Macro-level facilitators and impediments to fertility transition in Ethiopia: implications for reorienting family planning towards sustainable development

Fertility transition is essential for health and development, yet Ethiopia continues to face high fertility and rapid population growth. Due to limited evidence on macro-level derivers of fertility, this study assesses Ethiopia’s readiness and implementation capacity for fertility transition, alongside structural and programmatic barriers. A convergent parallel mixed-methods design was used, combining 14 key informant interviews with reviews of national policies and demographic data. Informants were purposively selected from Federal, Regional States, and Non-governmental institutions. Thematic and content analyses followed a predefined framework covering political commitment, legal and policy integration, institutional coordination, and implementation outcomes. NVivo 14 was used for coding, while policy texts and official speeches were systematically mapped and triangulated with fertility trends from national surveys and census data. Over the past three decades, Ethiopia has recognized the burden of high fertility, endorsed global agendas, prepared policies, and has achieved substantial expansion of services. Consequently, the CPR rose from less than 5% in 1990 to 42% in 2019, and the TFR dropped from 6.4 in 1990 to 4.1 in 2019. However, the transition is dominated by periodic declines without substantial changes in completed cohort fertility, preference for low fertility, and limiting behaviors, which are rooted in limited domestic political advocacy, weak multisectoral coordination, and blurring of the fertility, population, and development agenda from the family planning services. Slow development and economic transformation, pronatalist norms, and political instability can hamper further fertility decline. Ethiopia’s period fertility decline has been derived by supply and service expansions rather than a fundamental shift in preference for low fertility and the power to do so. Accelerating the transition and prevention of stalling requires reorienting the right-based family planning into informed, voluntary, and autonomous demand for low fertility, which integrates reproductive rights with development goals, through family planning-population-development nexus.