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Act With Her Ethiopia: Short-run findings on programming with very young adolescents


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Act With Her Ethiopia: Short-run findings on programming with very young adolescents

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Findings from a longitudinal study in conjunction with Act With Her Ethiopia on wellbeing outcomes for very young adolescents.

Findings from a longitudinal study in conjunction with Act With Her Ethiopia on wellbeing outcomes for very young adolescents.


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Act With Her Ethiopia: Short-run findings on programming with very young adolescents

  1. 1. Act With Her Ethiopia: Short-run findings on programming with Very Young Adolescents . Workneh Yadete (GAGE Ethiopia, Quest Consulting), June 2022 Primary school students in Ebenat, Ethiopia © Nathalie Bertrams / GAGE 2020
  2. 2. Presentation overview Introduction to GAGE Contribution of GAGE impact evaluation of the Act with Her programme Research sample and mixed methods impact evaluation design and analytical approach Short-term findings on primary and secondary outcomes Reflections on how programming could be further strengthened
  3. 3. GAGE timeline, age of cohorts and gender equality milestones YOUNGER COHORT 10-12 years 12-14 years 13-15 years 15-17 years GAGE launched (2016) 2017 2018 2019 2020 2021 2022 2023 Baseline Midline 1 Midline 2 Endline OLDER COHORT 15-17 years 17-19 years 18-20 years 20-22 years SDGs launched (2015) Family Planning Summit London (2017) BMGF Gender Strategy (2018) ICPD + 25 (2019) Beijing + 25 Decade for Action launch (2020) Generation Equality Forums (2021) Women Deliver Conference (2022) SDGs + 10 (2025) Very young adolescent stage Mid-adolescent stage Youth/ adolescent to early adulthood transition COVID-19 virtual data collection
  4. 4. UNICEF’sMakani programme (Jordan) Community based organisations (Jordan) Act with Her (Ethiopia) Plan International – Champions of Change (Rohingya) , starting 2021 World Bank adolescent education (Bangladesh) LOST& Na’baa (Lebanon) Room to Read (Nepal) Programmes GAGE is evaluating Update: Makani programme adapting to covid 19 and gov. engagement Update: engagement & application of midline findings Update: engagement & application of participatory findings Update: engagement & application of participatory findings Update: Programme now rolling out in Jan 21 due to covid 19
  5. 5. GAGE 3C’s Conceptual Framework
  6. 6. Impact evaluation sample and methodology Adolescent pregnant girl, Ethiopia © Nathalie Bertrams / GAGE 2020
  7. 7. GAGE longitudinal research sample
  8. 8. Context diversity is critical in understanding programming starting points Zones selected based on:  high prevalence of child marriage (as proxy for conservative gender norms) and then  districts that are designated food insecure (as proxy for econ vulnerability) In South Gondar:  96% of girls and 89% of boys are enrolled in school  Girls have completed a half year “more” school than boys: 4.8 versus 4.3 In East Hararghe  85% of boys and 69% of girls are enrolled  Boys have completed a half year “more” school than girls” 5 vs 4.5 In Zone 5, Afar:  Only 63% of teens are enrolled  Young adolescents have missed 24% of school days in the last two weeks  Average grade attainment is only 2.3 years School enrolment varies tremendously—and in different ways Figures from GAGE baseline
  9. 9. Context diversity is critical in understanding programming starting points In Amhara:  Age of marriage climbed from 14.4 to 16.2 between 2005 and 2016  “Only” half of girls are cut in Amhara, 3% are infibulated In Oromia:  Age of marriage was comparatively unchanged, 17.1 to 17.4  Infibulation is rarer in Oromia (7%), where girls are cut later In Afar:  Age of marriage dropped from 16.7 to 16.4  Nearly all girls under 15 are cut in Afar—70% are infibulated Similar diversity exists in terms of child marriage and FGM/C Figures from GAGE baseline Figures from DHS
  10. 10. Quantitative sample 4,518 VYAs in 173 kebeles Kebeles within woredas selected based on mapping of access to markets, infrastructure and services (high and low)  Amhara: 1,113 girls and 819 boys (74 Kebeles)  Oromia: 1,190 girls and 878 boys (79 kebeles)  Afar: 298 girls and 220 boys (20 kebeles) Aged 10-12 during GAGE baseline data collection (late 2017; midline late 2019 8 months after programming start) Randomly selected from a door-to-door household listing in communities Randomly assigned kebeles to different programming arms (and control) with implementation starting in early 2019
  11. 11. Summary statistics (Oromia and Amhara, control) Oromia Amhara n=377 n=423 HH size 7.154 5.388 HH head literate 0.269 0.378 HH currently receives PSNP benefits 0.306 0.355 FIES score(0-8, higher is morefood insecure) 5.173 3.537 HH experiences any food insecurity 0.888 0.766 Panel A: Household level variables
