Adolescent health, nutrition and sexual and reproductive health in Ethiopia – Ethiopia
By Nicola Jones, Elizabeth Presler-Marshall, Sarah Baird, Joan Hicks, Nardos Chuta and Kiya Gezahegne
While Ethiopia is renowned for its cadre of health extension workers (HAWs) who provide community-based preventive care across the country, and the government has developed a national adolescent and youth reproductive health strategy, we know relatively little about adolescent access and experiences. with these health services. The Ethiopian adolescent physical health evidence base focuses primarily on nutrition and sexual and reproductive health (SRH) behaviors of young people over 15 years of age. The health and nutritional needs of young adolescents, as well as the broader health vulnerabilities of all adolescents, are rarely addressed. This narrow focus has been driven largely by concerns about the reproductive health needs of the large number of adolescent girls at risk of child marriage, more than a quarter of whom are already pregnant or mothers by age 19 (CSA and ICF, 2017).
This report on adolescent health, nutrition and SRH in Ethiopia seeks to contribute to these knowledge gaps. It is one of a series of short reports presenting findings from basic mixed-methods research as part of the Gender and Adolescence: Global Evidence (GAGE) Longitudinal Study (2015-2024). We focus on adolescents’ perceptions of their health, nutrition and SRH and their experiences of accessing related services, paying particular attention to gender and regional differences, as well as differences among adolescents disabled and those without. We also discuss the range of change strategies currently being implemented to accelerate social change, as well as related gaps in the policy and program landscape.
In Ethiopia, our research sample includes a survey of over 6,800 adolescent girls and boys from two cohorts aged 10-12 (younger adolescents) and 15-17 (older adolescents), and larger qualitative research. in-depth with 240 teenagers. Their families. Baseline data was collected from selected sites in Afar, Amhara and Oromia regional states and Dire Dawa municipal government in 2017 and 2018. The sample includes some of the most disadvantaged adolescents (adolescents with disabilities, married girls and teenage mothers, adolescents from pastoral communities and remote rural communities, adolescents from internally displaced households and child-headed households). Three subsequent cycles of data collection will be carried out in 2019/2020, 2020/21 and 2022/23 with the youngest cohort when they reach 12-14 years old, 13-15 years old and 15-17 years old, and with the cohort the oldest at 17-19, 18-20 and 20-22. The main qualitative research will take place at the same times, but we will also undertake peer-to-peer and participatory research from late 2018/early 2019 on an annual basis to further explore peer networks and the experiences of adolescents. more marginalized. .
- General health: While adolescents perceive their health to be good overall, poverty-related illnesses remain common and adolescents’ exposure to modern health risks such as drug abuse is increasing. Overall, girls report higher levels of poor health than their male counterparts.
- Nutrition: The average adolescent in the GAGE sample lives in a moderately food insecure household and is more likely to report poor quality diet than insufficient quantity. Adolescents in rural areas are more at risk of poor nutrition than adolescents in urban areas, and adolescents in drought-prone areas remain particularly at risk.
- Puberty and menstruation: Young adolescents, especially those in rural areas, have limited access to timely information about puberty. Menstruation (often indeed a taboo subject) and the management of menstruation are sources of great anxiety for girls due to gendered social norms that confuse menstruation with female sexuality, making it a highly stigmatized bodily function.
- Sexual and reproductive health: Adolescents’ access to and use of contraceptive information, supplies and services vary widely. Amhara adolescent girls are in a relatively advantaged position, especially compared to their counterparts in Afar and Oromia, where gendered social norms leave single and married girls – even very young ones – at risk of pregnancy. .
HEWs play a central role in supporting improvements in health and SRH in rural areas, and in adolescent health services in urban areas. They are complemented by mainly school-based girls’ clubs, which in the communities where they operate educate girls about puberty and can support them through menarche. In terms of nutrition, the Productive Safety Net Program (PSNP) helps alleviate food insecurity at the household level and, in some areas, school feeding programs provide meals to school children.
Policy and Program Implications
The results of our baseline research point to the following policy and programmatic implications:
- Strengthen health awareness and outreach services for adolescents: While HEWs have helped improve communities’ access to basic health care, continued efforts are needed to educate parents about common ailments in children that require timely interventions. It is also necessary to improve access to basic medicines, which are often beyond the reach of the communities furthest from the district capitals. Services could reach adolescents in these areas by expanding school-based health clubs and through mobile immunization clinics in rural schools.
- Ensure that health awareness programs and services are informed by an understanding of the gender-specific risks and vulnerabilities faced by adolescents, including those of married and unmarried girls, to be able to better support their health and sexual and reproductive health rights in particular.
- Develop family and school nutritional support as a central pillar of social protection programs: To prevent long-term damage to development resulting from prolonged malnutrition, there is an urgent need to provide nutritional support to families in drought-affected areas. This should include expanding Productive Safety Net Program (PSNP) support to Afar in particular, as well as school feeding which reliably provides free, quality food to students in all communities in need. food insecurity. Over time, we also recommend that nutrition education programs address certain cultural beliefs about food and intergenerational food distribution that may impact children’s nutrition.
- Invest in educating children about puberty and engage communities to accept the need for such education: Age-appropriate puberty education classes that begin with young children should be provided in schools and other community settings, alongside classes for parents that help them answer questions and children’s concerns (while also ensuring that their own knowledge is accurate). To reduce period-related bullying, both girls and boys need accurate information about puberty and the changes it brings to both genders. Given the powerful role that community and religious leaders play in shaping gendered social norms, gaining parental and community buy-in is critical to educating children about puberty.
- Strengthen accessible and affordable menstrual hygiene support: Adolescent girls must have access to durable and affordable menstrual hygiene products, as well as simple ways to help them track their menstrual cycle, and to separate latrines, access to water and dedicated private spaces in schools so that they can change their sanitary products if necessary during the course of the school day.
- Expand access and improve the quality of adolescent-friendly SRH services: To reduce adolescent girls’ exposure to pregnancy and sexually transmitted infections (STIs), stakeholders need to adopt a multi-pronged approach that includes delaying first sex (to allow for cognitive and emotional maturity), increased access access to condoms, better education and services about STIs (particularly HIV), and reducing social barriers (eg, stigma, shame, and restrictive gender norms) that reduce contraceptive use.
Read the full report and policy brief