Social and Behavioral Sciences Commons^™

Exploring Changes In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Fafan And West Arsi Zones, Ethiopia, Getaneh Mehari, Asabneh Molla, Ayantu Mamo, Dennis Matanda

Reproductive Health

Globally, more than 200 million women and girls have undergone FGM/C. More than half of these girls and women live in three high-prevalence countries: Egypt, Ethiopia, and Indonesia. Given the increase in population growth, recent estimates show that the number of girls and women subject to FGM/C will continue to rise in the coming years unless sufficient efforts are undertaken to encourage abandonment of the practice. A descriptive analysis of changes in FGM/C prevalence over time in Ethiopia shows that the percentage of women aged 15–49 years who report undergoing FGM/C has been declining. Despite the decline, the FGM/C prevalence …

Associations Between Fgm/C And Hiv In Ethiopia, The Gambia, Kenya, And Sierra Leone: A Limited Analysis Of Demographic And Health Survey Data, Yetunde A. Noah Pinheiro, Zhuzhi Moore, David Gathara

Reproductive Health

Studies investigating the association between male circumcision and HIV have demonstrated the protective effect of male circumcision. In some settings, FGM/C and male circumcision are considered “equivalent” procedures. This working paper presents findings of a study that investigates the effect of FGM/C on the likelihood of HIV infection for women in practicing communities in Ethiopia, Gambia, Kenya, and Sierra Leone.

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Ethiopia, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. …

Exploring Barriers And Opportunities For Pre-Eclampsia And Eclampsia Prevention And Management In Ethiopia, Pooja Sripad, Hussein Ismail, Amy Dempsey, Karen Kirk, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project is a five-year cooperative agreement between the United States Agency for International Development (USAID) and the Population Council, in partnership with the Federal Ministry of Health Ethiopia, which seeks to expand access to quality underutilized interventions and commodities for the prevention and treatment of pre-eclampsia/eclampsia (PE/E). This report presents qualitative findings from formative research conducted to: 1) assess the policy and health systems environment related to PE/E prevention and management, 2) identify potential bottlenecks in the supply chain, 3) investigate PE/E knowledge, attitudes, and practices at policy, health system, and community levels, 4) describe the barriers …

Migration And Child Domestic Work: Evidence From Ethiopia, Annabel Erulkar

Poverty, Gender, and Youth

Domestic work is frequently the initial survival strategy for rural Ethiopian girls migrating to urban areas. Following migration from rural areas, most girls enter the workforce as domestic workers, because it is a readily available form of work requiring little or no education. In 2015–16, the Population Council undertook a study of migrant, out-of-school girls in urban and rural areas in six Ethiopian regions which demonstrated that this is a common phenomenon. Originating from poor rural areas and armed with little in the way of education, domestic workers receive low pay and frequently work in abusive situations, including sexual abuse. …

Child Domestic Work And Transitions To Commercial Sexual Exploitation: Evidence From Ethiopia, Annabel Erulkar

Poverty, Gender, and Youth

There are an estimated 17.2 million child domestic workers in the world, and the vast majority are girls. Domestic work keeps children out of school, confined to the home, socially isolated, and burdened with excessive domestic duties. Furthermore, evidence is emerging that domestic work is a feeder profession for sex work. In 2015–16, the Population Council undertook a study of migrant, out-of-school girls in Ethiopia. The domestic work conditions described in this brief create unbearable conditions for girls who enter into commercial sex work as an alternative, hoping for an improvement in their work situation. The study found that a …

Characterizing The Unmet Hiv Prevention Needs And Hiv Risk Vulnerabilities Of Adolescent Girls And Young Women In Ethiopia, Project Soar

HIV and AIDS

Adolescent girls and young women (AGYW) in Ethiopia, as well as across Eastern and Southern Africa, experience a disproportionate level of new HIV infections. AGYW who are out of school face a particular set of vulnerabilities, especially those living away from parents. Unfortunately, data characterizing unmet HIV prevention needs and risk vulnerabilities among AGYW, especially out-of-school AGYW, are lacking given the challenges in reaching and studying this population. To address this gap, Project SOAR is conducting an integrated HIV biobehavioral survey focused on out-of-school AGYW in three high HIV prevalence settings of Ethiopia. Study findings will inform HIV prevention and …

