Adolescent girl at a recycling plant in Dhaka, Bangladesh © Nathalie Bertrams / GAGE 2019 Dr Nicola Jones presents preliminary findings from the Gender and Adolescence: Global Evidence (GAGE) research program on how gender norms impact adolescents' uptake of contraception. GAGE studies 20,000 adolescents in six countries and finds that contraceptive knowledge is limited due to taboos around discussing sex. Social norms disadvantage unmarried and married girls by shaping their limited access to information and services. Programming needs to address gender norms, ensure accurate information reaches all adolescents, and make services adolescent-friendly to better support their health and empowerment.

1. Adolescent girl at a recycling plant in Dhaka, Bangladesh © Nathalie Bertrams / GAGE 2019
Dr Nicola Jones, June 2020
Gender norms and adolescents’ uptake of contraception:
Preliminary findings from Gender and Adolescence: Global Evidence (GAGE)

2. Outline of Presentation
1
• Introducing GAGE
2
•GAGE findings on contraception
3
•Implications for programming and policy solutions

3. Please note that the photographs of
adolescents DO NOT capture GAGE research
participants and consent was gained from
their guardians for the photographs to be
used for GAGE communications purposes.
GAGE overview
12 year old Syrian girl in Mafraq @ Natalie Bertrams / GAGE 2019

4. Adolescence: Age of opportunity
Adolescence
10-19 years
Rapid neuro-
development
changes Growing
adoption of
adult-like
roles, e.g.
work, intimate
relationships
Increased
salience of
gender norms
in daily life
Increased
interaction
with peers vs
parents
Psycho-
emotional
and self-
identity
changes
Physical and
reproductive
changes

5. Adolescence: The demographic imperative
% total population 10-24 years in 2013
Source: Accelerating adolescent girls’ education and empowerment:
G7 Whistler Meeting 2018 | May 2018
Globally, 1/6 of the world’s
population is an
adolescent.
In Ethiopia and Rwanda,
it’s 1:4.
In Jordan and Bangladesh,
it’s 1:5.
Multi-dimensional
poverty affects:
42% in Bangladesh
84% in Ethiopia
40% in Jordan
Multi-dimensional
poverty affects:
42% in Bangladesh
84% in Ethiopia
40% in Jordan
100% in Palestine
54% in Rwanda

6. Gender and Adolescence: Global Evidence (GAGE):
A longitudinal research programme (2015-2024)
By finding out ‘what works,’ for whom, where
and why, we can better support adolescent girls
and boys to maximise their capabilities now and
in the future.
We are following 20,000 girls and boys, the largest cohort of adolescents in the
Global South

7. Quantitative survey:
 Adolescent girls and boys + their
caregivers
 2 age cohorts: 10-12 yrs + 15-17
yrs in rural and urban locales, in
programme intervention and non-
intervention sites
 Sub-sample of adolescents with
disabilities
Qualitative and participatory
research:
 Nodal adolescents, their siblings,
caregivers, community leaders
 Nested sample of adolescents with
disabilities
 Key informant interviews and
historical process tracing with officials,
service providers and donors
Annual participatory research:
 Nodal adolescents, their
caregivers and peer networks to
better pinpoint shifts in
adolescent capabilities over time
 Social network analysis to
understand evolving influence of
peer groups
GAGE research sample
7

8. GAGE findings:
Gender norms
and contraception
Adolescent girl with her children in Dhaka © Nathalie Bertrams/GAGE 2020

9. Adolescent marriage and pregnancy in GAGE focal countries
In much of the Global South, sexual debut and
adolescent pregnancy are the result of child
marriage—not adolescent sexual experimentation.
This has significant implications for how social
messages are framed and delivered as girls’
‘demand’ for contraception is often shaped by their
husbands and in-laws.
10% of girls are
pregnant by
18—but child
marriage is rare
2/5 of Ethiopian girls marry as
children—and 1/5 are pregnant
by 18—pregnancy outside of
marriage is increasing, but
uncommon
37% of Syrian girls and 12% of
Palestinian in Jordan marry
before 18—pregnancy outside
of marriage is extremely rare
41% of Syrian girls and 12% of
Palestinian girls in Lebanon
marry as children—premarital
pregnancy is extremely rare
1/10 of Palestinian girls are
married before 18—
pregnancy outside of
marriage is rare
3/5 of Bengali girls marry as
children—2/5 are pregnant
by 18—pregnancy outside
of marriage is extremely
rare, esp for the Rohingya
2/5 of girls in Nepal marry as
children—more than 1/4 are
pregnant by 18—pregnancy
outside of marriage is rare

10. Contraceptive knowledge is limited—because talking about sex is taboo
In Jordan, 22% of 15-17 year
old adolescents can name a
form of contraception.
Girls are more likely
than boys to be able
to name a form:
30% vs 13%.
Only 43% of married
girls can name a form.
In Dhaka, Bangladesh, of
15-17 year olds, only 17% of
boys and 27% of older girls can
name a form.
In our Rohingya
sample, of 15-17
year olds, only 38%
of boys and 55% of
girls can name a
form.
Only 42% of married
girls in our Rohingya
sample can name a
form.
In Ethiopia, 42% of 12-14
year olds can name a form.
Regional differences
are huge: Amhara
(64%) vs. Afar (29%)
vs. Oromia (20%).
In Oromia, girls are less
likely to know a form
than boys: 14% vs 26%.

