At the Earth Summit in Rio in 1992, and in the formulation of the MDGs, population was deemed too controversial to address explicitly (Crossette 2004). Increasing conservatism on the part of many developed country governments, new concerns about terrorism and war, and the continued emphasis on US political discourse on mainstream issues such as the economy, crime, healthcare, education and taxes, leaves little room for a national debate about population and the environment.

10. Action agendas to address population

Governments, non-government organizations and the general public must mobilize the political will and resources to address the twin challenges of rapid population growth and environmental degradation. Current action is inadequate.

Environmental organizations can make an important contribution to this cause by educating their membership, policy-makers and the public about the need for global action to improve access to family planning both in the US and worldwide. Organizations concerned about the environment, population and/or economic development should pool resources to build and mobilize a base of grassroots activists to advocate for improved family planning and reproductive health policies and programmes, and to help raise public awareness about the links between population and environment.

An action agenda for developing countries should seek to implement the following.

  1. Improve the policy environment: both donors and developing country governments place inappropriate policy restrictions on access to family planning information and services. These restrictions are particularly onerous for unmarried and/or adolescent women, as well as those in need of abortion services.

  2. Strengthen family planning and related reproductive health services: in too many countries, these services are of low quality—underfunded, understaffed, lacking a broad variety of modern contraceptives—or are entirely unavailable. In settings with a high prevalence of HIV/AIDS or where risk of HIV infection is high, family planning and HIV/AIDS programmes should be integrated. Information about human sexuality, family planning and reproductive health must also be provided as an essential component of service-delivery programmes (Berer 2004).

  3. Increase human, commodity, and financial resources: about $24 billion annually is needed for family planning and reproductive health (excluding HIV/AIDS) programmes in developing countries. Unfortunately, neither developing country governments nor donors are anywhere near meeting the financial needs of these programmes. Of particular concern is the shortfall of contraceptive supplies to meet increasing demand. Their purchase from sources in developed countries can require developing countries to use scarce hard currency, making them difficult to obtain and appropriate for donors to provide as a part of their foreign assistance package. Equally important is the lack of trained personnel to manage and operate family planning and reproductive health programmes.

  4. Support safe abortion services: worldwide, an estimated 42 million women have abortions each year (Ahman & Shah 2007). However, the legality of abortion varies by country: 61 per cent of women live in countries with ‘liberal’ abortion laws, while 25 per cent reside in a country where abortion is illegal or allowed only to save a woman's life, and 14 per cent live in countries where abortion is only permitted to protect a woman's physical or mental health or to save her life (Alan Guttmacher Institute 1999). Yet, support for safe abortion services on the part of donors and governments remains controversial and varies according to domestic politics. Nevertheless, given the ongoing need for abortion and the high mortality associated with unsafe procedures, ensuring a supportive legal and policy environment as well as the provision of safe abortion services should be a priority.

  5. Invest in research: improved contraceptive and abortion technologies are needed to overcome issues relating to effectiveness, safety, cost, acceptability and side effects that hamper use of current methods. Demographic research and operations research to improve family planning and reproductive health delivery systems is also needed.

  6. Implement development programmes that help slow population growth: general economic development, especially investments in improving human capital, gender equality and education—especially for girls—all contribute to reduced fertility. The population momentum resulting from the young age structures in many developing countries can be partially offset by increasing the age of first childbirth as well as the intervals between births. There is a need for increased development assistance from the estimated 2007 figure of $103.5 billion to more than $250 billion annually—the target level to meet the agreed-upon standard of 0.7 per cent of gross national product (Ethelston et al. 2004; Organisation for Economic Co-operation and Development Assistance Committee 2008).2

(a) An action agenda for the US

A combination of anti-abortion activism and increasing social conservatism in local, state and national governments has hampered progress in US policies and programmes relating to population, family planning, and reproductive health and rights. This has translated into poorly funded family-planning programmes and restrictive policies relating to abortion, sexuality education and reproductive health services. In addition, immigration law and policy are out of step with the reality (especially with regard to undocumented immigrants), as low cost labour is often welcomed, and the legal status of employees is overlooked.

Early indications suggest that the new Obama administration and the Democratic majority in Congress will bring increased attention to family planning and reproductive health. An agenda for US advocacy and programmes should seek to do the following.

  1. Initiate research on and discussion about population growth and its implications for the environment: there is a need for increased recognition of the environmental and other costs associated with continuing rapid population growth in the US. Considering that the Census Bureau's medium-variant projection estimates nearly 600 million Americans by 2100, and the high variant suggests as many as 1 billion (Hollmann et al. 2000), it is time for the US to adopt an official population policy.

  2. Strengthen family planning policies and programmes: all reproductive health policies and programmes should be based on scientific evidence, rather than ideology. The Title X programme is in need of increased funding, and Medicaid must maintain the current 90/10 federal/state split of funding. In addition, the ‘waiver’ for Medicaid funding should be eliminated, and all states should be required to provide family-planning services for low-income women and men. Minimizing unintended pregnancy would substantially slow US population growth and does not require addressing more controversial population-related issues.

  3. Increase access to abortion: multiple policy restrictions on abortion—such as mandatory waiting periods and parental involvement laws—should be eliminated. There is also an urgent need to increase the number of medical practitioners offering abortion services, given that 87 per cent of US counties lack an abortion provider (Finer & Henshaw 2003). Provision of free or low-cost abortion services for those who cannot afford them would ensure access for women of all socio-economic levels.

  4. Support educational and service programmes for young people: adolescents should receive education that addresses human sexuality, contraception and abortion, including, but not limited to, abstinence. Teenage-friendly services that include abortion are a key contributor to low teenager birth rates in European countries and declining rates in the US.

  5. Seek new solutions to immigration: despite the complexity and controversy of the issue, immigration requires attention. Although the topic is controversial, there are some approaches to it that are not; for example, there should be little disagreement about efforts to improve economic opportunity and family planning in sending countries to diminish the economic and population-related motivation for emigration.

In summary, environmental advocates and conservation programme planners generally understand the importance of population issues, but have often given them a low priority. Reasons include lack of scientific expertise, the belief that tackling population issues is too controversial or unlikely to yield success, and a perceived absence of moral standing given the disproportionately high rates of consumption in developed countries. Prevention of unintended pregnancy is a strategy that, for most of the public, is not controversial, yet can have a substantial impact on reducing population growth and the concomitant pressures it places on the environment. The successful family-planning programmes found in many settings, as diverse as Thailand, Iran and California, show that such programmes are desired, feasible and cost-effective.

The population field needs increased commitment, appropriate policies, and adequate human and financial resources. If these conditions are met, population growth will slow, reproductive health will be improved, and the environment protected.

11. A new global green economy is needed

Better reproductive healthcare and decreased population pressures are essential but insufficient components of the transformed economy needed to preserve the environment. The global community must cease the profligate and ecologically unsustainable exploitation of natural resources. There is an urgent need for people everywhere, and especially high-consuming Americans, to advance a new economy that reduces consumption and the resulting waste and pollution, as well as preserves and restores natural systems (Hawken et al. 1999; Brown 2008).