Using Data To Target And Scale-Up Girls' Support Programs And Child Marriage Prevention, The Evidence Project

Reproductive Health

Though child marriage is declining globally, it is estimated that over 100 million girls under age 18 will be married in the next decade. A 2012 review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that offered incentives, such as conditional cash transfers or provision of school materials, and those that empower girls directly through interventions such as girls’ groups and training. The Berhane Hewan program in Ethiopia (meaning ‘Light for Eve’ in Amharic) was one of the earliest to test child marriage prevention interventions in sub-Saharan Africa. The …

The Journey Of Out-Of-School Girls In Ethiopia: Examining Migration, Livelihoods, And Hiv, Annabel Erulkar, Girmay Medhin, Lemi Negeri

Poverty, Gender, and Youth

Rates of urbanization in Ethiopia are increasing, and based on available data, HIV prevalence among urban girls who are in-migrants is significantly higher than among girls who are native to the area. Likewise, a significant number of out-of-school girls who migrate end up in low-status, exploitative, or risky professions, such as domestic work and sex work. This study of out-of-school girls in six regions of Ethiopia aimed to explore patterns of migration, transitions into different work roles, and situations that may put out-of-school migrant girls at increased risk of HIV infection or be protective and beneficial. Based on the study’s …

The Impact And Cost Of Child Marriage Prevention In Three African Settings—Brief, Population Council

Poverty, Gender, and Youth

Child marriage affects a significant number of girls in developing countries. The negative consequences of the practice are numerous and powerful, spanning health, welfare, development, and demographic domains. Yet there is limited evidence on what works to delay child marriage in different cultural contexts and even less information on programmatic cost. This brief reports on a study that aims to identify the most effective and minimum basic package approaches to delay marriage among adolescent girls in different African settings. The study was undertaken in rural areas of Burkina Faso, Ethiopia, and Tanzania. The study also measures the cost of implementing …

Understanding Adolescent And Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth Friendly Service Programming, Aparna Jain, Hussein Ismail, Elizabeth Tobey, Annabel Erulkar

Reproductive Health

To meet the unique sexual and reproductive health needs of its large adolescent and youth population, Ethiopia’s government has expanded and institutionalized youth-friendly services (YFS) at all levels of the health system. To help inform and improve these efforts, the Evidence Project, in collaboration with USAID/Ethiopia and the Ethiopian Federal Ministry of Health, conducted a study on adolescents’ and young people’s use of and opinions on YFS. Results showed that young people were satisfied overall with the health services they received, regardless of whether it was basic health services or YFS. Awareness and use of YFS was low, but many …

The Impact And Cost Of Child Marriage Prevention In Three African Settings, Annabel Erulkar, Girmay Medhin, Eva Weissman

Poverty, Gender, and Youth

Girls in sub-Saharan Africa are disproportionately affected by child marriage; by 2050, half of the girls married during childhood will reside in Africa. The negative consequences of the practice are numerous and powerful, spanning health, welfare, development, and demographic domains. Yet, there is limited evidence on what works to delay child marriage in different cultural contexts and even less information on programmatic cost. This study develops and tests the most effective and minimum basic package approaches to delay marriage among older and younger adolescent girls, and estimates the cost and cost-effectiveness of implementing the different approaches, in Burkina Faso, Ethiopia, …

The Impact And Cost Of Child Marriage Prevention In Rural Ethiopia, Annabel Erulkar, Girmay Medhin, Eva Weissman

Poverty, Gender, and Youth

The negative impact of child marriage, frequently prevalent in rural locations of poor countries, spans health, development, and demographic consequences. While evidence is limited, a systematic review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that empower girls by offering incentives such as conditional cash transfers. However, most impact evaluations of community-based programs lack rigorous costing data, a particular weakness of cash transfer schemes where programmatic cost would affect the ability to scale up successful interventions for large populations. To address the limited information on cost and scalability of …

Married Young Women And Girls' Family Planning And Maternal Heath Preferences And Use In Ethiopia, Aparna Jain, Elizabeth Tobey, Hussein Ismail, Annabel Erulkar

Reproductive Health

Married young women and girls are the primary users of youth-centered sexual and reproductive health services in Ethiopia and, given the health risks associated with early and closely-spaced pregnancies, represent an especially important population to reach with sexual and reproductive health services. This brief looks specifically at the needs and preferences for family planning and reproductive health services among married young women and girls, with recommendations for how to more effectively ensure that they have access to those services.

