Ethiopians Seeking Birth Control: Caught Between Church And State

Hide caption Worshippers stream through downtown Addis Ababa, Ethiopia, toward Bole Medhane Alem (Savior of the World) Cathedral, the largest Orthodox church in Africa. Previous Next Allison Shelley for NPR

Hide caption Participants sing during a wedding ceremony at Bole Medhane Alem (Savior of the World) Cathedral in Addis Ababa, Ethiopia. It's Africa's largest Orthodox church, and its message on contraceptive devices is clear: not permitted. Previous Next Allison Shelley/Allison Shelley for NPR

Hide caption A woman waits for a family planning consultation at the Family Guidance Association's Model Sexual and Reproductive Health Clinic in Addis Adaba. She's wearing a necklace that displays a symbol of the Ethiopian Orthodox Church. Previous Next Allison Shelley for NPR

Hide caption Worshippers pause before entering Bole Medhane Alem Cathedral. Previous Next Allison Shelley for NPR

Hide caption A couple walks by billboards advertising family planning methods in Addis Ababa. Previous Next Allison Shelley for NPR 1 of 5 i View slideshow

Her head draped with thin white fabric in the Ethiopian Orthodox tradition, Konjit walked to the stately entrance to the Holy Trinity Cathedral in Addis Ababa. But the soft-spoken 26-year-old did not go inside to pray because of her "sin." Days before, she had had an abortion; she had become pregnant after her birth control failed.

Like many women in Ethiopia, Konjit felt caught between two powerful forces when making decisions about reproductive health: the church and the state [note: we are using only her first name to protect her privacy].

The Ethiopian Orthodox church, established in the 4th century, officially prohibits any form of contraception that interferes with a woman's hormones, including pills, implants, intrauterine devices and shots. So the implant she got that week is definitely not sanctioned.

Abba Gebere Mariyam Welde Samuel, a 35-year-old priest at the Holy Trinity Cathedral, explained, "The Bible doesn't allow the use of pills." The only form of birth control the priests recommend is the natural method — abstaining from sex on Orthodox feast days — there can be up to 250 in a year — and when women are fertile.

And the church has a mighty reach: 43 percent of the 91.7 million Ethiopians are adherents.

Yet the number of Ethiopian women using hormonal birth control has steadily increased, from 8 percent in 2000 to 29 percent in 2014. This trend attests to the power of the government.

The ministry of health put a priority on family planning in recent years, investing in a decade-old community health worker program, and increasing funds for family planning. Foreign aid followed; Ethiopia was the largest recipient of family planning assistance in sub-Saharan Africa since 2000. The global health world, which convened in Addis Ababa in November 2013 for an international family planning conference, celebrated Ethiopia as a model of success.

"We are lucky with that we don't have a strong opposition from the religious institutions," Minister of Health Dr. Kesetebirhan Admasu said in an interview.

That's not totally accurate. Many, though not all, Orthodox leaders express opposition to the family planning programs. But in authoritarian, one-party Ethiopia, the church can't really openly oppose the state.

"They wouldn't go against the government," said a public health NGO worker, who spoke on background. "Not unless it was something really serious."

When pressed, Admasu described a "kind of gentleman's agreement we have with the church leaders."

Admasu explained that even though the church can't directly advocate against government policies, it can promote alternatives. So in the struggle against AIDS, the church could not stop government promotion of condoms but did push for abstinence. As for birth control, the church pushes natural methods rather than preaching against hormonal contraception.

"There are so many things we cannot challenge," said the Rev. Daniel Seifemichael, a theology professor at Holy Trinity College in Addis Ababa.

So the church works through its own channels, advising congregants directly and through sermons that while managing the family and providing for children is important, the permissible way to limit births is through natural means.

Women like Konjit hear two voices: the Orthodox preaching against birth control methods like her contraceptive implant and public health messages on the radio proclaiming that family planning is better for her family's health and finances.

The conflict between the church and the state policies on contraception was enough to make her feel guilty but not enough to change her mind.

As her two boisterous kids ran around the churchyard, Konjit expressed her determination that they stay in school longer than she did — she dropped out after sixth grade. And she described the challenge of supporting a family on her taxi driver husband's meager earnings.

While she was able to reconcile her faith with her choice, she had not reconciled with her husband. He did not know she chose the abortion; she told him she had a miscarriage. Nor does he know that she was using birth control. He wants her to have more children. "We would get divorced if he knew," she said. "He needs lots of children."

But neither the church nor her husband's wishes have changed her stance. Her shy smile belied a firm resolve. "We shouldn't have too many children in the world if we can't support them."