It may be too late to avoid substantial climactic change, but we have much of the technology needed to minimize further, and even greater damage (Intergovernmental Panel on Climate Change 2007). We must move from a petroleum economy to an electric economy, powered mainly by wind, photovoltaic, geothermal and other renewable energy sources (Kammen 2006

National Population Policy of Ethiopia


Home|| Population processes|| Population policy|| Population research|| Publications|| POP News

 

PREFACE

Since the Transitional Government of Ethiopia came to office in May 1991, a number of steps have been taken and policy instruments formulated first to rehabilitate the shattered social and economic infrastructure and secondly to lay down a strong foundation for sustainable development in the years ahead. The official adoption of the National Population Policy is an important aspect of this all round exercise.

This policy has for its major goal the harmonization of the rate of population growth and the capacity of the country for the development and rational utilization of natural resources thereby creating conditions conductive to the improvement of the level of welfare of the population. The setting of this broad goal is premised upon the realization and acceptance by the government of the importance of demographic factors in development planning and services.

The task of harmonizing the rate of population growth with the tempo of economic and social development requires the involvement and collaboration of a number of governmental and non governmental agencies. The general objectives specified I the policy cannot be handled without reference to the need for a well defined division of labor among these agencies.

While the publication of this policy represents a significant step towards the attainment of major goals, the development of specific programmes of action and their implementation represent the most important phase of the exercise. This is the point at which domestic and international technical and financial input will prove to be vital.

Tamirat Layne,

Prime Minister

 

 

1. BACKGROUND

The combined forces of political turmoil, adverse climatic conditions and an all round decline in productivity in all sectors of the economy reduced the population of Ethiopia into a state of abject poverty. There has not been any time, since the early 1980s when the economy grew at a rate higher than that of the population. GDP grew at an average rate of 2.7% between 1965 and 1980 and at 1.9% between 1980 and 1989.

Available data indicate that the population increased fourfold between 1900 and 1988. At the beginning of the present century the crude rate of natural increase was estimated at 0.3% per annum. This was a far cry from the 2.9% a year suggested by the 1984 census. The total population in 1900 was estimated at 11.8 million. It took 60 years for this to double to 23.6 million in 1960. It took only 28 years for the population in 1960 to double to 47.3 million in 1988 and at 2.9% between 1980 and 1989. If the prevailing fertility rate continues and mortality declines as would be expected under normal conditions, it is projected that the population of Ethiopia may grow at the rate of 3.1% or more a year during the remaining part of the present century.

Two demographic factors responsible for this dramatic growth are a continuing high birth rate and slowly declining mortality rate. Available data indicate that total fertility rate increased from 5.8 children per woman in 1970 to 7.7 children at present. Since there are no indications that the high fertility status of the Ethiopian population will change significantly within the foreseeable future, particularly in the absence of effective fertility regulation programmes, growth rates even higher than is the case at present are to be expected during the rest of the present decade and well into the early decades of the 21st century.

Fertility varies considerably by region and residence. Total fertility rate ranges between 5.1 children per woman in Wollo and 9 in Bale. In some of the regions such as Arsi, Bale, Gamo Gofa and Hararghe, the difference between rural and urban fertility are significant.

Both rural and urban fertility seemed to have increased significantly between 1970 and 1990. While it is highly plausible to attribute this increase to improved data collection systems, it is also possible that fertility has actually increased over the decade as a response to generally improved health conditions among which is the reduction in the prevalence of some deadly sexually transmitted diseases. It is often assumed that there has been a slow but persistent decline in the level of mortality in the last two decades or so. But this claim is often, but perhaps, justifiably disputed on the grounds that decades of war and natural disasters can only push death rate up instead of down, Mortality, measured in terms of a number of indicators such as the crude death rate and infant mortality rate, continued to be high and life expectancy at birth remained low even by Sub-Saharan Africa standard.

Between 1970 and 1981 the crude death rate declined by only two points, while the infant mortality rate declined by 14 points. The corresponding increase in life expectancy at birth was slightly more than 8 years. Between 1984 and 1991 practically no change was registered in infant mortality rate.

POPULATION DISTRIBUTION

It is sheer numbers only that matters in the interaction between demographic factors and development variables. How a population is distributed by such characteristics as age, space and so on is an important determinant of the prospects for economic and social development. Apart from defining who works and who does not, the age structure determines future patterns of population growth.

The spatial distribution describes the degree and quality of access of a population to land and other resources. This is manifested in either declining or raising population/land and population/resources rations. What is happening in Ethiopia today is the latter. Available data show that the man/and ration has been increasing over the last several decades in response to two important factors. The first is the rapid rate of population growth and the second the secular decline in environmental quality.

The distribution of a population by residence (rural and urban) in some ways indicate the degree of structural differentiation in the economy and the society. But the desired structural differentiation is not only one characterized by rapid changes in the pattern of residence but one that is accompanied by significant shifts from the primary to secondary and tertiary types of economic activity. This is not happening in Ethiopia to any significant degree.

AGE STRUCTURE

The population of Ethiopia is very young with a mean age of approximately 17 years. According to the 1984 Census, the proportion of total population under the age of 15 was 48.0%. Since the level of fertility has not changed at all, there is no reason to think that there has been any change in the age composition of the population since then. Assuming that the present high fertility level continues unchanged, there will be no significant change in the age structure in the foreseeable future. The threat that the population may even get younger under a continuous onslaught of a high fertility regime is a real one. There are two possible consequences of a young population age structure: First, given the present age structure, the potential for a rapid growth remains quite high in view of the large annual addition to the population of women in their reproductive years. The continuous flow of new entrants into the reproductive cycle makes for a high population momentum. The number of women in their child bearing ages is constantly replenished by the large number of female babies being born annually and surviving to puberty and beyond thus maintaining a high gross reproduction rate (GRR).

Another facet of the problem associated with age structure is that the high proportion of total population below the age of 15 (48.0%) represents a sizeable segment of the population that is outside the labor force. When this is combined with the approximately 4.0% of the total population 60 years and older it translates into a high age dependency burden. Even without taking into account such confounding factors as unemployment, underemployment and the high prevalence of physical disability in the population, an economically active person is obliged to carry more than one inactive persons. In such situations whatever is produced is immediately consumed limiting the opportunity for surplus production which may be reinvested in further development.

The age dependency burden is and is likely to continue to be heavy even during the first few decades of the next century if no significant and immediate changes begin to take place in the present high fertility regime. In 1993, for example, every one hundred active persons in the labor force carried 116 inactive ones.

SPATIAL DISTRIBUTION

The geographic distribution of the population is uneven a considerable regional variation in both size and density. The population density for the country as a whole is estimated at 47 persons per square kilometer. Shewa is the most densely populated region with an estimated 120 persons per square kilometre and Bale, the least densely populated, with approximately 14.5 persons per square kilometer. This presents both challenges and opportunities in terms of formulating policies and programmes facilitating the free movement of people from low to high opportunity areas and where the addition of human resources would expedite economic and social development.

DISTRIBUTION BY RESIDENCE

Most people in Ethiopia live in rural areas. In 1993 the urban population constituted only 14.6% of the total population. However, there are considerable regional variations in the level of urbanization. In 1993, the level ranged between 7.7% in Gamo Gofa and 28.2% in Shewa. As in may other developing countries the rate of growth of the urban population in Ethiopia is higher than that of the total population. In 1993, for example the rate of growth in the urban population is 5.4% while that of the total population is 3.2%.

2. POPULATION AND DEVELOPMENT

Environment

Experience over the last couple of decades in Ethiopia has shown that as human numbers increased, the population carrying capacity of the environment decreased. A high population growth rate induces increased demand for resources and the rate at which these resources are exploited. In Ethiopia where technology has not kept pace with the demands for greater productivity, environmentally harmful and economically counter-productive methods of exploiting land and associated resources (forests, animal resources, etc.) Are resorted to in order to meet immediate needs. As a consequence of this, climatic conditions are becoming erratic and soil quality is declining at an alarming rate.