Understanding Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth-Friendly Service Programming, The Evidence Project

Reproductive Health

In Ethiopia, significant attention has been given to improving youth sexual and reproductive health (SRH) services, including the establishment of youth-friendly services (YFS). Yet high rates of child marriage, unmet need for family planning, and adolescent childbearing persist, particularly in rural areas where over 84 percent of the population lives. Reaching rural youth with timely SRH information and services that are relevant to their varying ages and life stages remains a challenge. The Evidence Project is examining the coverage and reach of public and NGO-supported youth SRH services in several rural regions of Ethiopia. As this activity brief notes, the …

Experiences With Pregnancy Among Female Sex Workers In Ethiopia: A Link Up Exploratory Study, Population Council, Miz-Hasab Research Center, Organization For Social Services For Aids

HIV and AIDS

In Ethiopia, it is illegal to operate a brothel or procure sex workers as a commercial activity, but the sale of sex by women is not prohibited by law. Research suggests that the number of Ethiopian female sex workers is growing, with younger women and girls increasingly entering the sex trade. Public health programs and policies typically have emphasized HIV prevention in this vulnerable population. A 2014 study of 3,882 Ethiopian female sex workers found that HIV prevalence in the 10 study sites ranged from 15–33 percent, compared to national prevalence of 1.9 percent among women. Furthermore, since most female …

Addressing Mental Health Disorders And Hiv Vulnerability Of Marginalized Adolescents In Addis Ababa, Ethiopia, Nrupa Jani, Lung Vu, Sam Kalibala, Gebeyehu Mekonnen, Kay Lynn

HIV and AIDS

Ethiopia is experiencing an increasingly urban, female-centered HIV epidemic alongside a rise in rural migration of adolescents to Addis Ababa. Often these migrants are confronted by social challenges such as lack of education, inadequate housing, unstable employment conditions, and physical and sexual abuse. These difficult living circumstances contribute to psychological and mental health problems among these adolescents, potentially putting them at greater risk of acquiring HIV. However, knowledge about how targeted mental health interventions can impact HIV-related outcomes worldwide, and in Ethiopia, remains limited. The goal of this study was to pilot test a strategy for addressing mental health problems, …

Burundi Program Implementation Workshop, 3–5 June 2014: Link Up Meeting Report, Population Council, Alliance Burundaise Contre Le Sida

HIV and AIDS

Link Up is a global consortium of international and local nongovernmental organizations led by the International HIV/AIDS Alliance. Link Up aimed to improve the sexual and reproductive health and rights of young people in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda who are living with HIV or are affected by the HIV pandemic. At a workshop held in Burundi, 3–5 June 2014, the Population Council, Alliance Burundaise contre le SIDA, and local partners in Burundi identified successful activities, highlighted important challenges and best practices, and found innovative ways to improve Link Up programming. This document contains a selection of the most …

Evaluation Of Health And Education Impacts Of A Girls’ Safe Spaces Program In Addis Ababa, Ethiopia, Annabel Erulkar, Girmay Medhin

Poverty, Gender, and Youth

Approximately one in eight of the world’s population is a girl or young woman aged 10–24 and attention is increasingly focusing on the central role of adolescent girls in achieving global health and development goals. Areas of focus by the development field include girls’ education, health, child marriage, and the experience of violence. This study analyzes the educational and health impacts of a program for slum-dwelling girls, including child domestic workers and rural-urban migrants. Established in 2006, Biruh Tesfa (Bright Future) aimed to increase social networks and support for the most marginalized girls in the poorest urban areas of Ethiopia. …

Kalkidan (‘Promise’) Preventing Marital Transmission Of Hiv In Urban Ethiopia, Annabel Erulkar, Hanan Nourhussein

Poverty, Gender, and Youth

Most mainstream HIV-prevention programs focus on increasing knowledge related to HIV transmission and risky sexual behaviors. These initiatives often do not take into account gender issues or power dynamics, nor do they address the risk that marital partners face within their relationships. Such programs assume that marriage is a safe haven for women and that their HIV risk is minimal. In response, the Population Council launched the “Kalkidan” project to enhance couple communication, promote HIV prevention within marriage, reduce stigma and violence, and increase demand for HIV information and services, including prevention of mother-to-child transmission—which will collectively contribute to HIV-negative …

