Marie Stopes has been in Ethiopia for eon. It has provided safe abortions and a slew of healthcare services for thousands of women in Ethiopia. Risha Hess, the Country Director of Marie Stopes Ethiopia reflects with Samuel Getachew of The Reporter on the local mission of the international organization, what makes it an essential service, on its long history and on some of its pioneering capacity building programs within Ethiopia. Excerpts:
The Reporter: There is much misunderstanding going on in Ethiopia when it comes to Marie Stopes – many see it as a strategic partnership to control population growth while others sees is as a way to provide better health to women who cannot otherwise afford modern abortion. How do you define the role of Marie Stopes in Ethiopia?
Risha Hess: Marie Stopes International Ethiopia wants to enable Ethiopian women to have children by choice, not chance. Our mission is to give people a choice: the choice of when to have children, the choice of what type of family planning methods to use, and the choice of where and how to get them. The people who turn to us – our clients – are at the center of everything we do. By giving them choices, we are helping them to take control of their lives, and to achieve their dreams. Marie Stopes International Ethiopia is committed to delivering high quality, voluntary family planning and reproductive healthcare to women and families. In all our work, our clients’ needs are uppermost. We treat each person who comes to us as an individual and give them impartial advice, so they can make the best choices for themselves and their families. This is the only motivation for our services.
What makes the services of Marie Stopes essential to the Ethiopian society?
As recently as 15 years ago, the wards in hospitals like St. Paulo’s were filled with women dying of sepsis due to unsafe abortions. Indeed, unsafe abortions were the number one cause of maternal deaths. Through the efforts of the Ministry of Health and partners including MSIE, complications due to unsafe abortions have dropped significantly and are no longer the number one killer of mothers. The latest DHS in 2016 showed that this contributed to a 30 percent decrease in maternal deaths in Ethiopia in just five years; a remarkable achievement. Marie Stopes is proud to have been part of this.
It has been almost 30 years since the opening of the Ethiopian office. What have been the highlights so far?
Our clients are at the center of everything we do: through our innovation and partnerships, underserved women and couples are able to access services and make choices about their sexual and reproductive health. By providing high-quality services where they are needed the most, we prevent unnecessary deaths and make a sustainable impact on the lives of millions of people every year. What excites us is the impact we bring about through our work. In 2017 for example, we prevented 242,941 unintended pregnancies and 1076 maternal deaths.
There were widespread articles announcing the demise of the Ethiopian office and that has proven untrue. What started the confusion?
This was a very unfortunate situation that caused unnecessary concern for hundreds of women and families for whom our services are critical. Our doors are open for business and we are not in any way at risk of closing, as the vital, lifesaving work we do is too important. To our understanding, the misleading statements came from confusion between regulatory agencies. We are properly licensed and regulated by the Charities and Societies Agency and as they have publicly stated, we are in compliance.
I have to ask you about the leadership of Marie Stopes International. This is the same question I also ask the executives of the lone feminist bank in Ethiopia, Enat Bank. Like Enat, the current president, as well as the founders of Marie Stopes is all men. Can men effectively run a feminist organization; understand the rights of women such as Marie Stopes?
What a great question. Marie Stopes International was started in Ethiopia by Getachew Bekele, who is a passionate defender of the rights of women in Ethiopia. Feminism is not just a women’s issue. I think the key is to have the voices of women in leadership and decision-making positions. Just having myself as a female country director is not enough. We still need to work to ensure that there is adequate representation of women’s voices in our senior management team and at every level in the organization.
Marie Stopes is not an entirely non-profit institution. How do you differentiate who should and should not pay, in a society where people with deep pocket prefer to go to higher-end private clinics?
You are correct; Marie Stopes is a bit of a hybrid. We are fortunate to be working in Ethiopia where the government has seen that dependency on foreign donors leaves us at their whim. When countries move towards middle-income status, we see donor withdraw. Therefore, the income-generative activities (IGA) directive was issued and Marie Stopes was the first INGO to register for it, allowing us to charge for services as long as we pay taxes and all remaining profit goes back to charitable activities (such as providing waivers for women who cannot pay). Essentially this means that when a person pays for services at a Marie Stopes clinic, they are also helping poorer women access these services. If a woman comes into one of our clinics, we have a price list displayed and a note that if they cannot afford the services they should talk to us to see if they are eligible for a waiver or voucher.
Who funds Marie Stopes?
We have a variety of donors from foreign governments and private foundations. Additionally, any paying client at a Marie Stopes clinic is subsidizing the costs for those who cannot pay.
What is the process of going through the abortion process at Marie Stopes? Are there adequate counseling, after care to its clients?
Our work providing comprehensive abortion care is underpinned by our passionate commitment to save and improve women’s lives.The people who come to us are at the heart of everything we do. We treat each person as an individualand give them impartial advice, so they can make the best choices for themselves and their families. Part of safe abortion care is a six-week follow-up visit. At any time, any person can call 8044 for free and speak to a health care provider if they have any questions or concerns.
In a society where the need is much and resources scarce when it comes to the social safety net of its populations, how do you ensure some of your services are adequately allocated to those who need it most?
Marie Stopes strives to reach women and families throughout the country by meeting them where they are. For rural populations, we have 13 mobile teams who can provide free services and we train and support the government providers to ensure the highest quality services are available. For peri-urban communities we support the expansion of services and ensure quality by working with 321 BlueStar clinics and for urban populations we run 20 Marie Stopes medium clinics and four maternal and child health clinics. We also partner with groups who work with vulnerable populations, such as Addis Ababa Woman’s Associations and various safe houses to provide referrals for free services.
There is the hotline – 8044 – for women to call for some health advice. Is it meeting its target audience?
Currently 8044 serves several thousands of callers every month. Our counselors are health care providers themselves and are trained to support each of our clients as an individual and give them confidential, independent and impartial information on a full range of reproductive and maternal health services in order for them to make the choice that is right for them.
Marie Stopes claims to reach about 360,000 Ethiopian women yearly. That is a huge number. How are you targeting this many people and what are some of the services that are been accessed by them?
Further to the family planning and reproductive health services we provide in our Marie Stopes clinics, the BlueStar social franchise clinics,rural outreach and public sector work mentioned earlier, we also are in the second phase of our ‘Fit for Work’ program which entails supporting large private profit companies to provide increased access to quality sexual reproductive health services to their employees through training of their onsite workplace clinics or funding service uptake at nearby supported clinics. This allows us to reach and serve a vast array of women from all walks of life who need our essential services.
Tell me about your BlueLoan financial initiative program?
BlueLoan is an opportunity we provide for our highest tier BlueStar franchisees, allowing them to access loans to increase their capacity (usually investments in equipment and infrastructure). It is one of many benefits of being part of the BlueStar network andrewards private clinics who provide exemplary care to their clients.
Ethiopia continues to graduate record number of medical professionals with attractive competitor to the private sector. How do you entice the next generation of Ethiopian doctors to work in idealist medical institutions such as Marie Stopes?
We believe in the work that we do. Many health professionals are aware of the dire consequences for women if these services were not made accessible and are passionate about allowing women to have access to them. So, we don’t have a lot of work to do in the aspect of enticing these men and women who have dedicated their lives to providing these services to their communities.