The country was ravaged by both man made and natural disasters. The proportion of land with forest cover has been diminishing at alarming rates. The land area covered by forests has gone down from approximately 40.0% at the turn of the century to approximately 3.0% at the present time. The annual rate of deforestation is estimated at 88.000 hectares per year while the rate at which this loss is being replaced through afforestation is estimated at 6.000 hectares a year.

The soil has been and continues to be eroded in the absence of coherent and sustained conservation efforts. Popular awareness of conservation issues is, still, in its nascent stage. It is estimated that over two billion cubic meters of soil is being washed down, annually, by torrential rains down the Nile valley leaving most of the Ethiopian highlands with seriously eroded landscape and severely reduced population carrying capacity.

As population increased the demand for fuel and construction materials increased resulting in the practice of reckless tree felling. State ownership of forests and the exclusion of local communities from the management and legitimate utilization of forest resources may have contributed to the lack of any consistent effort to replace tress cut for various purposes.

Under the circumstances described in the preceding pages, achieving such important national goals as food sufficiency, universal primary education, improving the accessibility of health services to the largest possible number in the shortest possible time, increasing employment opportunities, reducing underemployment in the labor force and improving housing conditions, among others, are proving to be exceedingly difficult under a scenario of continuing high fertility.

Displacement of significant segments of the population due to political and war related causes further compounded the problem associated with man/environment interaction. The massive but haphazard movement of population from one part of the country to another, induced or self propelled, has aggravated the problem of environmental fragility in the 1970s and the 1980s. Large areas of the country are inhabited by nomadic pastoralists who move over large expanses of land with large herds of livestock playing havoc on the environment. Environmental degradation in these areas has caused and continues to cause serious hardship to pastoralist groups. Non pastoralist groups are also affected by environmental degradation in their own turf's. Thus conflict between peoples of differing social organizations of production but of overlapping needs for land come into frequent conflict with each other with serious consequences for peace and stability.

Declining Productivity in Crop Producing Areas:

Crop producing are becoming less and less productive. There are several sides to the problem of declining productivity in the crop producing sector. Among these are: lack of proper agricultural policy designed to stimulate dynamism in the sector, forced collectivization, the limited accessibility of modern factor inputs (suitable farm implements, fertilizers pest, control systems, methods of harvesting and storage, etc.) To small farmers outside the collectivized system and, in general, the weak and ineffective organization l set-up of the agricultural sector. Agricultural extension services are weak and, largely ineffective.

But more importantly, declining productivity is a function of increasing man/land ration occasioned by rapid population growth. Continued technological backwardness and absence of any vision about what the country should look like in the future have patterns have been affected by the expansion of large scale agricultural enterprises and the programme of relocating segments of the population from one part of the country to another.

It is often stated that it is only a small proportion of the potential arable land that is put under crops. For instance, it is reported that the period 1985-87, cropland represented only 12.7% of total land area, pasture land 41.0%, forest and woodland 25.0%, and other land 9 including wilderness) 21.4%.

The seriousness of the problem militating against the attainment of the goal of food self sufficiency is, further, illustrated by the direction in which changes in food supply have been going in relation to population dynamics. Alternative pictures of the food situation in Ethiopia under three population growth assumptions suggest that the growth in demand for food (cereals only) is primarily a function of population growth and only secondarily, a function of the increase in per capita consumption. Going by the high variant population growth assumption does not provide even the remotest hope of attaining the goal of food self sufficiency any time during the first few decades of the next century. On the other hand with significant reduction in the level of fertility the country will come close to achieving that goal sometime during the first two decades of the 21st century especially if this is accompanied by increased effort in increasing the rate of growth in food production. Under the low variant population growth assumption, demand for food is expected to grow at the rate of 2.3% a year between the years 2015 and 225 while under the high variant assumption demand for food would increase at over 5.0% a year.

EDUCATION

In spite of the fact that during the last several decades enrolment figures, in absolute term at various levels of education have significantly increased, large proportions of the school age population still remain outside the school system. Because of the more rapid rate which enrolment increased relative to facilities, the quality of education has serious deteriorated. Student/teacher ratios, number of students per class room and number students per textbook at all levels have been increasing and continue to increase rapidly.

The issue of quality of education is one that revolves around, inter alia, the increase demand occasioned by the rapid growth in the size of the school age population. Under the high variant assumption of population growth, the school age population (ages 7-18) expected to increase from 12.0 million in the year 2020 representing an average annual growth rate of 3.5%.

Considering the country's budgetary constraints, it is not difficult to appreciate the co implications of pursuing the goal of universal primary education and increasing access second and third level facilities.

HEALTH

Health policy in Ethiopia is rooted in the primary health care approach which has, head education, education in personal and environmental hygiene, nutrition, immunization a family planning for standard components. The network of health care services have always been limited in scope and the situation deteriorated in the face of intensified civil was rehabilitating the rundown health infrastructure and restoring them to the status quo ante in itself a tremendous task in the transitional period.

It was estimated that, around 1990, only 46 per cent or less of the population of Ethiopia lived within a reasonable distance from health care facilities - reasonable distance be defined as a radius of 10 kilometers from where people live. The population/physician population/nurse ratios were estimated at approximately 30,700 and 15,000 respectively. Daily calorie supply per capita was estimated at 76.0% of the recommended daily intials. Only 18% of the rural and 78% of the urban population has access to safe water supply 5.3% use any form of latrines. Clearly, even in terms of the basic necessities of life Ethiopian population is severely under-served and there is a long way to go in meet these needs even in the most rudimentary manner. There will be no basis for expecting that significant inroads would be made towards solving these basic health problems if the present high rate of population growth continues. The figures cited above represent national averages and as such hide a considerable degree of regional disparity.

Community based health care programs and outreach services are still in their rudimentary stage. The expanded program of immunization (EPI), the establishment of which generated so much optimism, has suffered serious setbacks in the late 1980s and the early 1990s. Data for the period covering July to September 1992 indicate the following:

 a) BCG 19.0%

 b) Measles 9.0%

 c) DPT-3 12.0%

 d) Polio-3 13.0%

 e) TT-2 + 7.0%

Continuing shortages of basic drugs has stunted the development of a coherent community base approach to health care.

FERTILITY AND MATERNAL AND CHILD HEALTH

Studies in a number of countries have shown that wherever fertility is high materna, infant and child mortality rates are high. Fetal deaths, low weight at birth and related problems are also associated with unregulated fertility. More specifically, high maternal, infant and child mortality rates are associated with such reproductive practices as short birth intervals, pregnancies in women under the age of 20 and above the age of 35 and so on. The situation is made more complex by the high prevalence, in the population, of infectious and communicable diseases as well as malnutrition.

The National Maternal and Child Health Center of the Ministry of Health was established as a practical expression of the belief that many of the causes of maternal, infant and child morbidity and mortality can be dealt with an effective MCH program combined with family planning.

Budgetary allocations to the health sector have been very limited and are likely to continue to be so in the foreseeable future because of the general budgetary constraints in the country compounded by a variety of contending demands for investment resources. It must also be recognized that side by with shortages in resources, this country has the problem of low resource utilization capacity.

