A presentation by Jude Sajdi on 'Observing the Evidence on Comprehensive Sexuality Education for Adolescents and Youth' at Adolescent and Youth Reproductive Sexual and Reproductive Health and Rights, Virtual Seminars by UNFPA, Higher Population Council and Royal Health Awareness Society, September 2020

1. Adolescent sexual and
reproductive health in Jordan
Hands of married girls, ITS in Jordan @ Natalie Bertrams / GAGE 2020
Jude Sajdi, Amman, September 2020

2. Presentation Outline
1
• GAGE overview
2
• GAGE findings regarding SRH
3
• Questions?

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
Married Syrian girl in ITS, Jordan @ Natalie Bertrams / GAGE 2019

4. 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 20000 adolescent girls and boys - the largest cohort of
adolescents in the Global South

5. GAGE 3Cs Conceptual Framework

6. GAGE longitudinal research sample
6

7. GAGE Jordan research sites and baseline sample breakdown
Nationality:
Syrian: 3,090
Jordanian: 642
Palestinian (Gaza Camp): 304
Other: 65
Vulnerable Groups:
Adolescents w/ disabilities: 417 (10%)
Married adolescents: 190 (5%)
Gender:
10-12 Girls: 1,108 Boys: 1,065
15-17 Girls: 1,006 Boys: 922
Location type:
Camps: 1,348
ITS: 308
Host communities: 2,445

8. Girl in a Gaza camp © Nathalie Bertrams /GAGE 2020
GAGE findings

9. Older adolescents have information about puberty—but…
Girls were more likely to have a
source of information than boys
(92% versus 79%)—though most
did not know about menstruation
until after it began.
‘I feel shy to tell him, but I can tell
my daughter without shyness.’
(Syrian mother, Zaatari)
Jordanians (95%) were more likely
to have an information source
than Palestinians (90%) and
Syrians (83%). Those in ITS were
esp. disadvantaged (76%).
‘I did not tell her about periods,
this generation is taught by
themselves, they teach each other.
Aren’t they working together?
They know more than me.’
(Syrian mother, ITS)
Adolescents reported learning
about puberty from their mothers
and aunts, at school, and—in very
rare cases– through Makani
classes.
‘My aunt told me… I feel like my
aunt is more like a friend of mine.’
(17-year-old Palestinian girl,
Gaza camp)

10. Knowledge about broader SRH is very limited
‘The longer the time between the time he knows about
these things and marriage, the more likely he is to do
Haram actions.’ (18-year-old Syrian girl)
 Adolescents often support limiting knowledge.
‘In our traditions, the girl is not told any of that till the
night of her wedding. This is because if the girl knows
about what happens beforehand, she would be afraid of
getting married.’ (16-year-old Syrian girl)
‘If you’re engaged, you’re not allowed to visit a girl
that’s married.’ (16-year-old Palestinian girl)
 Barriers are erected to ensure that girls in
particular do not learn about human sexuality.
 For girls, barriers are aimed at reducing resistance
to marriage.
Due to cultural
norms, sexuality is
rarely discussed
prior to marriage.
It is not uncommon
for girls to not learn
about sex until
their marriage day.
Efforts are made to
ensure that
adolescents do not
learn about sex until
they are to be
married.

11. Child marriage is common—and complicated
Percent already married
‘The girl is 13 years old and was pulled out of school. She ran away from home as she
did not want to get married so young. Now she stands by the window and thinks of
suicide. She does not leave the house. She has a psychological illness.’
(15-year-old Syrian girl)
 The youngest girls are forced—and generally married to cousins.
 Older girls often believe they want to marry—because their parents have
coached them to believe marriage is what is best for them.
‘She said that she didn’t want to marry since the
beginning...I played in her mind.’ (Syrian mother)
‘My father asked me, he said that it is better to marry because he won’t stay with me.
My father is an old man and he go to doctors and take medication. After that, I
agreed to marry.’ (16-year-old Syrian girl)
 Some girls also admitted to wanting to marry for the festivities.
‘I did not know anything. All I was happy about was the dress and the gold back
then, ha ha!’ (16-year-old Syrian girl married at 13)

12. For girls, marriage—and sexual debut– can be traumatic
‘He put the bed sheet over my face to prevent me from crying and he had sexual relationship with me. Then, he went
out and I started crying. I had bleeding. I told my uncle about it. He took me to a doctor.’
(Syrian 18-year-old mother of 4, married at 12)
Marriage can begin with rape.
‘He (my husband) said that we are going to see a doctor on Saturday to see whether you're a virgin or not. … I didn't
want to object or defend myself so he doesn't think I am hiding anything.’ (16-year-old Palestinian)
Girls who bleed ‘insufficiently’ can be subjected to virginity tests.
‘My mother in law told me to get the towels and use them when needed and when my husband is close to me.’
(16-year-old Syrian)
Even ‘prepared’ girls are not prepared.
‘I felt terrified. He was kind to me. He didn’t hurt me.’ (18-year-old Palestinian)
The best many girls can say is that their husbands did not deliberately hurt them.
‘If any woman asks me about my wedding night, I feel ashamed to answer her.’ (15-year-old Syrian)
Marriage customs surrounding virginity blood further horrify girls.

