Delivering transformative, rights-based family planning
Project Name: Abdiboru
Donor: Gates Foundation
Partner: Government of Ethiopia and Addis Continental Institute of Public Health (ACIPH)
Objective: Abdiboru aims to address structural determinants (agency, government institutions, and social norms) that act as barriers to empowerment in order to improve health, education, and economic outcomes for adolescent girls.
In Ethiopia, adolescent girls have great potential to bring positive change to their communities and country. Yet their lives, particularly in rural areas, are constrained and threatened because of structural determinants that consign them to low literacy, limited aspirations, early marriage, poor reproductive health and nutrition, and poverty.
This program targets three major structural determinants that hinder girls’ empowerment, namely:
- Government Institutions – To improve the accountability to adolescent girls of the government’s local and district health, education, and women’s affairs institutions
- Social Norms and Values – To bolster social and cultural norms and values that protect and prevent discrimination against adolescent girls
- Agency – To ensure that adolescent girls have some control over decisions that affect their lives
While key program elements have been implemented previously in Ethiopia to great effect, this program is highly innovative because it follows a cohort of 10-14-year-old girls over 3 years, combines cross cutting proven approaches, and it tests the relative and combined effects of a focus on girls’ agency and control, government responsiveness, and changes in social norms for girls’ empowerment.
Abdiboru is being implemented in four districts of the West Hararghe zone of the Oromia region, covering a population of 730,000. The intervention arms are as follows: 1) control/delayed intervention (in year 5); 2) government-level responsiveness and increased life skills of in-school adolescent girls; and 3) combined arm which includes improved government level responsiveness, girls’ agency, and addressing community social norms.
Arm 1: Control and delayed intervention
One district is a control arm with no intervention in the first four years. In the final year, the fine-tuned approaches learnt from the program will be applied in this district.
Arm 2: Government-level responsiveness and increased life skills of adolescent girls
This arm will enhance the support from and accountability of district-level service institutions, including health, education, and women’s affairs, to ensure that services are accessible, appropriate, and responsive to the needs of rural very young adolescent girls. This arm will also seek to substantially improve the power in-school adolescent girls have over critical decisions in their lives, such as age of marriage, continued education, access to food, selection of a life partner, timing of child bearing, and use of the health care system.
The main activities to reach this objective are:
- Consulting stakeholders to identify potential beneficiaries, including in-school & out-of-school girls
- For girls still in school, establishing girls’ clubs & strengthen clubs that already exist
- Working with existing girls’ groups or health extension workers to identify out-of-school girls not currently in a group
- Establish out-of-school girls’ groups & strengthen those that already exist
- Use Community Score Card to assess and address priority issues related to girls’ education, marriage, sexual and reproductive health, and nutrition
- Develop negotiated, detailed action plan from the prioritized issues
Arm 3: Combined arm
For girls to be successful, they must not only have enhanced individual skills and available services, they must also have the support of those around them. Under this objective, we seek to transform social and cultural norms in households and communities so that these norms protect adolescent girls’ health and prevent discrimination against them.
The main activities to reach this objective include:
- Barrier analysis, identification of reference groups and role models, and development of Social Analysis and Action (SAA) curriculum
- Use SAA to facilitate self-reflection activities with government service provider staff, reference groups, community members, and girls regarding values, discrimination, and social norms
- Implement action cycle to influence expectations of others in the community
- Use positive, persuasive messaging and images to promote idea that it’s normal for girls to have choice and a voice
- Provide support for implementation plans and follow-up initiatives developed through SAA method
- Hold role model public recognition events
Through Abdiboru, CARE and partner organization ACIPH hope to answer two main learning questions: 1) how can transforming social norms contribute to the empowerment, education, and sexual and reproductive health and nutrition outcomes of very young adolescent girls (age 10-14)? And 2) what is needed to develop the evidence base for a model of social norm programming that can be scaled up by the government in a cost-effective way?
CARE is also learning how best to work with very young adolescent girls in a sustainable way that can be scaled in Ethiopia. Further, CARE is exploring the relationship between improved individual agency and control, government accountability, and development outcomes like increased attendance at school, improved nutrition, and sexual and reproductive health.
The primary outcomes of this project include:
- Increased agency and control among adolescent girls
- Improved health and development outcomes in adolescent girls
- Demonstrated support for evidence-based scale-up in Oromia Region