In the face of such constraints, which are likely to continue for sometime to come, significant reduction in the rate of growth of the population will ease future burden of rapidly increasing demand and help in bringing the country a step or two closer to the attainment of the goal of health for all by the first decade of the next century.

The emphasis on reducing materna, infant and child morbidity and mortality is a well placed health policy concern because the health problems of this segment of the population contribute significantly to the high morbidity and mortality situation in the country. But the probability that this goal will, at least, be, partially, met depends, among others, on how effectively and expeditiously the issue of population dynamics is managed.

HOUSING

The quality of housing in Ethiopia, in general, is exceedingly low. Data from the census of population and housing of 1984 draw a grim picture of the situation. Since one of the major goals of development policy is improving the standard of living of the population, improvement of housing conditions is an concern with considerable implication for the health and well-being of citizens. Census data indicate the following features of the housing problem.

a) 70.2 % of dwelling units in the country have one room only;

b) In terms of structure the majority of the dwelling units in the country are below standard and lack adequate living space. The average number of rooms per dwelling unit is 2.3;

c) A considerable proportion of dwelling units are shared by more than one household;

d) The majority of dwelling units lack even the most basic sanitary facilities.

POPULATION, LABOR FORCE AND UNEMPLOYMENT

The problems of employment and underemployment have beleaguered the Ethiopian society during the second half of the century. There are, currently, thousands of school leavers who are without jobs and the situation had progressively deteriorated in the 1970s and the 1980s. As the economy and the society were brought under the total control of the state, there was very little room for employment generation through private sector initiatives. Additionally the situation of a war time economy that obtained since the mid 1970s starved the productive sector of the economy with the consequence that the sector practically came to a standstill. The situation is likely to be further aggravated by the rapid rate at which the population of working age is expected to increase under the high variant population growth assumption.

Even taking the middle of the road view, the total economically active population is expected to grow at the rate of 3.6% a year while the economically active female and male populations are expected to grow at average annual rates of 4.4% and 3.1% respectively. Between 1995 and the year 2000 the corresponding expected gender specific growth rates are 3.0% and 3.4%. The total economically active population is expected to grow at an average rate of 3.2% a year.

THE SITUATION OF WOMEN

The economic, social and political status of women have direct bearings on the level of fertility in any society. Where women's roles are exclusively defined in terms of household management and matrimonial duties, as is the case in Ethiopia, they are subject to the expectation that they replenish the race by bearing a large number of children and assume full responsibility for maintaining them almost single handedly. Since women are, by and large, economically dependent on men, the decision to have or not have children rests, primarily in the husband and his relatives. The conscious but unarticulated realization that not all children born survive, serves as an inducement to high fertility performance in order to compensate for the high rate of attrition by death.

The low female participation rate in formal education further reinforces the expectation that women play their domestic managerial and matrimonial roles to the fullest possible extent. School enrolment statistics for 1984 shoe the female participation rate to be somewhat lower than that of males (21.8% for females against 26.2% for males). Another indicator of the degree of female deprivation pertaining to access to education is the literacy rate. Census data indicate that, around 1984, female illiteracy rate was considerably higher than that of males (80.4% for the former and 65.4% for the latter). An important factor explaining the relatively low access of females to the educational system is the traditional value system placing greater premium on males than on females.

Since educational resources are scarce, parents often decide to use the limited resources available to them in sending male children to school in preference to females. It must, however, be noted that there has never been any government policy to restrict female access to formal education.

Another feature defining the low status of women in this country is the fact that their participation in the labor force is low. Even when they are employer they are found in non professional and dead-end type of jobs. Women represent negligible proportions of persons employed in the professional/technical and Administrative/managerial occupations.

Family laws, currently in force, restrict the right of women to regulate their fertility and discourage the widespread use of modern birth control methods. Thus, technically, all institutions providing family planning in this country, including government health institutions, are doing so illegally. Consequently, the contraceptive prevalence rate in Ethiopia is very low.

In the past a number of policy related and administrative problems impeded effective service delivery. Among these are:

 a) The practice of limiting family planning service delivery to formal health institutions;

b) The inability of health facilities to retain personnel trained in family planning.

c) Restrictions concerning the involvement of NGOs in family planning service deliver.

d) An inefficient system of delivery of contraceptives and related supplies to regional health facilities and the absence of accountability about how regional medical stores distribute such supplies to health facilities.

e) A near total absence of cooperation between regional medical stores and service delivery agencies in the regions resulting in a considerable wastage of supplies due to expiry of the shelf lives of contraceptive supplies and drugs. 

Given the fact that the vast majority of the population has exceedingly limited access to family planning, the unmet needs are immense suggesting that innovative approaches have to be adopted in order to make any headway in dealing with the problem of excessive fertility in this country.

Existing laws permit female marriage at age 15. This provision is made in compliance with the cultural requirement that females enter into the state of matrimony at an early age so that they begin their reproductive careers early enough. But practices in a large number of culture groups allow for marriage to take place at even younger ages. Early marriage for girls is one of the factors contributing not only to the maintenance of a high fertility regime but also to high maternal, infant and child morbidity and mortality.

Unwanted pregnancy is known to represent a serious problem in this country today although only limited empirical date are currently available. A study conducted in five hospitals in Addis Ababa around 1988 provide sufficient indication that many women resort to abortion year 1985/86, 3244 (55.2%) women out of a total of 6198 cases reporting to the obstetrics/gynecology departments of the said five hospitals were abortion cases. This went up to 58.6% in the reporting year 1986/87. Clearly, this can only represent a very small proportion of women, particularly those of younger ages who seek abortion from unauthorized sources. The conclusion to be drawn from the discussion of the current situation of women in the Ethiopian society is that vigorous steps have to be taken by government to remove all the cultural and social impediments militating against their full enjoyment of fundamental human rights. Raising the status of women involves, inter alia, increasing female participation in the educational system at all levels, removing all social and cultural impediments militating against their competitive involvement in the economy in general and the market place in particular. More importantly conditions must be created to increase their access to every amenity that facilitates the development of their entrepreneurial potential.

The situation cannot be changed without significant changes in societal attitudes to and perception of the place of women in a society aspiring to go democratic. This change of attitude has to take place at the national, regional, local community and household levels. Thus, information, education and communication programmes should and will be mounted to bring about such changes in attitude and perception. Efforts to change the situation to bring about such changes in attitude and perception. Efforts to change the situation should begin at the family, early and subsequent education l levels.

For example, the practice of differential assignment of males and females to different social, educational and professional roles must stop.

THE SITUATION OF CHILDREN AND ADOLESCENTS

Among the segments of the population most affected by drought, famine and war related displacement are children and adolescents. One only has to look at the streets of our cities and truism to realize the truism of this. Thousands of children have lost their parents either to war or to one or another type of natural disaster as a consequence of which they are forced to fend for themselves as best they can provided they survive the initial shocks of abandonment.

Even the most fundamental housing and sanitary facilities are not accessible to them. They are exposed not only to the vagaries of climate but are also exposed to the risk of death by epidemic, hunger and violence. As their number increases so does the chances of outbreaks of epidemics. City and township administrations cannot, without the participation of the community, cope with the increasing demand, by this segment of the population, for shelter, potable water and toilet facilities. Whatever gains are made in the improvement of social and physical infrastructure in towns and cities are soon eroded by the persistent onslaught of rural to urban migration between towns/cities.

