17 Thursday, April 2014

Program brings child brides out of the shadows

This piece about a remarkable program in Ethiopia that is changing the lives of child brides and their communities originally appeared on the International Center for Research on Women’s website and is reprinted with the permission of the ICRW.

Girls in Buro Kantuna, Ethiopia, wait to speak with an ICRW staff member on hand to learn more about their involvement in the TESFA pilot project carried out here in 2010-2011. Implemented by CARE Ethiopia and supported by ICRW,  the TESFA pilot was comprised of an economic empowerment (EE) arm, a sexual and reproductive health (SRH) arm, and a control group. --- David Snyder/ICRW
Girls in Buro Kantuna, Ethiopia, wait to speak with an ICRW staff member on hand to learn more about their involvement in the TESFA pilot project carried out here in 2010-2011. Implemented by CARE Ethiopia and supported by ICRW, the TESFA pilot was comprised of an economic empowerment (EE) arm, a sexual and reproductive health (SRH) arm, and a control group.
— David Snyder/ICRW

By Gillian Gaynair

A program that provided child brides in Ethiopia with unprecedented opportunities to learn about sexual and reproductive health as well as how to earn an income and save money proved to significantly enhance many aspects of the girls lives, according to new findings by the International Center for Research on Women (ICRW).

ICRW today releases “Improving the Lives of Married Adolescent Girls in Amhara, Ethiopia,” a summary of its evaluation of the groundbreaking program that took place over three years.

The program, called “Towards Economic and Sexual Reproductive Health Outcomes for Adolescent Girls” or TESFA, worked with 5,000 child brides ages 10 to 19, in Ethiopia’s rural Amhara region. Funded by the Nike Foundation and implemented by CARE-Ethiopia, TESFA sought to mitigate the effects of child marriage. It also provided opportunities for married adolescent girls – who are among the most marginalized members of society – to participate in the social, economic and political life of their families and communities.

For ICRW’s evaluation, led by Senior Social Demographer Jeffrey Edmeades, researchers employed innovative methodologies – including the Photovoice strategy – to understand not only if TESFA’s approach worked, but how and why. While a significant amount of research has explored the causes and consequences of child marriage in Ethiopia and elsewhere, little investigation and few programs have focused strictly on girls who are already married. TESFA – which means “hope” in Amharic – did. The program remains one of a few efforts globally that zeroed in on married girls and how best to support them as they transition to adulthood.

“Most global programming and policy efforts tend to center primarily on preventing child marriage, and ignore girls who are already married,” Edmeades said. “But it’s vitally important that we give more attention to this population. When their lives improve, so will their children’s, which can play a critical role in reaching global development targets to reduce intergenerational poverty and poor health.”

With her young daughter on her back, TESFA pilot project participant Kasansh Ayele speaks with staff of ICRW in Ayva Niva in Ethiopia's South Gondar Zone.  --- David Snyder/ICRW
With her young daughter on her back, TESFA pilot project participant Kasansh Ayele speaks with staff of ICRW in Ayva Niva in Ethiopia’s South Gondar Zone.
— David Snyder/ICRW

Launched in 2010, the TESFA program unfolded in several villages in the South Gondar region of Amhara. ICRW found that the girls’ economic and social lives as well as their health improved significantly. Among the changes ICRW recorded were:

  • Large gains in communication between the young wives and their husbands
  • Decreased levels of gender-based violence
  • Improved mental health among participating girls
  • Increased investment in productive economic assets, such as small businesses and agricultural supplies
  • Improved knowledge and use of sexual and reproductive health services, including family planning

TESFA built on CARE’s well-established Village Savings and Loan Association (VSLA) model, where girls were organized into groups and program content was delivered primarily through peer educators. While this approach has been widely used with adults, it had not been used extensively with adolescent girls exclusively, or as a mechanism for delivering a health-related curriculum.

The program divided participants into four groups that represented the type of education they received:

  • Economic Empowerment – Girls who received economic empowerment information and guidance, based on an adapted VSLA model.
  • Sexual & Reproductive Health – Girls who learned about issues related to their sexual and reproductive health.
  • Combined – Girls who received both EE and SRH programming.
  • Comparison – Girls who received a delayed version of the Combined curriculum and served as a comparison group.

It also directly engaged the community to a greater degree than is typical. In particular, community members, including village elders, religious leaders and health workers, were recruited as a part of Social Action and Analyses (SAA) groups – also called “gatekeepers.” These adults received training in areas related to the main project goals through a peer-education system similar to that used with the girls’ groups. They also acted as liaisons between the program and the community and were tasked with providing support to the girls’ groups.

Such engagement proved crucial for the success of the project and resulted in a number of benefits well beyond what the project team initially expected. SAA members provided direct assistance to TESFA through identifying potentially eligible girls in the community. They visited households to further explain the program to family members. They talked to the participant girls to discuss any issues they were having with the program. And, they provided overall support to the group through regular meetings.

“Fundamentally, these groups became agents for change in their own right,” Edmeades said, “actively engaging in child marriage prevention activities and promoting broader changes within their communities.”

For the evaluation, Edmeades and independent research consultant Robin Hayes analyzed whether providing economic empowerment and sexual and reproductive health programming together or individually was more effective. ICRW ultimately found little evidence indicating that combining both programs yielded even better outcomes than when offering the curricula separately. While the improvements in the economic outcomes were similar across the all project groups, there was no area where the combined arm consistently outperformed the economic group. This was also true when examining the sexual and reproductive health outcomes.

However, the combined arm generally experienced changes in both the economic empowerment and health dimensions. These were greater than the comparison group and than groups receiving solely one type of intervention.

“This suggests that while there was no evidence of a synergistic effect, girls who received the combined package may have experienced the greatest overall gains from program participation,” Edmeades said. “They, more than others, benefitted markedly in terms of both economic and health outcomes.”

In other areas important to married girls’ lives, ICRW documented large and significant improvements in communication among couples, in the girls’ mental health and in the community’s support for the girls.

“Each of these outcomes has a long-term impact on the girls’ health and economic behavior,” he said.

TESFA’s presence in communities also yielded a few unexpected results. Among them, ICRW witnessed husbands taking on responsibilities traditionally reserved for wives, such as childcare and cooking. Some girls returned to school to continue their education. And most notably, community members in the villages where TESFA unfolded prevented more than 70 child marriages from taking place.

“The project was not designed to reach any of these goals,” Edmeades stressed. “But these effects of TESFA’s presence in the communities are pretty powerful – they illustrated for us that the program’s messages, particularly about the consequences of child marriage, really resonated with communities.”

In its summary of the evaluation, Edmeades and Hayes contend that although TESFA provided a much deeper understanding of the needs of child brides, much more is required for this often forgotten population of girls. This, they say, includes determining how to reach the most marginalized of these girls, including those who are divorced or widowed and how to better work with couples, among other areas of work.

“While we should continue doing everything that we can to end child marriage everywhere, we should also not forget that this remains a widespread practice in a lot of places,” Edmeades said. “Even if we are very successful in fighting child marriage, we can realistically expect more than 100 million new child brides over the next ten years. These married girls will be among the most vulnerable members of their communities. They’ll also be critical to really achieving significant change in so many development objectives.

Allowing them to stay in the shadows mustn’t be an option for any of us.”

LEARN MORE:
Read the full report
Blogs, stories and other content about TESFA

Gillian Gaynair owns Mallett Avenue Media, a Washington, D.C.-based firm specializing in content that shows how foundations, nonprofits and corporations effect change in the U.S. and globally.

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