Act With Her (AWH)

AWH is designed to help girls and boys build skills and a supportive network to help them navigate the transition from childhood to adulthood, while supporting enabling environments for gender norm transformation. One of the programme's focus areas is tackling gender norms around menstruation and improving menstrual health literacy. In particular, the programme seeks to support improvements across the six Gender and Adolescence: Global Evidence (GAGE) capability domains: education, bodily integrity, health, psychosocial wellbeing, voice and agency, and economic empowerment.

The programme scaled up and adapted an existing girls' empowerment programme that focused on young adolescent girls called Her Spaces and at the same time sought to assess the potential value-add of an expanded version with additional AWH components that included boys, older girls, and the wider community. The specific activities of the expanded programme were:   

Group sessions with adolescents: These sessions form the core of the programme. Adolescents in age- and gender-segmented groups receive either 25 discussion modules (ages 15-19) or 40 discussion modules (ages 10-14). Topics covered include a wide range of themes including puberty and menstruation, health, nutrition, education, safety, gender, communication, and economic empowerment. The curriculum-based discussion groups are led by local "near peer" mentors of the same gender ages 18-25 (more details on mentors are below). This gender-synchronised programming helps adolescent girls and boys question and critically reflect on norms, behaviours, and expectations related to masculinity and femininity. Most of the weekly group discussions are segregated by gender, but four joint sessions bring the boys and girls together to discuss issues related to gender roles and negotiation skills. These joint sessions build mutual understanding and enhance participants' ability to address gender- and age-based challenges in their communities. The sessions are guided by the AWH curriculum, which has been tailored to the specific programme context for cultural sensitivity and specificity to the adolescent needs and gender norms in the project area. Between 2019 and 2023, the project reached more than 50,000 adolescent Ethiopian girls and boys.

Group discussions with parents and caregivers: AWH recognises that working with adolescents alone is not sufficient to change longstanding gender norms. The programme separately engages parents and caregivers in six sessions designed to improve their own knowledge and their ability to communicate about complex issues with their children. These sessions engage diverse community members who are fathers, mothers, and guardians to improve their relationships with their adolescent children.

Local community involvement: The project engages local communities to catalyse positive shifts in gender and social norms via CARE International's longstanding Social Analysis and Action (SAA) approach. SAA encourages regular participation of key norm holders, influential persons, elders, and religious leaders in creating their own solutions to challenge rigid, harmful social and gender norms within their communities. Through reflection, problem-solving, and dialogue, community members work together to address inequitable community norms that prevent youth from realising their rights.

Systemic change/service delivery: To ensure social accountability of local services, AWH used the Community Score Card (CSC), a two-way, ongoing participatory tool pioneered by CARE. It uses a participatory dialogue approach that engages service users and providers together to improve the quality of local services - and in the case of AWH, the adolescent-responsiveness of services.

Support for multi-stakeholder, cross-sector action: Key local power-holders from multiple sectors commit to jointly play a more vocal and proactive role in bringing adolescent issues to the forefront of local policy and community discussions.

Savings groups: Older adolescents form streamlined Village Savings and Loans Associations (VSLAs). The programme recommends expanding these self-managed, sustainable savings groups for use by younger adolescents and by adults participating in the parent or social norms activities.
 
Other supporting actions that were included as add-ons in certain areas included the following:  

• Improving youth-friendly health services at local clinics;
• Offering gender- and age- sensitivity training, with a focus on school-based violence;
• Strengthening implementation of a national school health and nutrition package;
• Improving menstrual health and hygiene management (MHM) in schools; and
• Establishing "Roll Back Early Marriage" clubs for girls.

Training and management of mentors: Mentors are the heart of the programme and are provided with training, stipends, and supportive supervision. They host the sessions for the adolescents and for the parents, support broader community activities, collect monitoring data, and provide valuable feedback throughout implementation. The programme recommends "near peer" mentors who are between the ages of 18-25 and who live in the same communities as the adolescents. Mentors are assigned to work in pairs, with each pair responsible for leading two groups together. This approach proved to be valuable in reducing the challenges posed by mentor attrition. Mentor trainings lasted for 2 weeks and included at least one refresher training in each area over the 10-month period of group programming.

Materials development: AWH developed a range of materials to support the group sessions for younger adolescent girls and boys, older adolescent girls and boys, and their parents, respectively. These materials include facilitation manuals for mentors plus participant handbooks. The curricula for boys and girls address key topics across the six GAGE domains (education, bodily integrity, health, psychosocial wellbeing, voice and agency, and economic empowerment).

Click here to view all AWH programme materials, which are open-access, editable materials for replication and adaptation.

Evidence generation and learning: One of the objectives of AWH was to contribute to global evidence generation and learning through external evaluation in Ethiopia by the GAGE research consortium. A randomised impact evaluation was conducted, and a range of learning materials were developed. See Related Summaries, below, for the results of a randomised control trial and "Snapshot of GAGE Quantitative Findings on Act With Her in Ethiopia (2019-2022)"  
[PDF, May 2023] for more information.

The Act With Her Implementation Learning Series includes briefs and infographics on the following programme strategies and activities:

• Working with Very Young Adolescent Girls and Boys
• Engaging Mentors in Very Young Adolescent Programming
• Strengthening Local Systems for Very Young Adolescents
• Mobilizing Adult Allies for Adolescents
• Gender-Synchronized Programming
• Using Savings Groups with Older Adolescents
• Delivering Adolescent Programming In A Migratory Pastoralist Setting
• Menstruation Matters In Very Young Adolescence
• What Applying A Gender Lens To Our Data Taught Us
• What Costs Are Involved Multi-Faceted Adolescent Programming?

For more information about the project, see "The Act With Her Program Legacy Report: Learning from Implementation in Ethiopia & Jordan (2017-2023)" [PDF, May 2023, which summarises the programme's cross-cutting implementation insights, key achievements, and challenges.

AWH also developed a guide for implementation teams: "Adapting and Implementing the Act With Her Program: A How-To Guide" [PDF, April 2023]. It offers 20 simple step-by-step suggestions for adapting the AWH programme for different contexts and for making basic startup preparations and decisions.

As Pathfinder explains, "While birth rates are falling in Ethiopia, over half of all Ethiopians are under the age of 20. Girls in Ethiopia are highly vulnerable to child marriage, female genital mutilation, and sexual or gender-based violence. Their voice and agency are more limited than that of boys, due to social norms that primarily value them as wives and mothers. While Ethiopia has made remarkable progress in equitably expanding primary education over the last two decades, the percent of Ethiopian girls in school drops significantly from 84 percent in primary to only 11 percent for secondary education."

According to Pathfinder, the unique strengths of AWH lie in the following:

• Serving very young adolescents: Early adolescence (ages 10-14 years) is an especially crucial phase that influences a girl's physical, psychological, and social development for a lifetime. Yet this phase of life has been largely neglected within global funding, research, and programmatic efforts. AWH serves two separate age cohorts, with one specifically designed to reach girls and boys in this early and underserved period of adolescence.
• Engaging boys and parents: A girl's ability to make positive choices and to have access to key health, education, and economic opportunities is most often linked to how others view her worth, her rights, and her future. AWH seeks to meaningfully connect with boys and parents to help ensure that adolescent girls have support now and in the future from peers, partners, and their family.
• Using a wide-angle lens: Improving adolescents' health knowledge, behaviours, and access to services is critical for their positive development. Yet ensuring a healthy, happy, and productive future also requires simultaneous attention to the diverse set of systems that influence a young person's trajectory. AWH uses a panoramic view of adolescents' well-being to holistically empower adolescent girls and enhance the social, health, and education systems that serve them.