Social services addressing the needs of such persons are still in a rudimentary stage and it is not likely that they will grow fast enough in scope to serve those who are already facing the problem let alone new entrants.

The government will do everything possible, in the years ahead, to mobilize official and non-official efforts to deal with the problem.

Many children are born and raised in the streets and they are, from an early age, exposed the street culture. Among the risks adolescents are exposed to is those of unwanted pregnancy and criminal abortion. For instance, the study in five hospitals in Addis Ababa cited earlier shows that out of 7364 reported abortion cases 916 or 13.0% were under the age of 20 some of which could very well be from the streets.

Immediate steps need to be taken in finding ways and means of enabling street families a other persons marginalized by adverse social and economic conditions to be self supporting by means of self-employment promotion programmes. This can be done through the development of small scale enterprises involving the production of goods and services thiscan be produced with relatively easily obtainable factor inputs. At the same family planning services would be accessible to them so that by practicing parenthood they reduce burdens which often prove to be impediments to self improvement.

Childhood malnutrition is rampant. Approximately 60.0% of all children under the age of five are 80.0% or less of the expected weight for this age group. It is estimated that only 10.0% of approximately 9.2 million children under the age of 5 attend modern health services. Because of adverse security and related conditions the momentum gained could not be maintained. The Government plans to look into various options of dealing with the problems of children and adolescents by mobilizing governmental and non governments resources to reduce the plight of this important segment of the population.

3. RATIONALE FOR A NATIONAL POPULATION POLICY

The analyses of the interrelationship between demographic factors on the one hand and developmental variables on the other reveal that demographic factors such as rapid population growth, young age structure and the uneven spatial distribution of the population fuelled by a continuing high fertility regime exacerbate the severe state of underdevelopment that characterizes contemporary Ethiopian society. Underdevelopment manifests itself among others, in the following ways:

 a) low productivity in almost all sectors of the economy resulting in high rates of unemployment and underemployment and hence in absolute deprivation and apathy, 

b) low accessibility of basic social services such as education, health and housing,

c) the perennial problem of food insecurity affecting many parts of the country,

d) high prevalence of maternal, infant and child morbidity and mortality - problems that are partially attributed to the low status of women and high fertility and 

e) low life expectancy at birth.

The picture emerging from a discussion of the general social and economic environment way these impact on the life chances of the people of this country is not one that the facile conclusion that the force of demographic problem, in itself, solves other governmental problems. The situation in Ethiopia clearly illustrates the truism that demographic and development factors reinforce each other. High fertility and rapid on growth exert negative influences on economic and social development and low economic and social development provide the climate favoring high fertility and rapid population growth. Because of an unholy combination of these forces, Ethiopia self in a vicious circle of failure and defeatism.

The major task of government, in its role as a catalyst of development, is to identify points through which to break into the circle of failure and defeatism and mobilize energy and resources to that end. Among them major steps the Transitional Government of Ethiopia has taken to deal with the current economic and social crises are:

  • The adoption of an Economic Policy for the Transitional period aiming at introducing fundamental structural changes in the economy designed to significantly reduce the public sector dominance in critical sectors of the economy and creating conditions by which market forces, by and large, determine the supply and demand of goods and services and promote private sector participation in the production and distribution of such goods and services.

This also allows policy makers at all levels of government, a large measure of latitude in development related decision making on the basis of the principle of comparative advantage thus increasing more effective exchange relationships among the various parts of the country on the basis of reciprocity.

And realistic population policy aims at ensuring that the rate of economic and development is ahead of the rate of population growth. The Government believes that this aim will be achieved if population programmes are planned and implemented in context of integrated and holistic development.

4. GOALS, OBJECTIVES AND STRATEGIES OF THE POPULATION POLICY

This policy has for its major goal the harmonization of the rate of population growth a the capacity of the country for the development and rational utilization of natural resources to the end that the level of welfare of the population is maximized over time. The necessary of pursuing this goal is dictated by the fact that the rudimentary state of technologies development combined with rapid population growth has made the effort of extricating the country from its severe state of underdevelopment; and extremely difficult task. Significantly reduction of the rate of population growth by, primarily, addressing the problem of his fertility will, in the long run, be helpful in easing the pressure from contending demands of development resources.

GENERAL OBJECTIVES

The paths to the attainment of the goal of harmonizing the interrelationship between population dynamics and other factors affecting the probability of development are many Given the assumption that there is a two way interaction between demographic factors of the one hand and other development indicators on the other, sound fertility reduction policy requires that action be taken in carefully selected areas in both spheres. Thus population policy aims at pursuing the following general objectives:

a) Closing the gap between high population growth and low economic productivity through planned reduction of population growth and increasing economic returns;

b) Expediting economic and social development processes through holistic integrated development programmes designed to expedite the structural differentiation of the economy and employment;

c) Reducing the rate to urban migration;

d) Maintaining/improving the carrying capacity of the environment by taking appropriate environmental protection/conservation measures;

e) Raising the economic and social status of women by freeing them from the restrictions and drudgeries of traditional life and making it possible for them to participate productively in the larger community;

f) Significantly improving the social and economic status of vulnerable groups (women, youth, children and the elderly).

SPECIFIC OBJECTIVES

a) Reducing the current total fertility rate of 7.7 children per woman to approximately 4.0 by the year 2015;

b) Reducing maternal, infant child morbidity and mortality rates as well as promoting the level of general welfare of the population;

d) Significantly increasing female participation at all levels of the educational system;

e) Removing all legal customary practices militating against the full enjoyment of economic and social rights by women including the full enjoyment of property rights and access to gainful employment;

f) Ensuring spatially balanced population distribution patterns with a view to maintaining environmental security and extending the scope of development activities;

g) Improving productivity in agriculture and introducing off-farm non agricultural activities for the purpose of employment diversification;

h) Mounting an effective country wide population information and education programme addressing issues pertaining to small family size and its relationship with human welfare and environmental security.

STRATEGIES

 i) Expanding clinical and community based contraceptive distribution services by mobilizing public and private resources;

 ii) Promoting breast feeding as a means of dealing with the problem of childhood malnutrition and increasing the time span between earlier and subsequent pregnancies through IEC;

 iii) Raising the minimum age at marriage for girls from the current lower age limit of 15 to, at least, 18 years;

 iv) Planning and implementing counseling services in the educational system with the view to reducing the current high attribution rate of females;

 v) Providing career counseling services in second and third level institutions to enable students especially girls to make appropriate career choices;

 vi) Designing and implementing a coherent long term policy that is likely to create conditions facilitating an increased integration of women in the modern sector of the economy;

 vii) Undertaking feasibility and experiments in respect to micro enterprises, and creating a system for providing technical and credit support to men and women who have the aptitude for engaging in small to medium sized private enterprises;

viii) Making population and family life related education and information widely available via formal and informal media;

ix) Establishing a system for the production and effective distribution of low cost radio receivers and information materials such as posters, flyer and all kings of promotional materials;

x) Amending all laws, impeding, in any way, the access of women to all social, economic and cultural resources and their control over them including the ownership of property and businesses;

xi) Amending relevant articles and sections of the civil code in order to remove unnecessary restrictions pertaining to the advertisement, propagation and popularization of diverse conception control methods;

xii) Ensuring and encouraging governmental and non-governmental agencies involved in social and economic development programs that they incorporate gender and population content in their activities by establishing within their organizations, appropriate units to deal with these issues;

xiii) Establishing teen-age and youth counseling centers in reproductive health;

xiv) Facilitating research program development in reproductive health;

xv) Developing IEC programmes specially designed to promote male involvement in family planning;

xvi) Diversifying methods of contraception with particular attention to increasing the availability of male oriented methods;

