ESS Survey Offers Glean into Ethiopia’s Fast-Changing Demographics

The results of a comprehensive demographic and health survey published this week by the Ethiopian Statistical Service (ESS) highlight the quiet but fundamental changes taking place in health, fertility, education, employment, and socio-economic status as the country shifts gradually toward urbanization and technological adoption.

The Demographic and Health Survey covers a nine-month period beginning August 2024, and was carried out with assistance from USAID, the Global Fund, UK Aid, UNICEF, UNFPA, UN Women, and the Gates Foundation.

In implementation, surveyors opted to subdivide each of Ethiopia’s 19,460 kebeles into what the report calls “Enumeration Areas (EA),” each consisting of an adequate number of households for counting purposes. The survey was conducted in a total of 797 EAs spread across the country, covering both rural and urban areas.

The survey confirmed that the majority of Ethiopians, 42 percent of whom are under the age of 14, still live without adequate access to basic services.

Only 57 percent have access to clean drinking water, while just 40 percent enjoy the benefits of electricity in their homes. Access to basic hygiene services, and clean fuel and technology, remain even lower.

While 62.5 percent of those surveyed reported ownership of farmland (similar figure for ownership of livestock), just 10 percent have refrigerators, while only 3.8 percent own a vehicle, including three-wheel autorickshaws (bajaj).

While the country has made measurable progress in terms of sanitation, the figures included in the survey indicate much work remains to be done.

Less than a third of the population has access to the most basic type of sanitation, while 14 percent has access to “limited sanitation services.” More than a quarter of Ethiopians still practice open defecation, according to the report.

The survey also reflects the country’s shifting demographic landscape, driven by a steady decline in the national total fertility rate. A quarter of a century ago, at the turn of the millennium, an average Ethiopian woman gave birth to nearly six children over her reproductive lifetime.

Today, that national average has fallen dramatically to under four children per woman, signaling a cultural shift toward smaller family sizes and structured reproductive planning. However, the national average masks an immense, stark dichotomy between those living in bustling urban centers and those residing in the vast agrarian interior.

In Addis Ababa, the fertility rate has plunged well below the demographic replacement level, hovering around two children per woman. Meanwhile, in the rural heartlands, where traditional labor structures persist and institutional resources remain scarce, the average woman still bears closer to five children.

This contraction in fertility is intimately bound to the growing availability and acceptance of modern family planning methods, which have seen remarkable progress over the past two decades.

The percentage of currently married Ethiopian women actively utilizing contraception has experienced a nearly fourfold increase since the early 2000s. Injectable contraceptives and long-acting hormonal implants have emerged as the clear options of choice among Ethiopian women, offering discreet and highly effective reproductive control.

Yet, the reach of these family planning networks remains highly fragmented. While regions like Sidama and South West Ethiopia boast contraceptive prevalence rates exceeding fifty percent, more conservative or nomadic pastoralist regions like Afar and Somali report figures that remain locked in the single digits, heavily weighed down by cultural preferences and localized infrastructural vacuums.

The fruits of Ethiopia’s grassroots health extension program are more visible in the indicators of childhood survival. Under-five mortality has plummeted from a peak of 166 deaths per 1,000 live births in 2000 to 51 deaths per 1,000 live births in the current survey period. Infant mortality has followed a similarly steep downward trajectory, while maternal mortality rate sits near 141 deaths per 100,000 live births.

The reductions are largely owed to decentralized childhood immunization campaigns, improved diarrheal disease management, and vitamin supplementation programs implemented across the country’s rural kebeles.

Nonetheless, the survey found that unlike the sweeping reductions seen in older children, neonatal mortality has proved frustratingly stubborn, declining at a far slower pace and now accounting for nearly half of all under-five deaths in the country.

The immediate window surrounding childbirth remains an exceptionally perilous gauntlet for an Ethiopian infant. The survey notes that a staggering 68 percent of newborns nationwide receive absolutely no postnatal health check within the first critical week of their lives. Only about one-third of infants are examined by a skilled professional within forty-eight hours of delivery.

