Adolscents to Youth to Young Adults_Hainsworth_5.11.11

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  • As one can see from the statistics, Ethiopia is facing a burgeoning youth population coupled with high rates of early marriage and early childbearing. In Amhara, the situation is particularly dire with almost half of all rural women married before they reach 15. Nationwide 40% of all 19 year olds are either pregnant or have given birth.
  • The underlying reasons for early marriage and childbearing are pervasive gender inequality where little value is placed on girls or women’s lives, Poverty where marriage is seen as a way to pass the economic burden of having a girl onto another familyCultural norms that prescribe early marriage as a way to protect against unwanted pregnancyAnd scial expectations that pressure young women to prove their fertility directly after marriage
  • To combat these issues and empower girls and youth women, Pathfinder began the WAGE program in 2004 with funding from the Packard Foundation. Many of the activities were also cost-shared with the USAID flagship FP/RH project. We are now in the third phase of the program but for the purposes of my presentation, I will focus on Phase II since Phase III has only been running for a little over a year and we don’t yet have evaluation data
  • The program is implemented at the local level throughWomen’s associations (AAWA, ORWA, AWA)Health Extension WorkersLocal NGOs (YMCA, ECS)Girls’ clubsYouth CentersCHWsPeer Educators
  • The overall goal of the program is To improve the SRH, rights, and social status of adolescent girls and women in Amhara, Oromia, and Addis With key objectives of Increase awareness of gender, gender-based violence (GBV) and SRH issuesAdvocate for elimination of harmful traditional practices (HTPs) and GBVIncrease access to and utilization of youth-friendly services (YFS)
  • The WAGE program is a multisectoral program that is based on a lifecycle model. As you can see from these slides, many of the issues cut across many of the age groups although some are unique to particular age cohorts. Interventions were then designed to address the different challenge faced within the lifecycle and while some of the interventions are open to a wide age range, some of them tend to target the younger women like keeping girls in school through scholarships and support networks or the teen star program which is a life skills program, while others such as YFS tend to focus more on older adolescents. The GBV and HTP prevention activities however span the entire lifecycle. The intended program outcomes are: Increased school retentionImproved SRHImproved life skills and SRH decision makingIncreased access to SRH servicesLook at slideand the intermediate impacts areEducational attainmentIncreased % of young women in leadership roles Delay of marriage & childbearinReduction in unintended pregnanciesReduction of STIs and HIVReduction of HTPs & GBV
  • Some of the results of Phase II were more than > 8 million adolescents and women reached with SRH information10,549 students completed the Teen Star program49,323 students reached by PEs (Year 3) and 43,603 in- and out-of-school youth counseled by youth counselors
  • 231,789 YFS visits– 18,444 clinical services 213,345 for IEC 70 adolescent girls received scholarships432 fistula cases identified and repaired1,962 law enforcement officials trained on laws related to early marriage, HTPs, and GBV
  • External evaluation conducted by ACPHI in 2009 found that: Girls’ clubs and CACs instrumental in cancellation of > 4,000 early marriages. This photo is a girl whose marriage was cancelled as a result of the programModern contraceptive use increased from 25% to 35%52% had been tested for HIV – a 26% increase from baselineIncreased awareness of existence of YFS and YFS location. Data limitations prevented a trend analysis in YFS visits.
  • In addition, MEASURE conducted an evaluation of early marriage in Amhara in 2009 focused on the catchment areas of Pathfinder’s WAGE program and World Learning’s program. Most of the findings presented here highlight Pathfinder’s interventions.It found75% of young women, 83% of young men, and 65% of caretakers exposed to early marriage prevention messages through non-print media.Religious leaders are key change agents, influencing public opinion.CHWs, peer educators, and providers also played important role.Girls’ Club members more likely to initiate discussions about stopping planned marriages and higher prevalence of cancelled marriages.