Building The Assets To Thrive: Addressing The Hiv-Related Vulnerabilities Of Adolescent Girls In Ethiopia—Policy Brief, Population Council

Poverty, Gender, and Youth

In Eastern and Southern Africa, HIV is the leading cause of death among girls aged 15–19. Despite decades of investment and substantial progress against HIV, adolescent girls remain at disproportionate risk of infection. Few programs have sought to take a “whole girl” approach to addressing the multiple vulnerabilities to HIV infection experienced by the most marginalized adolescent girls in the poorest communities in Africa. “Building the Assets to Thrive: Addressing the HIV-related Vulnerabilities of Adolescent Girls in Ethiopia” is a comprehensive review of three programs implemented and evaluated by the Population Council and the Ethiopian government beginning in 2007: Biruh …

Formative Research To Develop An Intervention For Addressing Mental Health/Psychosocial Issues And Hiv Vulnerability Of Marginalized Adolescents In Addis Ababa, Ethiopia, Nrupa Jani, Katie D. Schenk

HIV and AIDS

Children and adolescents who migrate from rural regions to Addis Ababa, Ethiopia often flee their households to escape from abusive families, forced marriages, poverty, lack of economic opportunity and education, and other social problems. They are often met with equally harsh, if not worse, challenges when they arrive in Addis Ababa, including treacherous living situations, abusive working conditions with meager compensation, limited opportunities for education and socialization, and absence of family support. This study conducted a qualitative needs assessment to determine type and extent of mental health and psychological needs among adolescent migrants living in Addis Ababa in order to …

Assessment Of The Availability And Use Of Maternal Health Supplies In The Primary Health Care System In Amhara Region, Ethiopia, Sarah Raifman, Sisay Mellese, Kelemua Hailemariam, Ian Askew, Annabel Erulkar

Reproductive Health

Maternal mortality in Ethiopia remains among the highest in the world. A UN Commission Report in 2012 identified 13 life-saving commodities—defined as medicines, medical devices, and health supplies—that effectively address avoidable causes of death during pregnancy and childbirth that, if more widely accessed and properly used, could significantly reduce preventable deaths among women. This assessment, conducted by the Population Council, evaluates the availability of these life-saving commodities that are essential for basic emergency obstetric and neonatal care, and safe and clean delivery services within primary health care in Ethiopia. The report concludes that Ethiopia’s pharmaceutical procurement and supply system is …

De La Recherche À La Conception Programmatique Et À La Mise En Oeuvre : Programmation À L'Intention Des Filles Des Milieux Ruraux D'Éthiopie—Boîte À Outils Du Praticien, Annabel Erulkar

Poverty, Gender, and Youth

Cette boîte à outils décrit comment créer ou améliorer des programmes pour les filles de l’Éthiopie rurale, en vue d'accroître le nombre de programmes organisés à leur intention et de les rendre pertinents et mieux adaptés à leur contexte. La boîte à outils décrit un processus d’élaboration programmatique fermement ancré dans les faits. Les chapitres procèdent dès lors d’un point de départ axé sur la recherche pour identifier et décrire les filles, pour se concentrer ensuite sur le développement programmatique émanant des données, et aboutir enfin sur la mise en œuvre guidée par le suivi et l’évaluation permanents.

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Addis Birhan Wendoch ('New Light Boys'): Working With Boys And Young Men To Create Healthier Futures, Woldemariam Girma, Diane Rubino, Annabel Erulkar, Worku Ambelu, Ayenechew Kerie

Poverty, Gender, and Youth

The Population Council and the Ethiopian Ministry of Women, Children, and Youth Affairs designed Addis Birhan Wendoch to impart life skills and promote gender-equitable, nonviolent, and healthy behaviors among boys and young men aged 10 to 24. The program helps out-of school boys and young men in Ethiopia navigate toward a healthier future by providing them with trained, compassionate mentors and safe environments in which they can find the support needed to share ideas and take positive actions. Through frank and open discussions, boys have the opportunity to get the facts on a range of essential topics from financial literacy …

Berhane Hewan ('Light For Eve'): Increasing Opportunities To Delay Marriage And Promote Schooling, Annabel Erulkar, Eunice N. Muthengi