  12. 12. Summary statistics (Oromia and Amhara control) Girlsn=216 Boysn=161 Girlsn=241 Boysn=182 Age 12.921 12.969 13.000 13.054 Enrolled in school during most recent session 0.619 0.819 0.987 0.851 =1 if hungry in thepast 4 weeks 0.229 0.368 0.042 0.138 Number ofmeals with animal protein previous day 0.086 0.097 0.164 0.188 =1 if sourceof information on puberty 0.500 0.693 0.828 0.772 Has begun menstruation 0.106 na 0.050 na =1 if can namea modern method of contraception 0.053 0.195 0.667 0.561 =1 if Ever Married 0.046 0.006 0.046 0.000 =1 if Has savings 0.686 0.675 0.344 0.260 =1 if Has not experienced/witnessed HH violencein last 12 months 0.444 0.638 0.451 0.567 =1 if Has an adult s(he)trusts 0.452 0.716 0.697 0.674 Panel B: Individual level variables Oromia Amhara
  13. 13. Qualitative sample 1 kebele per intervention arm and 1 control per region (i.e. 5 kebeles in Amhara and Oromia and 2 in Afar) 275 adolescents (179 HS or AWH participants) Inclusion of socially disadvantaged adolescents based on disability (10%) and marital status (10%) but largely non-programme participants Amhara:  112 adolescents (77 HS or AWH participants)  73 parents  10 mentors  34 key informants Oromia:  112 adolescents (77 HS or AWH participants)  87 parents  13 mentors  33 key informants Afar:  51 adolescents (25 AWH participants)  48 parents  7 mentors  10 key informants
  14. 14. Analysis approach for short-term findings  All adolescents and parents in our study who live in an AWH community are considered treated, whether they were part of the program or not.  Generally considered the policy relevant outcome (as uptake of these programs is always less than 100%, and often much lower) These are intent to treat estimates:  Interest in the program was high across regions (much higher than generally seen with these programs)  Still manually entering attendance data to give exact numbers on enrollment and attendance (time consuming!!)—working for better process moving forward Future quasi-experimental analysis will look at treatment on the treated (e.g. are there larger impacts for those who actually participated in AWH) Full pre-analysis plan can be found here. Trial is registered at AEA RCT Registry (#AEARCTR-0004024), (#NCT03890237), and went through the BMGF review process.
  15. 15. Analysis approach for short-term findings Qualitative data was thematically coded in MAXQDA and disaggregated by region, gender and by participant status. Qualitative data used to triangulate findings from quant survey, to provide context specificity to findings, and to disentangle potential pathways to explain positive, negative or non-effects. Key informant interviews provided additional understanding of community, district and zonal political, economic and social dynamics. Quotes are used to illustrate findings; where they represent the voices of outliers this is noted.
  16. 16. High-level findings on short-term outcomes for girls in Amhara and Oromia Adolescent girl in Oromia, Ethiopia © Nathalie Bertrams / GAGE 2019
  17. 17. Reminder on Girls’ outcomes Outcomes for adolescent girls: • Education • Bodily integrity • Physical health, nutrition and SRH outcomes • Psychosocial wellbeing • Voice and agency • Economic empowerment • Cross-cutting: attitudes, knowledge, support systems Adolescent girl in Oromia © Nathalie Bertrams / GAGE 2020
  18. 18. Girls’ primary indices: Her Spaces vs. AWH (no assets)  Significant changes generally all in the right direction, with larger improvements for the AWH arm  Significant differences in mental health and gendered attitudes with greater improvement for the AWH group over Her Spaces  Significant program impacts on mental health (AWH only), resilience, voice and agency and knowledge (both AWH and Her Spaces) provide a pathway to longer-run impacts.
  19. 19. Girls’ primary indices: AWH (assets) vs. AWH (no assets)  Girls in communities assigned to receive the asset transfer also showed improvements in Voice and Agency, Knowledge and Econ empowerment, and Violence  Did not see impacts on mental health or gender equitable attitudes  Improvements in Mental Health, Resilience, Voice & Agency, and Knowledge  No Impacts in Econ Empowerment, Violence, Gender Equitable Attitudes AWH (assets) AWH (no assets)
  20. 20. Normalization of menstruation (qual and quant) ‘Thanks to the education, we don’t feel shame about it currently.’ (Girl, Her Spaces) ‘We learn to manage menstruation with a clean piece of cloth so that we can attend class conveniently. The menstrual flow will not spill down on our legs.’ (Girl, assets) Girl in East Hararghe © Nathalie Bertrams / GAGE 2020  Sig. positive impacts on improved menstrual hygiene and menstrual management (many girls not menstruating yet)  Where groups were running well, there was good learning regarding puberty and menstrual hygiene management.