5. MAJOR AREAS OF POPULATION ACTIVITIES REQUIRING PRIORITY ATTENTION

 a) Improving the Quality and Scope of Service Delivery:

 Existing service delivery systems are limited in both scope and diversity. At present family planning services are available only through the formal health structure. User choice of methods are restricted by the fact that the contraceptive mix currently available is limited. Steps will, therefore, be taken to expand coverage and afford greater choice of methods to users by:

i) Expanding the diversity and coverage of family planning service delivery through clinical and community based outreach services;

ii) Encouraging and supporting the participation of non governmental organizations in the delivery of population and family planning related services;

iii) Creating conditions that will permit users the widest possible choice of contraceptives by diversifying the method mix available in the country

b) Population Research, Data Collection, Analysis and Dissemination:

Among activities to be given priority attention in programme development and implementation processes is improving and strengthening domestic capacity for generating, analyzing and disseminating demographic and population related information by making more domestic and external funds available to institutions engaged in demographic and population related research and training. In addition, collaboration with foreign research and academic institutions will be actively sought. Further, research activities will focus attention on the study of the complex interrelationship between population factors and development variables. Thus the information generated this way will represent critical inputs in development planning processes and provide relatively more accurate bases for forecasting probabilities and trends of development. Work in this important area will be considerably facilitated by:

I) Enacting laws/regulations making the registration of vital events (marriage, birth and death) compulsory;

ii) Providing existing research institutions (Population Analysis and Studies Center (PASC), the Demographic Training and Research Center (DTRC), etc.) With the necessary technical and material support in order to enable them to process and disseminate data generated by censuses, sample surveys (inter-censal surveys, demographic and health surveys, household consumption surveys, labor force surveys, etc.).

c) Expansion and Strengthening Domestic Capacity for Training in Population:

The requirements for high level technical personnel are currently met by sending men and women abroad for graduate training in demography and population studies as well as providing graduate training in population studies at the Demographic Training and Research Center of the Addis Ababa University. Training of family planning workers is currently provided by the Family Guidance Association of Ethiopia (FGAE) and the Ministry of Health through its institutions for the training of nurses, midwives and health assistants. But in view of the critical need for more trained personnel t man expanded population programs envisaged in this policy it is necessary to expand existing domestic capacity. Accordingly:

- Medical Schools

- Nursing and health assistants= schools

- Junior Colleges

- Technical and vocational schools (e.g. institutions for the training of home economists and teachers training institutions) in order to accelerate the integration of family planning with existing social services, particularly health.

 iii) In-service training for teachers and other development agents will be organized.

d) Expansion of IEC and Social Mobilization:

 Information, Education and Communication (IEC) pertaining to population and development issues play a vital role in increasing popular awareness of the issue of population and development and facilitated community participation in the implementation of programmes. An effective implementation of a carefully designed IEC program calls for the mobilization of all available institutional and manpower resources directly or indirectly involved in the sphere of population and development information. Specifically IEC policy will focus on formulating comprehensive policies and programs that will permit:

 i) A wider and more systematic use of multi-media channels to facilitate the use of population IEC in expediting behavioral change relative to family size, reproductive behavior, reproductive health, family nutrition, personal and environmental hygiene;

ii) The dissemination of population related information through community organizations, interest groups, political bodies, women and youth groups, NGOs, adult education classes, industrial and other work establishments where there is a significant concentration of workers and so on;

iii) The incorporation of population and family life education topics as integral parts of formal education curricula at relevant levels of education;

iv) The incorporation of population related topics in the package of information carried to the rural population by agricultural extension workers, informal community leaders, and other community level development practitioners;

v) The strengthening of the capacity of population and women's affairs units in relevant government development agencies to produce and disseminate IEC programmes.

6. ORGANIZATIONAL MECHANISMS FOR THE IMPLEMENTATION OF THE POPULATION POLICY

The multi-disciplinary Nature of Population Programs:

The population concern touches upon nearly all facets of economic and social life of people. Given the magnitude and complexity of the developmental problems our country faces, it no longer makes sense to justify the enactment of a population policy on health grounds only. Population policy is justified by its multifaceted impact on all aspects of economic and social life. Population/demographic factors have to be regarded as both determinants and consequences of the level of economic and social development. Such an insight of the scope and importance of the role of population in nation building efforts determines the type of organizational mechanism required to effectively implement policies pertaining to it.

In this country population matters have been, heretofore, accorded low priority. The current view that demographic variables permeate all aspects of economic and social life makes it imperative that population policy be managed in such a way that all the relevant sectors of the economy and society are equitably served by it.

Structural Arrangements for the Implementation of Population Policy

In view of the difficulties likely to encountered in ensuring inter-agency concerted action via the option of designating one ministry as a coordinating agency for population matters, the most effective structural alternative, strategically speaking, for the implementation of this policy is to view it as a special sector in the Office of the Prime Minister. This involves two things, namely, the establishment of a National Population Council (NPC) to be chaired by the Prime Minister or a senior official to be designated by him and an Office of Population within the Office of the Prime Minister.

Population activities in this country will be undertaken under the general framework defined by this policy and the technical and programmatic guidelines to be developed by the Office of Population in consultation with the NPC.

Implementation of programmes takes place at the grass roots level and therefore, a close relationship between the Office of Population and other bodies with related functions at the regional, zonal and wereda levels is vital. It is equally important that a clearly defined division of labor be indicated at the outset and once agreed upon adhered to.

Members of the National Population Council:

- The Minister of Planning and Economic Development

- The Minister of Health

- The Minister of Education

- The Minister of Information

- The Minister of Labor and Social Affairs

- The Minister of Natural Resources Development and Environmental Protection

- Addis Ababa University (to be represented by a demographer, sociologist/ geographer)

- The General Manager of the Central Statistics Authority

- Head of the Regional Administration Affairs Sector in the Office of the Prime Minister

- Head of the Women's Sector in the Office of the Prime Minister

- Head of the Office of Population in the Prime Minister's Office

- The President of the Family Guidance Association of Ethiopia

- Two prominent persons in the field

The restriction of membership to the National Council is necessitated by the requirement of efficiency and the need to create a forum for those who are more directly involved in the varied facets of the programme. However, larger groups of interested persons from the regions will be convened, from time to time, to consider basic issues concerning programme implementation and make recommendations about how things may be rectified. The requirement of broader participation in programme management will be further ensured through grass roots involvement in the programme evaluation process. Additionally, to link the activities of the NPC and the Office of Population with the broad spectrum of governmental bodies involved in population and development activities at all levels, such bodies will be convened in a consultative framework at least once a year and as the need arises to deliberate and advise the government on ways and means of facilitating implementation processes.

The National Population Council will be responsible to the Council of Ministers for:

i) Developing specific policies and programs pertaining to population and development to be undertaken in the various sectors of the economy and creating conditions conducive to inter-sectoral collaboration;

ii) Defining a broad legal framework within which population and development related information (IEC) are to be accessible to the general population by various governmental and non-governmental groups;

iii) Reviewing short, medium and long term plans of actions leading to a significant reduction of the current high level of fertility as soon as possible and recommend same for adoption by government;

Functions of the Office of Population:

The Office of Population will be composed of a team of experts in the various dimensions of population activities without whose contribution the goal of harmonization of economic, social and demographic concerns cannot be attained. The Office will be headed by a senior member of the Prime Minister's staff with the rank of Minister who will be directly accountable to the Prime Minister and who can effectively work with personnel of varied expertise and must be vested with considerable authority so as to enable him/her to do effective program enforcement and coordinating work on behalf of the Council through its chairman. The Office will be technically supported by a multi-sectoral committee whose members are to be drawn from a wide variety of institutions .

