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Originally published Thursday, February 12, 2009 at 4:47 PM

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The high price of drought and lack of family planning

With the threat of another long-term famine in Ethiopia, CARE CEO Helene Gayle argues women need more access to family planning services. These options help women make informed decisions, so fewer lives hang in the balance each time rain gauges go dry and food prices soar.

Special to The Times

FATUMA Abrahim's mother never has had much in the way of choices. She can't make it rain, force crops to sprout from the parched earth or bring down the high price of food. Consider that the cost of a sack of corn in the Ethiopian village where Fatuma lives has increased eightfold in just two years. As 8 million people now face starvation, mothers like Fatuma's are confronted with the worst kind of choice: which child gets the last piece of bread-like injera.

Last month, 11-year-old Fatuma came to a health clinic weighing half what she should. Whereas families in America spend about 10 percent of their household income on food, poor families in countries like Ethiopia spend approximately 75 percent on food alone. As crops failed and food prices rose, households like Fatuma's could not afford to buy enough food for the family. Malnutrition rates are rising among children and expectant mothers, fueling fears that child and maternal mortality will increase.

To alleviate the suffering, more immediate relief is needed in the short-run. But a greater focus must be placed on the underlying causes of poverty and a fix that endures. It's helpful sometimes to put aside what people have no control over, like the weather and commodity prices, and empower them with something in their reach — the size of a family, for example.

In a country where far too few women have access to family planning or a say in whether to space out their children, many mothers are facing their worst fear. They have dwindling resources and too many mouths to feed. As a result, 25 years after the mass starvation that prompted Live Aid, the stage is set for another hunger crisis in Ethiopia. Only now the population has nearly doubled to 80 million.

Much of that growth has come in the form of families such as Fatuma's. She's one of eight children. Or at least she was. Just after Fatuma's arrival at the CARE-supported clinic, one of her sisters died in their mother's arms. And despite the family's best efforts to ration, the sorghum they harvested is about to run out, portending more trouble ahead.

In Ethiopia, which has one of Africa's highest marriage rates, 19 percent of girls marry by the age of 15. Most are expected to give birth nine months later. At that age, girls are twice as likely to die during childbirth than a woman in her 20s. In Ethiopia, one in 24 women dies during pregnancy or childbirth. Unfortunately, it's still not acceptable to discuss family planning among adolescents or unmarried women.

There is good news, however. The use of modern contraception in 1,250 villages where CARE works has shot up from 5 percent in 1996 to 30 percent in 2005, well above the national rate of 14 percent. And one taboo has been broken. The mere mention of family planning once got some women beaten with a stick. Now couples are discussing options and the relationship between family size and quality of life. To build on this momentum, more champions must support the government's efforts to educate youth and help drive consensus to give family planning a chance, for everyone.

Educating families, providing access to contraceptives and challenging cultural norms will not provide immediate relief. These tools alone will not prevent history from repeating itself. But they will provide a critical element that is missing in Fatuma's life. They help provide choices. When people like Fatuma and her mother are empowered to make informed decisions, fewer lives will hang in the balance each time rain gauges go dry and food prices soar.

Helene Gayle, M.D., is the president and CEO of CARE. She previously was director of the Gates Foundation's HIV, TB and Reproductive Health program in Seattle.

Copyright © 2009 The Seattle Times Company

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