  21. 21. Room for improvement on knowledge about SRH (control)…. Girlsn=216 Boysn=161 Girlsn=241 Boysn=182 % Correctly identifiied foods that contain iron vs. not 0.480 0.498 0.607 0.569 Correctly identifies healthy number ofmain meals per day for an adolescent 0.833 0.839 0.983 0.917 Correctly answers: Approximately how often does menstruation usually occur? (Once per month, every four weeks, or once per 28 days=1, any other frequency=0, DK=0) 0.281 0.176 0.584 0.374 Correctly answers: Getting pregnant early in puberty can be bad for the health of the girl and the baby. (True=1, False=0, DK=0) 0.641 0.588 0.693 0.641 Correctly identifies the legal age of marriage for girls 0.068 0.210 Correctly identifies that FGM/C hasrisks 0.157 0.213 0.510 0.389 Knows whereto get help for violence 0.292 0.522 0.269 0.55 Knows whereto keep money 0.734 0.759 0.887 0.93 Knowledge Oromia Amahra
  22. 22. ‘They told us that they’ll give her a pill right away and they’ll make sure the offender gets proper punishment too. If a girl is raped, they told us that she has to take examinations at the clinic.’ (girl, Her Spaces)
  23. 23. ‘Since I joined this program, I understand that child marriage is a harmful tradition. Therefore, I would tell them that I will only marry once I completed my education and once I am self-sufficient.’ (12-year-old girl, AwH)
  24. 24. Mixed effects on parent-adolescent communication (quant and qual) ‘Previously I was shy to express my thoughts even in the classroom. But now I can express my feelings and thoughts.’ (13-year-old girl, assets) ‘If they’re planning to make me skip school so that I’ll do something for them, I’ll tell them whatever it is they want me to do, I’ll get it done after school.’ (Girl, assets)  Girls report being better able to speak up— at home and at school.  BUT– the overwhelming theme is that girls are obeying more specifically because of what they’ve learned in AWH. ‘The thing is whenever they order us something we used to disobey them but now that we took the lessons we don’t do that anymore….’ (Girl, Her Spaces) ‘I used to say no and be rebellious... But now…I will always say yes.’ (Girl, curriculum)  HOWEVER —improved obedience is improving mother-child relationships—and may be strengthening resilience because girls feel more supported.
  25. 25. Shifting gender attitudes is not straightforward ‘The learners listen to the education when they attend it. They forget it when they go out of the education session. They put it aside when they meet male adolescents.’ (13-year-old boy, AwH, Oromia, reflecting on girls’ submissive behaviour around boys)
  26. 26. Afar Adolescent girl with her father, Afar © Nathalie Bertrams / GAGE 2020
  27. 27. Afar: context snapshot Zone 5 is politically marginalized in the region which exacerbates service deficits; some very remote communities which are seldom visited by district officials and have no NGO presence. During baseline and midline serious clan conflicts as well as conflict with the Argobba ethnic group in a neighbouring district make difficult terrain even less accessible, and also risky for adolescents. Drought conditions experience at baseline had much improved, as had local food security - but rapidly rising rates of migration of adolescent girls to Djibouti and MENA. Major change in midline in civil service cadre – new generation, with greater competencies and vision for change. Gender norms: • absuma (mandatory maternal cousin) marriage system; • Type 3 FGM and sometimes infibulation carried out as young as infancy through to early adolescence
  28. 28. Afar: sample • Smaller sample size. This was always meant as a pilot from the research POV. Can we successfully conduct longitudinal mixed methods research in remote pastoralist settings. • Implementers able to contact 84% of GAGE sample; 95% interested in programming. • Successfully surveyed 81.5% of the sample at midline • Not differential by treatment, nor based on baseline characteristics • Just a very hard to reach population! Research sample: • Quantitative: 298 girls and 220 boys (20 kebeles) • Qualitative: • 51 adolescents, 48 parents, 7 mentors, 10 key informants
  29. 29. Baseline characteristics (control) Overall HH size 6.320 HH head literate 0.053 HH currently receives PSNP benefits 0.398 Pastoralist HH 0.877 Girls Boys Age 10.952 10.762 Enrolled in school during most recent session 0.713 0.536 Did not miss a week of school in the past year (among enrolled) 0.656 0.756 Has not experienced or witnessed HH violence in last 12 months 0.575 0.56 Has an adult s(he) trusts 0.464 0.337