The Office of Population will have the following duties and responsibilities:

(i) Serving as the secretariat of the National Population Council;

 (ii) guiding the development and articulation of operational programs in the field of population and related activities;

 (iii) Coordinating the activities of the various sectoral agencies (governmental and non-governmental) operating population and development related activities at different administrative levels;

 (iv) Monitoring and evaluating the impact of population programs;

 (v) Promoting policy-oriented national research program on population and development;

 (vi) Ensuring that the programs conducted by various ministries and other agencies comply with the population policy and Council guidelines;

 (vii) Establishing multi-sector technical committee and special task forces as required to assist in the effective implementation of the Policy;

 (viii) Organizing and carrying out national and international events (Conferences, symposia, seminars, etc.) on population issues;

 (ix) Ensuring that inter-sectoral programs in population activities are effectively coordinated by instituting a sound information exchange system;

 (x) Facilitating the effective operation of existing family planning service delivery institutions;

 (xi) Facilitating conditions that will promote the creation of domestic capacity for the production of a variety of contraceptives;

 (xii) Facilitating conditions that will promote the creation of domestic capacity for the production and distribution of materials and equipment to increase people's access to population and development information.

 (xiii) Establishing effective working relationships with international agencies like the World Bank, the African Development Bank, the United Nations Population Fund and other global agencies for the purpose of facilitating the mobilization of technical and material resources that will be useful in goal attainment;

 (xiv) Ensuring the smooth functioning of existing demographic data mobilization systems and establishing new ones including the establishment of nationwide registration systems of vital events like birth, marriage, death and change of residence; etc.

(xv) Strengthening domestic capacity for demographic and population related research and problems by mobilizing internal and external resources;

(xvi) Strengthening national capacity for training demographic personnel by facilitating the mobilization of technical material and financial resources.

Structure at Regional and Zonal Level:

a) Structure at the Regional Level:

The structure at the National level will be replicated downwards through the regional to the zonal levels. There shall be a Regional Population Council (RPC) to be chaired by the Chief Executive Officer of the region or his representative. The members will be:

- The Head of the Regional Office of Population

- The Head of the Regional Bureau for Planning and Development

- The Head of the Regional Bureau for Health

- The Head of the Regional Bureau for Education

- The Head of the Regional Bureau for Environment and Natural Resources

- The Head of the Regional Bureau for Information

- The Head of the Regional Bureau for Labor and Social Affairs

- The Head of the Regional Women's Affairs Bureau

- Chairman of the Regional Branch Association of the Family Guidance Association of Ethiopia

The Regional Council will be assisted by a secretariat to be located in the Office of the Chief Executive of the region. While it is not possible to replicate the staff pattern at the national level, efforts must be made to staff the regional secretariat with appropriate personnel. The size and composition of the regional secretariat must reflect the magnitude and complexity of the tasks to be performed.

Duties and responsibilities of the Regional Population Council:

The RPC shall be responsible to the National Population Council through the Council's Executive Officer of the Region for:

 i) Determining the relevance of population related goals, objectives strategies and ensuring that such goals, objectives and strategies are set taking into account prevailing socio-economic realities in the Region and subdivisions;

 ii) Identifying unmet needs in the sphere of population related activities services and mobilizing regional and zonal resources for the purpose strengthening existing services and creating new ones where they do exist;

iii) Issuing guidelines on ways and means of financing family planning service;

 iv) Consulting with the Office of Population in regard to legislative administrative measures to be taken at the regional level to make delivery more effectively accessible to the peoples of the regions;

 v) Submitting periodic reports to the Secretariat of the National Population Council.

Duties and Responsibilities of the Regional Population Office:

The Office will have the following duties and responsibilities:

i) Serving as the secretariat of the Regional Population Council,

ii) Coordinating the activities of the various sectoral agencies (governmental, non-governmental) undertaking population and development related activities at the regional and zonal levels,

iii) Monitoring and evaluating population programs in the Zones, promoting regionally focused policy relevant research and undertaking research on population and development,

iv) Establishing technical committees as required for the effective implementation of the population policy at regional levels,

v) Providing information as well as advisory and technical assistance on population matters to zonal population Office(s),

vi) Organizing and carrying out events on population issues at regional levels,

vii) Participating, actively, in the collection of data on population and development,

viii) Stimulating community participation through effective IEC,

ix) Undertaking such activities as may be required by the Office of Population at the National level.

b) Structure at the Zonal Level:

There shall be a Zonal Population Council (ZPC). The ZPC shall be chaired by the Executive Officer of the Zonal administration. The members of the ZPC will representatives of ministries/agencies responsible for Planning, Education, Health, and Social Affairs, Women's Affairs and Natural Resources and Environmental Protection at the zonal level. There shall also be a zonal office for and shall be headed by a senior officer to be appointed by the head of the administration and who will also be a member of ZPC.

Functions and Responsibilities of the Zonal Population Council:

Zonal Population Council shall be responsible to the Regional Population Council for the following:

 i) Ensuring that guidelines for the establishment and effective functioning of a system of registration of vital events - marriage, birth, death and migration- throughout the zone are in accordance with principles and formats stipulated by the National Population Council;

ii) Establishing a system for the systematic mobilization of population and related data including those on unemployment and underemployment in accordance with principles and guidelines developed and provided by the National Population Council;

iii) Creating conditions that will stimulate and encourage community participation in population and related activities;

iv) Submitting periodic reports to the Regional Council;

v) Doing such other things as may be required of it by the National Population Council;

 Duties and Responsibilities of the Zonal Population Office

The Office will have the following duties and responsibilities:

 i) Serving as the secretariat of the Zonal Population Council;

 ii) Coordinating, supervising and monitoring all population and development related activities in the Zone;

 iii) Assisting and facilitating the collection of data on population and development and reporting same to the regional population office;

 iv) Ensuring that population related service providers maintain performance statistics in accordance with formats established by the National Population Council;

 v) Evaluating population programmes and activities in the Zone;

 vi) Ensuring that the different bureau representatives at the zonal level and Wereda Committees comply with the National Population Policy in the management of programmes;

vii) Establishing technical committees as required;

 viii) Providing information as well as advisory and technical assistance population matters to wereda population units;

ix) Organizing and carrying out public events (seminars, workshops, etc) population issues at the zonal and Wereda levels;

x) Stimulating community participation through effective IEC;

xi) Performing such other tasks as may be required by the regional and zonal councils.

c) Structure at the Wereda levels

At this stage of the development of the country it is difficult, if not impossible, to visualize specialized structural arrangements of any meaningful degree of complexity at the Wereda level, primarily because of the difficulties likely to be encountered in mobilizing the required technical expertise at this level. However, Chief executive officers at wereda levels may operate through wereda committees on population.