This absence of early neonatal care means that easily preventable or treatable complications, such as neonatal sepsis, birth asphyxia, and hypothermia, frequently turn fatal before a family can seek help.

The challenges continue after infancy.

Even when children survive the immediate dangers of the neonatal period, their long-term developmental prospects remain clouded by localized challenges in preventative care. While the survey shows that treatment-seeking behavior for common childhood afflictions like acute respiratory infections, fevers, and diarrheal illnesses has ticked upward over the last decade, routine immunization coverage is characterized by deeply concerning economic disparities.

The survey found that a staggering 40 percent of children under five are stunted (too short for their age), and 15 percent are severely stunted. Five percent are wasted (too thin for their height), 18 percent are underweight (too thin for their age), and four percent are overweight.

In education, too, the findings paint a stark picture dominated by discrepancies between gender and rural-urban divides.

While urban residents are much more likely than rural residents to be educated, nearly a quarter of females age seven and older in urban areas have no education. The figure rises to a shocking 46 percent in rural areas.

The corresponding proportions among males are 15 percent and 33 percent.

Addis Ababa has the lowest proportions of both females and males with no education (12 percent and six percent, respectively), while the Somali region has the highest proportions (69 percent and 57 percent, respectively).

The report notes that the proportion of women with no education has decreased over time, from 75 percent in 2000 to 33 percent in 2024–25. Still, 43 percent of Ethiopian women aged 15-49 are illiterate, as are 24 percent of men in the same cohort.

The survey found wealth inequality is relatively high in places like Tigray, Afar, Somali, Amhara and Oromia, which together account for the vast majority of the population, while wealth distribution is relatively equal in Addis Ababa, Dire Dawa, South West Ethiopia, and Sidama.

On a related note, just 41 percent of women aged 15-49 are currently employed, as compared with 87 percent of men. The survey found that, among women aged 15-49, the percentage who are currently employed declined sharply from 57 percent in 2000 to 29 percent in 2005 before increasing to 38 percent in 2011 and 41 percent in 2024–25.

The percentage of men who are currently employed has remained at 87 percent since 2000.

“Women aged 15-49 who worked in the 12 months before the survey are primarily employed in agriculture (37 percent) and sales and services (34 percent). Men are most commonly employed in agriculture (55 percent), unskilled manual labour (13 percent), and sales and services (12 percent),” reads the report.

Among women employed in the 12 months preceding the survey, 60 percent of those engaged in non-agricultural work are paid in cash only, 46 percent are self-employed, and 70 percent work year-round. In contrast, among women employed in agricultural work, 81 percent are not paid, 63 percent are employed by a family member, and 59 percent work on a seasonal basis.

Fifty-six percent of women and 46 percent of men are not paid for their work, according to the report.

Only 36 percent of women in Ethiopia have a bank account they use, 49 percent own a mobile phone, and just 12 percent used a mobile phone for financial transactions in the 12 months prior to the survey.

Among the survey’s other eyecatching findings are the high rates of death and injuries due to non-traffic accidents. In Tigray, these accidents claim the lives of 704 per 100,000 population, followed by Gambella (467 per 100,000 population).

“The majority of deaths or injuries…that were not due to road traffic accidents were accidental (60 percent), followed by those due to conflict (13 percent). Twelve percent of deaths or injuries were due to violence/assault and eight percent to natural disasters,” reads the report.

Meanwhile, the number of deaths due to road traffic injuries is eight per 100,000 population, with males more than six times more likely to be involved in a fatal traffic accident. Motorcycle accidents are the most common road traffic accidents, accounting for more than half of those killed or injured in the 12 months preceding the survey.

“Ethiopia faces a major road safety crisis driven by rapid urbanisation, increased vehicles, and weak infrastructure, with reported traffic fatalities (mostly among pedestrians) ranging from 3,000 to 3,600 annually (although numbers are likely higher as a result of underreporting),” reads the report.