13. Married girls also face knowledge barriers
‘I worked with some children who were pregnant and they
found that they’re pregnant in their like sixth month…because
these children they do not know that sexual relations makes
women pregnant.’ (Key informant, host community)
Married girls Unmarried girls
 Some married girls do not understand the link
between sex and conception.
‘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.’
(18-year-old Syrian girl)
 Many married girls believe that contraception
causes sterility if used to delay motherhood.
Less than half of married girls admit to
recognizing a form of contraception.

14. Pressures for early pregnancy are multi-faceted
‘All of them want to have boys and girls.’
(17-year-old Syrian girl, married at 13, threatened with a
second wife for not conceiving quickly enough)
‘My mother in law and her neighbor brought a pregnancy test. This woman brought her four
brothers with her and all of them wait me behind the door of the W.C. So, I didn’t accept to do it.’
(16-year-old Syrian girl whose parents were brought in to beat her for refusing to take the test)
‘I told him that what he doing was haram… we have been
married for seven or eight months, and that his parents have
started to talk about that.’
(17-year-old Syrian, married at 14, whose husband used
condoms)
 Husbands demand early pregnancy.
 Mothers-in-law are often behind pronatalism.
 Girls feel the pressure to conceive so strongly—they own it.
An adolescent girl in Amman, Jordan © Nathalie Bertrams
/GAGE 2020

15. Girls can be subject to dangerous fertility treatments
 Several girls in our sample reported that their husbands or
mothers-in-law had forced them to take fertility treatments to
speed up conception.
Clinic in Zarqa – Mafraq, Jordan © Nathalie
Bertrams/ GAGE 2020
‘My mother-in-law told me, " My son is old and I want to see his
children. When he sees his son, he will stop talking to the girls by the
phone and he will be committed.” At first my mother-in-law took me to
a gynaecologist and obstetrician; she was a Russian doctor. When she
knew my age, she said, "A child and she wants to have a child!"… Then
my mother-in-law took me to Ma'an and told the doctor that I am 19
years old…… She gave me treatment which caused me illness… This
treatment almost caused me uterus explosion … I stayed at a hospital
for two days, because my mother-in-law wants me to have children!’
(17-year-old married at 14)
‘The doctor said if you took the needle your womb might blow and you could die. He said it’s fine I
want her to take it. The doctor kicked him out. He told him you just give me the prescription, and
I’ll inject her with it. It’s won’t be your responsibility. And he did get the prescription.’
(19-year-old Syrian girl)

16. Despite the risks, repeated early pregnancy is common
‘He wanted children…. The third was a pregnancy outside
the uterus…. Between us, I get happy when I get my
period. I’m afraid of getting pregnant.’
(18-year-old Syrian girl who was told after two C-sections
to delay a third pregnancy to let her body heal)
‘I told her (the doctor) I did not want the baby. I could not raise
a baby. She told me this is not right. I told her I did not want the
baby. The doctor refused miscarriage.’
(18-year-old mother of 4, married at 12, who begged for an
abortion for her 4th pregnancy)
The youngest girls
often have difficult
pregnancies and
complicated—
surgical—
deliveries..
Girls’ own wants
and needs can be
ignored by health
care providers.
Some girls are
forced to disregard
medical advice and
repeatedly
conceive.

17. SRH care is generally good—but complicated by COVID
‘I am pregnant, I went to the hospital, but they only
receive emergency cases and the private clinics are
closed.’ (17-year-old Syrian)
‘What will I do?! I’m afraid that no one will come
to deliver the baby, I swear.’ (18-year-old Syrian)
‘I went for an ultra sound and they told me that I have
twins.’ (18-year-old Syrian)
‘Because my body is weak and small so they decided to
do an operation for me.…. I almost died, really it was
death.’ (14-year-old Syrian married at 11)
 Girls report regular antenatal care, surgical
deliveries, and postnatal follow-up.
 COVID travel restrictions have made it difficult for
girls to access care—and increased fear.
Doctor in Mafraq, Jordan © Nathalie Bertrams / GAGE 2020

18. Questions?

19. GAGEpublicationsinJordan
For more resources see:
https://www.gage.odi.org/countries/jordan/

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