Demographic Transitions and Social Change Helping Achieve Health/Nutrition MDGs in Ethiopia: Sustaining These and Reducing Disparities

Ethiopia is a positive deviant in terms of most of the health MDGs: despite being a very poor, mainly rural and food insecure country with high female illiteracy, it is on track in 2011 to achieving both the underweight and under-five mortality MDG goals. In the 1990-2011 period, underweight has fallen from 46 to 29%; and U5MR from 210 to 88. While many claim that this can be attributed mainly to innovative and rapidly scaled up rural health sector interventions, our research shows that other non-health program social and demographic factors have enabled these achievements. The social change factors  include: sharp rise in female literacy and primary school attendance, individual selection of marriage partner; rise in age at first marriage, rise in protestant religious affiliation, higher youth aspirations, greater paid work force participation and socio-technological networking. The fertility transition and changing demographic structure since 1990 include: decline in TFR from 6.6 to 4.8; lower desired mean family size norm from 6 to 4; lower annual population growth (from 3.1 to 2.5%);  lower percentage of the population 0-5; sharp rise in age at first pregnancy; reduction in percentage married among women 15-49; increase in migratory movement (rural-urban migration and temporary/labor migration);  increase in percent urban, and increasing population/land/environment pressure. We present the trends, pace and magnitude of these changes, with projections to the year 2015, and both bivariate and multivariate analyses. Major disparities by rural-urban location, wealth, education, region and ethnicity still exist, but some of these are being reduced. Major challenges remain in lowering the high maternal mortality and chronic stunting. This suggests that sustaining the under-five mortality and underweight MDG achievements, and reducing maternal mortality, as well as the inequities, are best done through multisectoral policies that promote social and demographic change and reduce vulnerabilities.