DEVELOPMENT IMPERATIVES

Barriers to Sexual and Reproductive Health (SRH)

Despite global progress, millions of women and girls still lack access to essential SRH services.

• 218m women worldwide want to avoid pregnancy but are not using safe and effective contraceptive methods (UNFPA, 2022).
• 1 in 3 women experience unmet need for family planning in Sub-Saharan Africa (WHO, 2023).
• Limited access leads to unintended pregnancies, unsafe abortions, and maternal deaths, undermining community health and economic stability.

Reference: UNFPA State of World Population 2022; WHO Family Planning Fact Sheet 2023.

SRH Challenge: Balancing Access, Cost, and Sustainability

Ensuring reliable access to essential SRH products in Ethiopia remains complex.

• High reliance on imports means medicines and health commodities consume significant foreign exchange, placing pressure on national reserves (Marew et al., 2022).
• Public procurement systems, though designed to maximize equity through free provision, face challenges such as high transaction costs, centralized warehousing, and distribution delays that make it difficult to consistently meet community needs (Getahun et al., 2025; Bilal et al., 2024).
• Private-sector participation remains limited, as donor subsidies and free public supply can unintentionally reduce incentives for local investment in manufacturing, distribution, and innovation.
• The result is a dual reality: while free public supply is essential for equity, women and youth often face stockouts at facilities, higher costs in private pharmacies, or long travel distances to reach services.

References: Marew et al., 2022; Sisay et al., 2021; Getahun et al., 2025; Bilal et al., 2024.

Gender Inequity & Economic Exclusion

Women’s potential is constrained by systemic barriers to education, resources, and opportunity.

• Globally, women earn 20% less than men on average (World Bank Gender Data Portal, 2023).
• Women perform 76% of unpaid care work (ILO, 2022), reducing their ability to participate in formal economies.
• Only 15% of landholders in Africa are women, despite their central role in food production (FAO, 2021).

References: World Bank Gender Data Portal; ILO Global Care Report 2022; FAO Gender and Land Rights Database.

HIV Burden and the Gap in Prevention Awareness

Ethiopia continues to face a significant HIV burden, particularly among young women and key populations. While treatment programs have expanded, prevention remains under-prioritized, and awareness about new prevention methods is very limited.

• An estimated 610,000 people are living with HIV in Ethiopia (UNAIDS, 2023).
• Women account for over 60% of new infections, with adolescent girls and young women (15–24) at two to three times higher risk than their male peers (UNAIDS Ethiopia Fact Sheet, 2022).
• Communication gaps are a major barrier: reproductive-age women in “hotspot” regions with low media access show significantly lower knowledge of HIV/AIDS (Agegnehu & Tesema, 2020). Even among testing service users in Gondar, knowledge and preventive behaviors remain suboptimal (Terefe et al., 2023).
• Vulnerable groups face even higher risks: only about 36% of street dwellers reported practicing HIV prevention behaviors (Wassihun et al., 2024). Female sex workers in Ethiopia also remain disproportionately vulnerable, with HIV prevalence estimated between 20–25% in urban centers (UNAIDS, 2022).

These findings highlight two urgent needs:

1. Strengthened communication and awareness campaigns — to build demand and normalize HIV prevention across diverse communities, using locally resonant, positive messaging.
2. Development of channels for introducing new HIV prevention products — particularly PrEP (oral and injectable) for key populations such as sex workers, young women, and high-risk youth.

References: UNAIDS Ethiopia Country Fact Sheet 2022; UNAIDS Global AIDS Update 2023; Agegnehu & Tesema, 2020 (BMC Public Health); Terefe et al., 2023 (HIV/AIDS – Research and Palliative Care); Wassihun et al., 2024 (PLOS Global Public Health); Muschialli et al., 2025 (Systematic Review of HIV Communication Campaigns).

Climate Change and Fragile Supply Chains

Women and youth in low-income communities are disproportionately affected by climate shocks and weak health/product supply systems.

• Climate change is expected to push 132 million people into poverty by 2030 (World Bank, 2020).
• In Sub-Saharan Africa, 70% of medicines and SRH commodities are imported, leaving systems vulnerable to disruptions (UNCTAD, 2021).
• Rising transport and energy costs make last-mile health delivery unaffordable and unreliable.

References: World Bank Climate Poverty Report 2020; UNCTAD Trade and Development Report 2021.