  • Peer education is critical as more adolescent girls turn to their friends than to family or teachers when faced with an unwanted marriage.Total planned marriages cancelled: 27% (intervention) 19% (control)Changes only noted in urban areas
  • Based on these findings, some considerations and recommendations looking to the future are to:Emphasize changing male attitudes and practices regarding early marriage, couples communication, SRH and gender equity—(reach boys who are forming attitudes)Explore why little change in rural areas regarding early marriage and needed changes in program strategyEvaluate what happens after a girl’s marriage is cancelled (long-term implications on age of marriage?)Assess changes in girls’ agency as a result of program interventions (decision-making, negotiation, participation)
  • Follow up girls who received scholarships to determine: impact on subsequent SRH decisions and behaviors (age of marriage, FP use, spacing of children)impact on education, participation in workforce or public spheres
  • Adolscents to Youth to Young Adults_Hainsworth_5.11.11

    1. 1. Women’s and Girls’ Empowerment Program in Ethiopia <br />Gwyn Hainsworth<br />Senior Advisor for ASRH<br />Pathfinder International <br /><ul><li>CORE Group Meeting
    2. 2. May 11, 2011
    3. 3. Baltimore, MD</li></li></ul><li>Ethiopian Context<br />Pop: 77 million, 35% aged 10-24<br />Median age of marriage: 16.5 years<br />48% of rural Amhara women married < 15<br />CPR among married 15-19 year olds: 8.6%<br />Fertility among 19 year olds: 40%<br />Total Fertility Rate: 5.4<br />
    4. 4. Issues Related to Early Marriage & Childbearing<br />Pervasive gender inequality<br />Little value placed on girls<br />Unequal power relationships and decision-making<br />Poverty<br />Girls are economic burden <br />Marriage forms family alliances  economic benefits for family<br />Cultural norms<br />Prescribe marriage before puberty (Amhara)<br />Social expectation<br />Immediate childbearing – “prove fertility”<br />
    5. 5. Program Background<br />Funded by Packard Foundation; cost-share with USAID<br />2007-2009 building on Women’s Empowerment Program<br />Multi-faceted model to empower and equip girls and young women with:<br /><ul><li>Information
    6. 6. Skills
    7. 7. Support needed to implement SRH decisions appropriate for their lives</li></li></ul><li>Program Background (2)<br />Works through:<br /><ul><li>Women’s associations (AAWA, ORWA, AWA)
    8. 8. Health Extension Workers
    9. 9. Local NGOs (YMCA, ECS)
    10. 10. Girls’ clubs
    11. 11. Youth Centers
    12. 12. CHWs
    13. 13. Peer Educators</li></li></ul><li>Program Goals and Objectives<br />Goal<br />To improve the SRH, rights, and social status of adolescent girls and women in Amhara, Oromia, and Addis Ababa<br />Objectives<br /><ul><li>Increase awareness of gender, gender-based violence (GBV) and SRH issues
    14. 14. Advocate for elimination of harmful traditional practices (HTPs) and GBV
    15. 15. Increase access to and utilization of youth-friendly services (YFS)</li></li></ul><li>Interventions<br />Outcomes<br />Adolescent Girls<br />Age 10 - 14<br />Adolescent Girls<br />Age 15 - 19<br />Adolescent Girls<br />Age 20 - 24<br /><ul><li>Improved school retention
    16. 16. Increased SRH knowledge
    17. 17. Improved life-skills and SRH decision-making
    18. 18. Improved access to quality YFS
    19. 19. Positive changes in community norms regarding HTPs and GBV
    20. 20. Increased number of adolescent girls receiving treatment for fistula