Wereda Committees on Population and Related Activities

The Wereda Committees shall be responsible to the wereda legislative council and the chief executive officer of the Wereda for:

I) Enforcing laws concerning the establishment of population registration systems at the wereda level and ensuring their effective functioning;

 ii) Mobilizing voluntary community participation and support for population and development related activities;

 iii) Establishing mechanisms by which the functions assigned to them are properly discharged;

 iv) Acquiring such technical and material resources from governmental and non-governmental agencies which will permit them to discharge their responsibilities as effectively as possible;

 v) Monitoring and supervising population and development related activities at their levels;

 vi) Facilitating the collection, compilation and reporting of data on population and development;

 vii) Organizing and carrying out public events (seminars, workshops, etc) on population issues at the wereda level;

viii) Submitting periodic reports to the secretariat of the ZPC;

ix) Performing such other functions as may be required by the regional and zonal offices.

7. FRAMEWORK FOR POLICY AND PROGRAMME IMPLEMENTATION

In order to more clearly define the roles of the multiplicity of agencies that are involved in the development, implementation, monitoring and evaluation of programmes, the following organizational format is put in place (SEE FIGURES 1 and 2). There are three major sectors in this format. The first is the policy organ which comprise the Council of Ministers (COM), the National Population Council (NPC), the Regional Population Council (RPC) and the Zonal Population Council (ZPC). The second set comprises the Multi-sectoral Technical Committee and the various specialized task forces called upon to promote technical backup to the policy organs and their secretariats that are responsible implementation. The Office of the Prime Minister (OPM), the Office of Population (OP) and the various administrative and technical units at various levels constitute the executive organs.

8. RESPONSIBILITIES OF VARIOUS GOVERNMENTAL AND NON-GOVERNMENTAL ORGANIZATIONS

The share of each ministry in the implementation of policy and the various programmes emanating from the Population policy are described below.

Ministry of Education

* Introduce population and family life education in curricula of junior and senior secondary schools and in the higher institutions of learning.

* Expand Population and family life education and assist in basic training of IEC through the Educational Media Agency.

* Study the factors militating against female participation in the educational system and design appropriate corrective measurements.

Ministry of Information

* Expand IEC by increasing appropriate air time.

 * Increase coverage of population related materials in the print media.

 * Provide training opportunities to journalists in Demography and/or population studies.

* Strengthen media facilities for a better IEC.

Ministry of Health

* Strengthen and expand existing MCH programs

* Provide FP services at all levels of the health service delivery stations.

* Strengthen reproductive health content in health education programs

* Strengthen and expand training of health personnel in collaboration with relevant institutions.

* Set standards for the provision of family planning services

Ministry of Labor and Social Affairs

* Establish mechanisms within the ministry that will permit the collection and representing of data concerning employment and underemployment.

* Monitor the implementation of legislation of fair hiring and firing practices in various sectors of the economy with particular reference to women.

* Promote understanding of the humanitarian, economic, social and cultural implications of aging of the population for the development process.

* Introduce social services and educational programs to promote the family as integral unit for supporting the elderly.

* Propose and stimulate action oriented programs aimed at guaranteeing social and economic security for the elderly as well as providing opportunities for them to contribute and share the benefits of development.

* Integrate population and family planning elements in the home economics and other related activities.

* Render counseling services for families in relation to family planning.

* Establish conducive population and family planning programs in collaboration with governmental and non-governmental agencies.

Ministry of Housing and Urban Development

* Keep track of trends of change in the demand for housing and harmonize the demand with population trends.

* Design medium to long-term plans for the development of intermediate towns at cities in the context of general urban master plans to stem uncontrollable rural urban migration.

Ministry of Planning and Economic Development

* Incorporate activities related to the implementation of the population policy in the national development plan.

* Encourage and extend technical assistance to sectoral agencies in the integration of demographic variables in development processes.

* Develop guidelines for the incorporation of these variables at both micro and macro planning levels.

* Evaluate and monitor planning activities in the various sectors for the purpose of ensuring that the guidelines indicated above are taken into consideration in their respective planning activities.

Ministry of External Economic Cooperation

* Facilitating the mobilization of external resources for the development and implementation of population programs,

* Monitor, evaluate and follow-up population programmes.

Ministry of Natural Resource Development and Environmental Protection

* Provide training and deploy environmental extension workers,

 * Formulate appropriate environmental education policies particularly addressed to ways and means of stimulating community participation in environmental protection activities,

 * Develop sets of guidelines to be used by local communities in their efforts to use effective water and soil conservation measures and restoring list forest resources,

 * Extend technical assistance to regional, zonal and other bodies to promote effective performance in the areas listed above.

Ministry of Justice

* Revise all laws, government and public practices pertaining to population and demographic issues, amend all legal provisions and practices that have heretofore militated against rational consideration and handling of population and related issues and formulate and enforce legislative measures deigned to be instrumental in eradicating all harmful customary practices such as gender (sex) discrimination,

* Revise all laws, regulations, administrative measures and practices relative to population and related issues,

* Ratify and fully incorporate international instruments and bill of rights into domestic laws,

* Develop legal instruments that will remove restrictions against personal enjoyment of such important civil rights as access to information, education, employment, occupation, housing, health, etc.

* Amend existing laws and ordinances that restrict the right of individuals families to regulate their family size.

Ministry of Agriculture

* Integrate population and family planning elements in agricultural education, agricultural extension programs and services,

* Promote female participation in rural areas in population activities in the context of general rural development programs,

* Provide training to field staff in information dissemination,

* Increase efforts at enhancing agricultural productivity to meet the growing den for food by a growing population.

Ministry of Culture & Sports

* Mobilize, for purposes of promoting population awareness, traditional folkloric, forming arts, as well as modern indigenous theatrical institutions and creative groups and individuals, at the national, regional and community levels,

* Organize and encourage writers, theatrical and other performing groups to participate in the production of promotional literature and public presentations at national regional and local levels.

 Addis Ababa University

* Provide in-service training on issues related to population and development collaboration with other agencies,

* Provide trained manpower in demography/population studies for managing the various tasks related to the implementation of he population policy,

* Engage in varied research activities in the field of population and disseminated findings through appropriate media,

* Assist in the monitoring and evaluation of programs designed to facilitate the implementation of the population policy,

* Provide advisory services in data collection, research, etc.

The Central Statistical Authority

* Collect demographic data through Censuses and sample surveys,

* Facilitate the establishment of vital registration systems,

* Participate in the evaluation and monitoring of population related programs in collaboration with appropriate academic and research institutions,

* Determine patters and trends in gender specific activity rates through labor force sample surveys in both rural and urban areas in collaboration with appropriate academic and research institutes,

* Determine trends in household consumption patterns of basic items and relate same with changes in household sizes in collaboration with appropriate academic and research institutions,

* Publish and disseminate statistical data.

 Family Guidance Association of Ethiopia and Other NGOs

* Expand networks of family planning service delivery by increasing the number of family planning clinics and reaching out heretofore unreached communities with community based distribution and social marketing systems,

* Provide in-service training and contraceptive technology workshops to health personnel involved in family planning service delivery in collaboration with MOH and other agencies,

* Operate controlled trials in new methods of contraception in collaboration with medical research institutions and participating in programs of replication of methods of proven safety and utility,

* Undertake Operational Research Activities in alternative methods of service delivery,

* Introduce gender specific career counseling within the framework of existing counseling services.


This home Page is maintained by Kibruyisfa Achamyeleh
© 1997

0 thoughts on “Case Study Non Birth Control Population Policy Of Ethiopia”

    -->

Leave a Comment

Your email address will not be published. Required fields are marked *