Poverty, Gender, and Youth

This policy brief describes the findings of a pilot study on girls’ experience of early marriage, education, and sexual behavior in rural Amhara Region, Ethiopia. The brief also discusses efforts in the region to delay marriage and promote girls’ schooling. The Amhara Bureau of Women, Children and Youth Affairs and the Population Council pilot-tested a program to delay marriage and support schooling in rural Amhara Region. The program, entitled Berhane Hewan (Amharic for “Light for Eve”), included community conversations, support for remaining in school, and conditional cash transfers if girls remained unmarried and in school for the duration of the …

The Cost Of Reaching The Most Disadvantaged Girls: Programmatic Evidence From Egypt, Ethiopia, Guatemala, Kenya, South Africa, And Uganda, Jessica Sewall-Menon, Judith Bruce, Karen Austrian, Raven Brown, Jennifer Catino, Alejandra Colom, Angel Del Valle, Habtamu Demele, Annabel Erulkar, Kelly Hallman, Eva Roca, Nadia Zibani

Poverty, Gender, and Youth

The most disadvantaged adolescent girls are the poorest girls from the poorest communities. They suffer from human rights abuses, lack education and economic opportunity, are affected by HIV/AIDS, and have poor reproductive and maternal health outcomes. To effectively reach these girls so that they can receive critical services such as gathering spaces, life skills, financial literacy, savings accounts, and reproductive health knowledge, they must be targeted as a distinct segment. It is important to invest in building the capacities of local partners and governments to deliver and scale-up low-cost, well-targeted programs. This technical report is intended to assist programmatic officers, …

Retarder Le Mariage Précoce Chez Les Filles Défavorisées En Milieu Rural Dans La Région Amhara, En Éthiopie, Grâce Au Soutien Social, À L'Éducation Et À La Sensibilisation Des Communautés, Eunice N. Muthengi, Annabel Erulkar

Poverty, Gender, and Youth

L'Éthiopie affiche des taux extrêmement élevés de mariage d'enfants et une épidémie de VIH qui touche les femmes de façon disproportionnée. Dans la région rurale d'Amhara, 50% des filles sont mariées avant l’âge de 15 ans et plus de 80% sont mariées avant l’âge de 18 ans. Les chercheurs ont réalisé une enquête auprès de plus de 1800 adolescentes dans la région d'Amhara. Sur la base des conclusions, en 2004, le Bureau Régional de la Jeunesse et des Sports d'Amhara et le Population Council ont créé le projet Berhane Hewan («Light for Eve»). L'objectif de Berhane Hewan est la mise …

Biruh Tesfa Procure Aux Employées Domestiques, Aux Orphelines Et Aux Immigrantes Des Zones Urbaines Éthiopiennes Une Assistance Sociale, Une Formation Sur Le Vih Ainsi Qu'un Programme De Développement Des Compétences, Annabel Erulkar, Belaynesh Semunegus, Gebeyehu Mekonnen

Poverty, Gender, and Youth

En Éthiopie, l'épidémie de VIH se révèle de plus importante en milieu urbaine et chez la population féminine. On estime que 7,7% de la population urbaine d'Éthiopie est séropositive, par rapport à moins de 1% de la population rurale. À l'échelle nationale, le rapport femme/homme en termes d'infection par le VIH est de 3 à 2. Il est possible que les filles qui migrent depuis les zones rurales vers les milieux urbains soient moins protégées, plus vulnérables à la violence et aux agressions sexuelles, et également moins bien équipées pour se prémunir contre ces situations d’abus (toutes susceptibles d’accroître le …

Addis Birhan Project: Working With Boys And Men To Address Young Girls' Social Vulnerability, Annabel Erulkar, Louis Apicella, Abebaw Ferede

Poverty, Gender, and Youth

In Ethiopia, the Ethiopia Ministry of Youth and Sports, the Amhara Regional Bureau of Youth and Sports, and the Population Council implemented programs for vulnerable girls. As these programs increased in popularity, demand for support programs arose from husbands. Qualitative, in-depth interviews were undertaken among adolescents, men, and women in the Amhara Region, exploring the roles of men and women, risk-taking behavior, and patterns of HIV and reproductive health vulnerability. Addis Birhan (“New Light”), a program of the Regional Bureaus of Youth and Sports in Amhara and Tigray and the Population Council for rural men in Ethiopia, targets married men …