PSI Ethiopia
4 min readAug 30, 2023



Author: Yonatan Tamiru, Communication and PR Specialist, PSI Ethiopia and Fana Abay, Marketing and Communications Director, PSI Ethiopia


Our world is characterized by a rich web of sociocultural, religious, and economic facets. The interplay of religion, cultural experiences, and social norms significantly influences society’s perceptions and understanding of several important life issues, including sexual and reproductive health and family planning. The Afar region of Ethiopia is an example of this, with its pastoralist community possessing a distinct sociocultural and religious viewpoint.

The Afar region is known for having one of the lowest rates of using modern family planning methods. According to EDHS 2019, only 13% of married women (ages 15–49) in the Afar region use modern family planning methods, compared to the national average of 41%. Several factors contribute to the low use of modern contraceptives in Afar; one major factor is the contrasting views of childbearing and family planning. In Afar, children are symbols of prosperity and divine blessing, and having more children is considered a greater blessing, and using contraceptives is seen as hindering God’s plan and sin.

Despite efforts by the regional health office to address these sociocultural and religious-based concerns, results still need to meet expectations. Therefore, the Roadmap to Integrating Smart Start in Ethiopia (RISE) program aims to address sexual and reproductive health needs in the Afar region through a tailored program that addresses sociocultural and religious barriers.

Adapting “Smart Start Counseling” for the Afar Region

The RISE program is a groundbreaking program that addresses the sexual and reproductive health needs of married adolescent girls ages 15 to 19 through an innovative approach called Smart Start. To better serve pastoral communities in Ethiopia, the RISE program adapted the Smart Start counseling approach to the Smart Start Family Circle. This community-specific adaptation involved married adolescent girls, couples, traditional birth attendants, religious and clan leaders, and health workers. By actively involving these stakeholders, the Family Circle model is developed by the community for the community.

One of the essential elements of the Family Circle model is promoting open dialogue among community members and dispelling myths and misconceptions about family planning and modern contraceptive methods. Influential community members such as traditional birth attendants (Ultatinas) and religious and clan leaders are encouraged to address couples’ and community members’ questions and concerns about family planning. The story of Sheikh Ali, a spiritual leader, illustrates the impact of community influencers in advocating for sexual and reproductive health.

Sheikh Ali: a religious leader and a champion of sexual and reproductive health.

Sheikh Ali Alhamdu Mohammed

Since the launch of the RISE program in the Aysaita Woreda in Afar, Sheikh Ali, a religious leader, has addressed community concerns about family planning and modern contraceptives. Sheikh Ali admits he initially had reservations about advocating for family planning in his community. He said, “I thought it was against our culture and religion to discuss sexual and reproductive health and promote modern contraceptives.”

Health experts like Hussein, who oversees the RISE program in Afambo Woreda, take a lot of time to educate the community about the value of family planning and the use of modern contraceptives for maternal and child health. They also address misconceptions and concerns about modern contraceptives, such as infertility. Sheikh Ali emphasized the value of his conversation with Hussein: “The health expert in our community helped us understand the importance of family planning and contraceptive in providing health solutions for our community under Allah’s teachings.” The insightful conversation with Hussein significantly changed Sheikh Ali’s perception of family planning and contraceptives, leading to a new understanding and acceptance of the importance of contraceptives in enabling couples to make informed family planning decisions. Sheikh added, “In Islam, it is forbidden to have children unless you have the financial means to provide for them. Yet young couples often struggle to determine when to have children.”

According to Sheikh Ali, the negative attitude toward modern contraceptives in the community is due to a misunderstanding of religious teachings and a lack of awareness of the health benefits of family planning. He stresses the importance of religious leaders changing their communities’ attitudes toward family planning. Sheikh Ali underlines his support for the RISE program: “Most of you may think that I support the program because I am closely associated with it, but the truth is that the program is a great support for me because it provides the community with sexual reproductive health knowledge and contraceptive options they need.”

Tesfu Matiwos, the RISE program Institutional Advisor for the Afar region, highlights the influence of religious leaders, “The role of community influencers has been immense and crucial to the success of the Family Circle program. We can confidently say that religious leaders and other community influencers are bringing positive change in the health sector.”

Through his advocacy, Sheikh Ali has been instrumental in creating a safe space for married girls and couples to talk openly about sexual and reproductive health, including family planning. His active involvement with the RISE program includes attending community meetings organized by the local health department, where they work together to address the sexual and reproductive health needs of their community. Following the introduction of the RISE program in Aysaita Woreda, contraceptive use among 15- to 19-year-olds increased by 59% (145 users from January 2022 to August 2022 compared to 231 users from August 2022 to April 2023).

Sheikh Ali is one of many local voices making significant contributions to changing opinions and views on sexual reproductive health and family planning. By working with these influential figures, the RISE program has promoted a more inclusive and comprehensive approach to advancing sexual and reproductive health and addressing misconceptions and traditional norms in the Afar region. Now married adolescent girls and couples have the knowledge, support, and access to sexual reproductive health and family planning services.



PSI Ethiopia

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