Coffee and contraception; linking health education to coffee drinking

Ethiopia is one of the biggest coffee producers in the world, a fact that Ethiopians are eager to share with you. They are very proud of their rich coffee culture and are happy to invite you over for a so-called ‘buna ceremony’ (coffee ceremony). The word ceremony here is to be taken seriously and sharing a coffee usually entails an undertaking of an hour easily. The coffee will be freshly made on the spot; green beans get washed, roasted, pounded and then the coffee is brewed. Drinking less than 3 cups is considered rude. Oftentimes injera, the other Ethiopian pride in terms of food and beverages, will accompany your drink, as well as freshly made popcorn. Being invited over for coffee therefore usually means your thirst and hunger will be quenched and satisfied completely.

Even though coffee is one of the major pillars of the Ethiopian economy, for the ordinary rural inhabitant a cup can be a real treat, due to the relatively high price. Often it is reserved for guests and used to accompany important life events. Working as the gynaecologist of a rural Ethiopian hospital, I noticed that one of these major events is the delivery of a newborn baby. Whenever women leave the hospital, a buna ceremony will be held in their house to celebrate the successful outcome of the pregnancy (a celebratory custom comparable to the eating of ‘beschuit-met-muisjes’ in the Netherlands, if you will).

Since it has such an important cultural meaning, one of my preceding tropical doctor colleagues introduced the coffee ceremony in the maternity ward. Until recently it was only being held occasionally, but I decided to make it a weekly event. I was hoping it would draw the attention of people in the surrounding communities of the hospital, possibly altering the hospital’s image in a positive way and contributing to more hospital deliveries. The ceremony was intended for postpartum patients and their personal helpers (‘astamammi’). But since we noticed that many more people were interested in a cup of coffee, I decided to invite all maternity and gynaecology inpatients as well as their ‘astamammi’. Who after all can say ‘no’ to a free cup of coffee?

For several months now we have had a weekly buna ceremony. Besides celebrating the newborns, we are using this opportunity to educate people in an informal way. While the coffee is being prepared and drunk, we discuss several relevant health topics; antenatal care, delivery and all that comes with it, but also more general topics like contraception and birth spacing. Discussing all these subjects, we learned that many misconceptions exist, especially about contraceptives, such as their usage and possible side effects. In a country where ‘gravida 10’ in a patient file is not at all a surprising finding, and with birth rates still being very high, discussing birth spacing and contraceptive usage seems worthwhile.

Normally when I discuss these kinds of subjects during outpatient consultations, I do not have a lot of time to talk in depth about thoughts and practices concerning these issues. But during the ceremony I find out a lot about what is common practice amongst Ethiopian women and why. This definitely helps me understand my patient population much better, which makes it possible for me to serve them better by answering their health concerns more precisely. Whether our hospital delivery rates will also rise as a result of the coffee ceremonies remains to be seen.

Sometimes only 3 people attend a meeting, but other times as many as 25 people attend and lively discussions arise. Therefore the ceremony is a great opportunity for me to learn more about Ethiopians and their culture, their beliefs and (mis)understandings of health issues, as well as offering me a chance to educate them. Besides that, it gives me the opportunity during the often hectic days to kick back and enjoy the best coffee in the world myself!