Aragaw Lamesgin, Gebeyehu Mekonnen, Annabel S. Erulkar Population Council Ethiopia Presented at: 16 th ICASA, 2011 Addis Ababa Ethiopia Meserete Hiwot: A Program Supporting Married Adolescents with HIV Prevention and Reproductive Health in Rural Ethiopia ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth 1

Why target young married women in rural Ethiopia? Adolescents in general and out-of-school adolescents in particular often lack access to health information, counseling and legal protection. (Paxmam JM, 1989) Most programs in Ethiopia overlook vulnerable girls- girls who are out of school and at risk of child marriage and those who are already married. (Erulkar et al 2004 ) Globally early marriage is declining, still in Amhara region, 48% of girls are married by age 15. (Erulkar et al 2004, Pathfinder, 2006, UNICEF2005 ) In many settings, married adolescent girls may be at greater risks for HIV infection compared to unmarried peers who are sexually active. (Clark S, 2004, Seifu A et al, 2006) ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth 2

Target Continued … Research by Population Council found that many girls experienced early unwanted arranged marriages resulting in early unwanted sexual initiation and pregnancy as well as social isolation in new marital homes. (Erulkar S. et al 2004) Moreover, few (33%) of these young wives had knowledge of HIV and reproductive health and few (5%) received support during pregnancy or childbirth. To address these issues, the Amhara Bureau of Women, Children and Youth Affairs in partnership with Population Council created the Meserete Hiwot program in 2008 with support from USAID/PEPFAR. ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth 3

What is Meserete Hiwot (Base of Life) program? Fig. 1. Club members attending mentorship session at Woji sub district, South Gondar Ethiopia The program builds married adolescents’ knowledge, skills and social assets Designed to help married girls in rural Amhara Ethiopia increase social networks, better protect themselves from HIV and learn about reproductive health. Female mentors living in the community recruit participants house-to-house. Out-of-school married adolescents and young women (10-24 years) are mobilized into clubs. Clubs consists of 25 members and meet in community spaces usually, under trees. M ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia inistry of Women, Children and Youth 4

Courses in Meserete Hiwot Club members receive a 4-month course including: Communication skills, Basic facts about HIV and AIDS, Harmful traditional practices, Gender based violence, Services referrals for CT, PMTCT, ART and FP. Method is entirely participatory and learner- centered. Contextually relevant illustrations are used to create dialogue, self-exploration and beliefs among groups in a safe space that is free of criticism and judgment. ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth 5

Cumulative Program Performance since ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth Source: Population Council (MIS) and project annual reports

Performance continued… 425 female mentors recruited and trained. These mentors mobilized 175,116 adolescents and young women to the program. Over 322 Kebeles reached in 18 districts. Quasi-experimental research comparing married girls in intervention sites with those in comparison areas examine changes in girls’ knowledge, health seeking behavior and level of familial support (endline ongoing). ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth 7

What difference does the program make in the lives of Married Adolescents? Source: Population Council (MIS) and project annual reports ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth 8 Participants referred to HIV and RH services ( ) Type of referralsNumber% Single CT50, Couple CT17, PMTCT5, STIs FP24, ANC9, PNC3, Others (ART, Delivery)1, Total112,

Qualitative Evidence Suggests… Improved spousal communications, faithfulness, and shared responsibility among couples. “When I talk to my husband he understand me. Previously, I couldn’t even express myself and my ideas to my husband. Now we talk each other”. (Married young women, age 22, 1 child, never been to school) Increased knowledge of HIV and AIDS and changes in their relationship with their husbands. “As a result of the program, I started using family planning. I would be pregnant by now if I had not started it. I went with my husband to health facility and received CT. That helped us to lead a healthy life. We developed a good relationship, respect and support each other”. (Married adolescent, age 18, never been to school) “Before, I was scared to take CT. After the program, I understand taking CT service is very important. Now, I received the service and encouraged my mother too. I was married when I was 11-years old and that affected my life. I learned a lot and never have sex without condoms and I will also advise my friends to do so”. (Divorced adolescent, age 18, 3 years education) 9 ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth

Way Forward Married adolescent girls in rural Ethiopia are potentially at greater risk of HIV. Married adolescent girls are at high risk for maternal morbidity and mortality from early first births. When girls marry early, personal development is hindered and intergenerational poverty is perpetuated. Despite early skepticism, Meserete Hiwot demonstrates that programs that target married girls have the potential to reach extremely large numbers and make a difference in the lives of girls. ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth 10

11 Ameseginalehu! Thank you ¾›=ƒÄåÁ ôÅ^L© Ç=V¡^c=Á© ]øwK=¡ ¾c?„‹ I퓃 “ ¨×„‹ Ñ ’>e‚` The Federal Democratic Republic of Ethiopia Ministry of Women, Children and Youth