In his article "Population, Development, and Environment in Ethiopia," Sahlu Haile, senior program advisor and Ethiopia country representative for the Packard Foundation, wrote that Ethiopia's runaway population growth and declining natural resources are undermining the country's health systems and development. Citing "inaction, disinterest, and ambivalence by senior officials" in dealing with the country's population problem, Haile wrote, "Ethiopia's leaders must make a strong commitment to family planning and reproductive health at all levels. Without such commitments, local programs may make progress, but will not make a dent in the overall population situation." Published in Environmental Change and Security Project Report 10, Haile's piece won the Population Institute's 2005 Global Media Award for Best Population-Environment Reporting, and stands today as a benchmark for what has—and hasn't—changed about Ethiopia's population policies.
At an Environmental Change and Security Program and Africa Program event on March 6, Haile accepted the Global Media Award from Population Institute President Lawrence Smith, who said, "We recognize this [article] as a major contribution because [Haile] synthesizes the issues that plague much of Africa and much of the developing world." Haile said, upon learning of the honor, "This [award] will make an invaluable contribution to our efforts to mainstream population and environment issues in the national development agenda."
Two years have passed since Haile first wrote the article, and the situation in Ethiopia, he said, remains unchanged. Two million people are added to the population each year—roughly 38,000 per week—and Ethiopia recently surpassed Egypt to become the second most populous African nation, behind Nigeria. "Although the government is investing considerable amounts of resources for social services, including health and education, this is being neutralized by the number of new people needing new services," Haile said.
Agriculture, the mainstay of the Ethiopian economy, has become a source of great turmoil. Land once apportioned in hectares is now doled out in square meters. According to Haile, land apportionment issues have compounded as crops become unsustainable, leaving less food and less money: "Deforestation, soil erosion, and the resulting shortage of bread and water is creating conflict among people who have been living peacefully together for years."
U.S. Ambassador to Ethiopia David Shinn, who also spoke at the event, pointed out that crops and food production must increase significantly each year just to feed the additional two million mouths added to the population. "This is an enormous cost to any government or to any society, to have to take care of that many new people," Shinn said, adding that this is a problem even when drought is not a factor: "During a good rain year Ethiopia has a structural food deficit of 4 to 6 million people…and in a bad rain year, which has been the case, the deficit gets worse."
Since Haile's report, the Ethiopian government adopted the Millennium Development Goal of reducing poverty by 2015. Programs have been implemented to improve the health care and education sectors, but population policy remains largely uncharted. "I think it is just not a priority. It simply hasn't risen to the level of other problems" for the government, Shinn said. Only in the past year, Haile noted, has the government begun to acknowledge how great an effect population has on development. He quoted a December 2005 report from the Ministry of Finance and Economic Development: "A crucial mechanism, which has perpetuated poverty in Ethiopia, is the interaction of … population pressures with environmental fragility." In addition, the government's 2005 Poverty Reduction Strategy Paper states that "population growth remains the major barrier to poverty reduction."
Improving reproductive health, Haile and Shinn agree, is key to reducing population growth. On average, women in Ethiopia bear six children. Haile noted that 78 percent of women want to space their children or end childbearing, but have no means to do so. Due to recent health care improvements, infant mortality has dropped more than 25 percent and contraceptive prevalence has increased by 250 percent over the past five years. Yet the overall figure is still meager: only 15 percent of the population has access to birth control. However, Haile noted that during a recent trip to southern Ethiopia, he learned that two regional governments had budgeted for reproductive health activities for the first time.
Despite these improvements, Ethiopia's health care sector struggles with a unique challenge: how to manage a system currently flush with AIDS funding, but little else. "For the last 10 years we've been fighting for resources to deal with HIV/AIDS," Haile said. "Now we are inundated with them. And I am starting to doubt whether our health system can support such a huge amount of money coming into [it]." Ethiopia's HIV/AIDS budget is bigger than the country's entire health care budget, he said, noting that health workers regularly leave their original posts for the AIDS sector because of its significant funding. "Will this sector be at the cost of mothers and children?" he asked. "Will it be at the cost of the malaria eradication program?"
While HIV/AIDS is surely an epidemic in Ethiopia, one attendee mentioned that the forthcoming Demographic and Health Survey (DHS) will report that the HIV/AIDS infection rate is much lower than previously thought: improved testing and reporting practices reveal a more accurate estimate of 4.4 percent, rather than 12 percent. While this data appears hopeful, the global health community remains skeptical. Another attendee said, "I see nothing to suggest that we should be less concerned about HIV/AIDS in Ethiopia than we are now."
With all the resources for fighting HIV/AIDS, Shinn noted that there is no reason why related health care cannot be integrated into Ethiopia's AIDS strategy. During his time as ambassador, Shinn said he heavily promoted family planning and asked the government to link it to HIV/AIDS. "These are clearly programs that go hand in hand," he said. "You're dealing with the same kind of outreach in the case of both HIV/AIDS and family planning."
The 2005 Human Development Index, which ranks countries based on life expectancy, education, and standard of living, placed Ethiopia at 170 out of 177. Mentioning this ranking, Shinn said that Ethiopia's problems are many and complex. Yet, he also noted that many of these problems could be made less severe with population control: "It is clearly easier to make life better if you have fewer people to make life easier for. If you can reduce the growth rate to something more manageable, you have a better time achieving your goals."
Drafted by Alison Williams.