  30. 30.  45% less likely to disagree that a ‘woman should obey her husband’  20% less likely to agree that ‘boys and girls should share HH tasks equally’  No change in knowing where to keep money  No change in knowing that menarche allows for pregnancy Positive effects: Negative effects: No effects:  29% more likely to know about the risk of FGM/C  82% more likely to know of a place to go for help from violence
  31. 31. Mentors Some positive gains – especially in terms of knowledge and changes in attitudes and practice re gender division of labour in the household In Afar, challenges in recruiting mentors from same locale and clan slowed acceptance by communities of the programme Concerns expressed by mentors included limited support from supervisors, limited site visits (due to both distance –tended to live in Harar and challenging to visit districts during unrest), yet significant resistance and backlash from some communities esp. due to SRH content and fears about religious conversion. In Oromia, communication around girl-only asset sparked considerable discontent among boys, parents, community leaders – in sites with the asset transfer as well as neighbouring communities, and was exacerbated by over-promising by some mentors
  32. 32. Mentors  Mentors themselves were very engaged, emphasized that being part of the project was personally empowering in terms of hard and soft skills  However, in Oromia, also high levels of dissatisfaction reflected in higher turnover than elsewhere, uneven attendance, some disbanding of groups prematurely The change is not only for the trainee girls but also for myself… When I was in school and also before I joined Act With Her, I was so shy; I was not even sharing ideas with others. However, after I joined this programme I began to communicate with everyone without fear and shyness.’ (female mentor, Amhara AWH-E) Teacher in a girls’ room, Ebenat, Ethiopia © Nathalie Bertrams GAGE 2020
  33. 33. Summary and reflections for programme strengthening Adolescent girls in East Hararghe, Ethiopia © Nathalie Bertrams / GAGE 2019
  34. 34. Summary Largest short-run impacts are on:  adolescent voice and agency,  girls’ knowledge,  with suggestive evidence on mental health, resilience, and menstruation For more detail see these region-specific GAGE knowledge products For more resources see:
  35. 35. Emerging lessons to further strengthen outcomes for adolescents More concrete and tailored planning with adolescents about alternative pathways – not just professional careers but also TVET etc. Specific curriculum content on GBV prevention and response – and service visits – especially in terms of awareness of reporting violence/ child marriage to justice sector / police for adolescents and potentially also parents More region-tailored approaches to tackling child marriage and FGM/C – e.g. how do you resist brokers in Oromia, how do you advocate against FGM/C in Amhara that speaks to the reality of the practice Less curriculum content but more repetition/ recap in low literacy communities
  36. 36. Emerging lessons to further strengthen outcomes for adolescents Better support for mentors facing backlash and risks Programming that engages with boys’ challenges around masculinities and norms More early engagement with religious leaders at woreda levels to secure buy-in to programme aims Systems strengthening work that is out of school to test approaches that are school-based vs out-of-school – esp as those in school are not the most disadvantaged.
  37. 37. GAGE recent reports on mid-line f indings For more resources see:
  38. 38. Recent journal publications on Ethiopia etwixt-and-between-adolescent- transitions-and-social-policy-lacunae-in- ethiopia/ ned-choices-exploring-the-complexities-of- adolescent-girls-voice-and-agency-in-child- marriage-decisions-in-ethiopia/ no-adolescent-behind-addressing-inequities- in-educational-attainment-in-rural-ethiopia/ norms-violence-and-adolescence-exploring-how- gender-norms-are-associated-with-experiences-of- childhood-violence-among-young-adolescents-in- ethiopia/ gender-attitudes-and-norms-influence-physical-and- mental-health-during-very-young-adolescence-evidence- from-bangladesh-and-ethiopia/ on/intersecting-inequalities- gender-and-adolescent-health-in- ethiopia/ ing-the-role-of-evolving-gender-norms-in- shaping-adolescents-experiences-of- violence-in-pastoralist-afar-ethiopia/
  39. 39. Contact Us WEBSITE TWITTER @GAGE_programme FACEBOOK GenderandAdolescence About GAGE:  Gender and Adolescence: Global Evidence (GAGE) is a nine-year (2015-2024) mixed- methods longitudinal research programme focused on what works to support adolescent girls’ and boys’ capabilities in the second decade of life and beyond.  We are following the lives of 20,000 adolescents in six focal countries in Africa, Asia and the Middle East.