Delivering transformative, rights-based family planning
Project Name: Towards Economic and Sexual Reproductive Health Outcomes for Adolescent Girls (TESFA)
Donors: Nike Foundation; Johnson & Johnson
Partners: International Center for Research on Women (ICRW), Organization for Rehabilitation and Development in Amhara (ORDA), Family Guidance Association of Ethiopia (FGAE), and Birhan Research and Development consultancy (BRDC)
Duration: 2011-2013; 2015-2018
Objective: TESFA aims to improve sexual and reproductive health and economic outcomes for ever-married adolescent girls (ages 10-19).
Today, there are nearly 70 million child brides worldwide, with an estimated 142 million more destined for early marriage over the next decade. Child marriage violates girls’ basic human rights and brings their childhoods to a swift end. Married adolescent girls are often the most vulnerable individuals in their societies and communities. They also hold great potential. But unfortunately, married girls remain a forgotten population in global programming and policy efforts, which have focused increasingly on preventing – rather than mitigating – child marriage and supporting girls who are already married.
The TESFA program took place in two districts in the South Gondar region of Amhara, Ethiopia, where girls are at great risk of early and forced marriage and female genital cutting, and where they are the brunt of social norms that favor boys. These norms affect girls’ educational opportunities, decision-making power within their households and increase their vulnerability to violence, sexually transmitted infections and other health concerns.
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 facilitators. 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 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 Analysis and Action (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. Based on the SAA approach, the community groups of “gatekeepers” 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.
ICRW conducted an evaluation of TESFA, where researchers analyzed whether providing economic empowerment and sexual and reproductive health programming together or individually was more effective. TESFA participants separated into specific groups based on the type of training they received (economic empowerment only, sexual/reproductive health only, combined intervention with both, and a control group who received the combined curriculum after everyone else was finished). ICRW compared the relative effectiveness of each group’s approach in improving the economic empowerment and sexual and reproductive health outcomes for girls. The design also provided an opportunity to see the effect of each of these compared to a de facto “do nothing” scenario, where the girls did not receive any programming.
The evaluation found that the lives of married adolescent girls in the TESFA program improved significantly in economic, health and social terms. The changes included:
- 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
- Improved knowledge and use of sexual and reproductive health services, including family planning
- Increased social capital and support
For more details and results on the ICRW TESFA evaluation, click here.
Continuing the TESFA Model
After the original implementation was complete, TESFA scaled geographically to additional areas of South Gondar region, reaching 2,587 more girls and 1,440 "norms gatekeepers" between 2015-2017. The model underwent slight adaptations, including reaching in-school girls. The evaluation used innovative qualitative methods to measure changes in social norms, and indicated impressive shifts in social norms around married girls' mobility and household roles, decision making and communication with husbands and mothers-in-law in just 2.5 years. An external brief on these findings will be published soon.