    21. 21. Increased leadership opportunities for girls and young women </li></ul>Intermediate Impacts<br />Educational attainment<br />Increased % of young women in leadership roles <br />Delay of marriage & childbearing<br />Reduction in unintended pregnancies<br />Reduction of STIs and HIV<br />Reduction of HTPs & GBV<br />Key Issues<br />Girls clubs<br />School drop-out<br />Identification & treatment of fistula<br />Interventions<br />Early marriage<br />Teen STAR (life skills education)<br />Early pregnancy<br />Scholarships & supportive learning<br />environment for girls<br />Outcomes<br />Unintended pregnancy<br />Mentoring<br />Fistula<br />Peer education<br />Intermediate<br /> Impacts<br />STIs and HIV<br />Key Issues<br />Youth friendly services & youth centers<br />Age 10 - 14<br />Age 15 - 19<br />Age 20 - 24<br />Other HTPs (FGC) and GBV<br />Age 10 - 14<br />Age 15 - 19<br />Age 20 - 24<br />IEC and community outreach through VCHWs & HEWs<br />Reduced TFR<br />Increased CPR<br />Improved SRH and Well-Being<br />Prevention of HTPs (early Marriage, FGC) & GBV:<br />Community Action Committees, community conversations, training of judicial & law enforcement officials on HTPs, GBV and legal framework<br />
    22. 22. Select Results<br /><ul><li>> 8 million adolescents and women reached with SRH information
    23. 23. 10,549 students completed the Teen Star program
    24. 24. 49,323 students reached by PEs (Year 3) and 43,603 in- and out-of-school youth counseled by youth counselors</li></li></ul><li>Select Results (2)<br /><ul><li>231,789 YFS visits
    25. 25. 70 adolescent girls received scholarships
    26. 26. 432 fistula cases identified and repaired
    27. 27. 1,962 law enforcement officials trained on laws related to early marriage, HTPs, and GBV</li></li></ul><li>External Evaluation Results<br />Girls’ clubs and CACs instrumental in cancellation of > 4,000 early marriages<br />Modern contraceptive use increased from 25% to 35%<br />52% had been tested for HIV – a 26% increase from baseline<br />Increased awareness of existence of YFS and YFS location. <br />Data limitations prevented a trend analysis in YFS visits.<br />A young girl whose marriage was cancelled<br />
    28. 28. 2009 MEASURE Evaluation in Amhara<br /><ul><li>75% of young women, 83% of young men, and 65% of caretakers exposed to early marriage prevention messages
    29. 29. Religious leaders are key change agents, influencing public opinion.
    30. 30. CHWs, peer educators, and providers also played important role.
    31. 31. Girls’ Club members more likely to initiate discussions about stopping planned marriages and higher prevalence of cancelled marriages.</li></li></ul><li>MEASURE Evaluation (2)<br /><ul><li>Peer education is critical as more adolescent girls turn to their friends than to family or teachers when faced with an unwanted marriage.
    32. 32. Total planned marriages cancelled:
    33. 33. 27% (intervention)
    34. 34. 19% (control)
    35. 35. Changes only noted in urban areas</li></li></ul><li>Considerations and Recommendations<br />Focus more on shifting male attitudes and practices on early marriage, couples communication, SRH and gender equity<br />Explore why little change in rural areas regarding early marriage and needed changes in program strategy<br />Evaluate what happens after a girl’s marriage is cancelled<br />Assess changes in girls’ agency as a result of program interventions (decision-making, negotiation, participation)<br />
    36. 36. Considerations and Recommendations<br />Follow up girls who received scholarships to determine:<br /> impact on subsequent SRH decisions and behaviors (age of marriage, FP use, spacing of children)<br />impact on education, participation in workforce or public spheres<br />
    37. 37. Co-Authors<br />Worknesh Kereta<br />Senior Adolescent Sexual and Reproductive Health Advisor<br />Pathfinder International, Ethiopia<br />BogalechAlemu<br />Senior Advisor for Gender and Harmful Traditional Practices<br />Pathfinder International, Ethiopia<br />Mengistu Asnake, MD, MPH<br />Deputy Technical Director, Integrated Family Health Program<br />Pathfinder International, Ethiopia<br />
    38. 38. For More Information, Please Contact: <br />Pathfinder International Headquarters<br />Nine Galen Street, Suite 217<br />Watertown, MA 02472 USA<br />Phone: (617) 924-7200<br />Fax: (617) 924-3833<br />Web: http://www.pathfind.org<br />or<br />Integrated Family Health Program-Ethiopia<br />P.O. Box 12655<br />Tel 251 1 440 7642 <br />Fax 2511 1 440 7679 <br />Addis Ababa, Ethiopia <br />wkereta@pathfind.org<br />

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