Improving the Lives of Married Adolescent Girls in Amhara, Ethiopia: A Summary of the Evidence

This 16-page evaluation report discusses the experience and impact of the Towards Economic and Sexual Reproductive Health Outcomes for Adolescent Girls (TESFA) project, which focused on empowering married girls with reproductive health and financial knowledge and skills. The evaluation "found that the lives of married adolescent girls in the TESFA programme improved significantly in economic, health and social terms. "

According to the report, married adolescent girls are some of the most vulnerable, and forgotten, populations, and most programming and policy efforts focus on preventing child marriages rather than supporting girls who are already married. These married adolescents are at very high risk of sexually transmitted infections, including HIV, and face complications resulting from early pregnancy, yet are often the most removed from services or any kind of support network. Led by Care Ethiopia and the International Center for Research on Women (ICRW), the TESFA programme used peer education to empower married adolescent girls with reproductive health and livelihood information and skills, while also building community support.

The programme brought girls together to, for instance, "learn how to communicate and negotiate with others, stay healthy during their reproductive years, and earn and manage money, increases their knowledge and self-confidence. Meanwhile, helping married adolescents develop support networks alleviates the social and economic isolation many of them experience." Community members, including village elders, religious leaders, and health workers, were recruited as a part of Social Action and Analyses groups (gatekeeper) and, through a peer-based education system, "undertook critical dialogue and reflection on the factors that contribute to early and forced marriage. They supported role models and took action against early and forced marriage. They also acted as liaisons between the program and the community and were tasked with providing support to the girls groups." The rationale is that "[f]amilies and community elders are traditionally responsible for deciding when and whom a girl marries. Therefore, having community leaders critically reflect and realize how early and forced marriage impacts girls' and their families' health and futures often sparks change that is both powerful and sustainable."

To test the impact of offering sexual reproductive health (SRH) and economic empowerment (financial skills and livelihood training) separately or together, the participating girls were divided into 4 groups. One group received economic empowerment (EE) information and guidance, a second received training in issues related to their sexual and reproductive health, and a third received programming that combined the two. A comparison group received a delayed version of the combined curriculum.

The evaluation noted the following impacts:

Economic Empowerment

The evaluation found that all groups, including the comparison group, increased the proportion of girls participating in paid employment and income-generating activities, but the change was most profound in the intervention groups. "By the end of the program, 36 percent more girls in the EE and SRH arms and over 40 percent of girls in the combined group were engaged in work for pay, than at the beginning of TESFA. There was a roughly 27 percent increase in the Comparison group." Improvements across all groups are attributed to a rapidly changing economic context, but those involved with TESFA demonstrated a greater likelihood of participating in paid work. Moreover, the number of girls who stated that they saved some of their earnings was much greater in the TESFA groups, with 28% in the EE group, 23% in the combined group, 20% in the SRH group, and only 3% in the comparison group reporting saving any earnings. Those in the EE and combined groups "showed far greater increases in their use of savings for productive investments, such as small businesses and agricultural supplies." These groups were also far more likely to report accessing small personal loans. In terms of decision-making in the household, it was found that the girls had the most power in financial decisions related to their loans or small value assets in the household; men continued to be the sole decision-makers when it came to higher value household assets.

Sexual and Reproductive Health

Girls who participated in the TESFA project demonstrated increased knowledge around topics such as maternal health and family planning. The greatest increase in use of contraceptives was found to be in the SRH and combined groups; in the SRH arm, 78% of the girls were using family planning by the end of the project, an increase of 27%. There was a 15% increase in the combined groups, and while the EE and comparison groups had less change, there was some increased family planning in these groups as well - which is attributed to greater confidence and the fact that the girls became more mobile and visible in their community. The girls across all groups also gained knowledge about sexually transmitted infections, saw increased incidences of testing for HIV, and demonstrated improved ability to communicate and negotiate with their partners around reproductive health issues. Improved communication is cited as one of the most significant impacts of the project. "More of them discussed family planning with their husbands. More of them felt that their opinions were taken into consideration. And more girls were involved in decisions about whether or not to have a child."

Overall, ICRW's evaluation found that "the lives of married adolescent girls were greatly enhanced by girls' participation in TESFA, particularly those involved in the SRH group. Large and significant improvements in communication among couples, in the girls' mental health and in the community's support for the girls were documented – each of which affects young wives' health and economic behavior." Some unintended benefits are also noted - for example, shifting gender roles as men took on some roles traditionally reserved for women, prevention of a number of child marriages, and some girls returning to school.

The evaluation found little evidence that the combined EE and SRH programming results in better outcomes when considering the impact of each individually. There was no area where the combined arm consistently outperformed the EE or SRH groups, when assessing those outcomes. "However, the Combined arm generally experienced changes in both the EE and SRH dimensions that were greater than the Comparison group and than arms that received solely one type of intervention. This suggests that while there is no evidence of a synergistic effect, girls receiving the Combined package may have experienced the greatest overall gains from program participation, benefiting significantly in terms of both economic and health outcomes."