11. Social norms shape exposure and knowledge
 Mass media—and (for boys)
pornography— is exposing
adolescents to sexual topics.
 v
‘There are some advertisements on TV
on birth control pills that say if you
want to do something illicit, this pill
will keep you safe. But they do not say
to refrain from illicit activities.’
(Teacher, Bangladesh)
‘Due to easy access to technology and
internet, some adolescents are now
downloading porn videos that are
shared to other. This inspires teenage
children’s desire to sexual intercourse.’
(Teacher, Ethiopia)
 Married teens often have poor information.
‘I asked my girl friends. They told me to shower once the
intercourse is over and it would be like nothing has
happened.’ (Married 17-year-old Palestinian girl, Jordan)
‘They say that if you take them from the beginning of
your married life before you have a child, you may not
be able to pregnant forever, you have infertility.’
(Married 18-year-old Syrian girl, Jordan)
 Adults are afraid to provide accurate
information—for fear of encouraging sex.
‘If we tell them directly ... it will be like encouraging
them.’ (Family planning officer, Bangladesh)
‘I don’t advise her to use family planning methods to
avoid pregnancy. Our advice at this age level
abstinence.’ (Ethiopian father)

12. Girls—especially unmarried girls—are disadvantaged
 Girls in Jordan and Palestine are often not
told about sex—much less contraception.
 In Rwanda, unmarried girls are blamed
for not accessing contraceptive services.
 In Ethiopia, unmarried girls face social
barriers to information and services.
‘To tell the truth we didn’t give training
for the youngest women. Because when
you talk about contraceptives… they feel
ashamed of themselves.’ (HEW)
‘I had no idea what marriage was. I
thought that marriage is all about
supporting my husband. I had no idea that
it included a sexual relationship. Nobody
told me anything, even my family.’
(Married girl, Gaza)
‘When a girl faces an unwanted
pregnancy it means she is not using the
health services in the community.’
(Health officer)
 In Bangladesh, adolescents are not taught
how to prevent pregnancy.
‘We explain what would happen to them if
they get into an intimate relationship, but
we don’t teach them what actions should be
taken.’ (NGO health provider)

13. Married girls are expected to (re)produce—regardless of risks
Pregnancy is understood as risky.
‘If she gets pregnant while she is still
young… this will negatively affect her
health.’ (Syrian mother, Jordan)
Early fertility is preferred.
‘I am not using [family planning] now
– before I have one child. If you stay
without a child for a longer time, they
will tell you, you are barren.’
(Married 15-year-old, Oromia,
Ethiopia)
Pressure is top down—and lands on
girls.
‘My husband would tell me -because
of his parents’ pressure on him- that
everyone had children but him, he
would hurt me and I had to
suffocate.’ (Married girl, Gaza)
Repeat pregnancies can be
expected.
‘Here a 20 years old girl have at least
4 children. They don’t use any kind of
birth control technique.’
(Health provider, Bangladesh)

14. Adolescent programming
In Ethiopia, Act with Her is
teaching young
adolescents about their
bodies and how pregnancy
happens—but messages
are not always clear to
teens.
‘After her period comes the
next 14 days are safe to
have sexual intercourse but
after that it’s risky.’
(Ethiopian girl)
In Jordan, a small minority
of Makani centres include
classes on puberty.
‘I took a course at Makani
called the woman and the
girl, and they got us a
female doctor so we could
ask her anything.’
(Older Syrian girl)
In Rwanda, 12+ is teaching
adolescents about puberty,
abstinence, and condoms.
‘They tell us how to protect
ourselves from sexually
transmitted diseases.
Teachers also teach us to
abstain from sexual
intercourse and if one
cannot [abstain], they have
to use a condom.’
(Younger girl)

15.  In Ethiopia, successful messages are framed
around health, education, and economic
risks to girls—and encourage delay as well
as spacing.
Messaging needs to be fit for purpose
‘How can I have children while my life is not
good enough? I don’t want to give birth before
becoming financially stable?’
(Married 16-year-old girl who is using
contraception with husband’s support)
‘Adolescents of this time are taking contraceptives
as soon as they marry. In the past, girls were
giving birth immediately. This created birth
complications. Nowadays, girls are aware and
they are not exposed to such problems.’ (Mother)An adolescent girl with her child, Afar, Ethiopia @
Nathalie Bertrams / GAGE 2020

16. Messaging needs to be fit for purpose
 In Jordan, delays are rare—but messaging
for spacing has some traction.
‘I do not want to get more… at the current
time at least. First, because the boy is still
too young.’ (16-year-old Syrian mother)
 In Bangladesh, Rohingya families are often
large by the time contraception is used.
‘I have taken Depro….By the grace of
Allah I have three children now. How
would I take care of them!’
(17-year-old mother of 3)
A father with his child in Azraq Camp
©Herwig/UNICEF/2019

17. PRESENTATION NAME AND DATE
Links to solutions
An adolescent girl with her child, Kigali, Rwanda @ Nathalie Bertrams / GAGE 2020

18. Programming and policy implications
1
• Ensure in- and out-of-school adolescents have timely and accurate information about
reproductive biology and contraception. Leverage mass and social media to deliver accurate—and
teen friendly– information.
2
• Ensure parents’ information is accurate and support parents and teachers to have frank
conversations with the adolescents in their lives.
3
• Openly address—with all actors- the gender norms that stigmatise girls’ sexuality and leave girls
with limited control over their own bodies.
4
• Ensure SRH services—and service providers-- are adolescent friendly.
5
• Couple marriage officiation/registration with programming aimed at improving young couples’
knowledge and open communication.
6
• Target messages to need, working with religious leaders to build longer-term support for delayed
pregnancy.

19. GAGEpublicationsonSRH
For more resources see: https://www.gage.odi.org/publications/

20. Contact Us
WEBSITE
www.gage.odi.org
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.