Adolescent girls, Early Marriage and Migration in Amhara Region and Addis Ababa

ACTIVITY UNCHANGED FROM FY2008

COP 2008 NARRATIVE

Amhara Region has the lowest age at marriage in the country, with 46% of girls marrying by 15 years. Most of these vulnerable girls have not had sex before marriage and, in this population, the earlier a girl marries, the earlier she has sex. Orphan girls are more likely to experience early marriage than non-orphans. In addition, Amhara Region has one of the highest rates of divorce in the world, with early marriage being a predictor of divorce (Tilson and Larsen, 2000). A study by Population Council (PC) in low income areas of Addis Ababa found that 45% of adolescent girls had migrated from rural areas; among the most common reasons given for migration were education, work, and to escape early marriage (Erulkar et. al. 2006). Though migrants hope for a better future in urban centers, many end up highly vulnerable, often in lowly paid and exploitive domestic work or in sex work. Being economically vulnerable and socially isolated, such girls and young women are highly vulnerable to forced or coerced sex, transactional sex for daily or periodic support, and negative reproductive health outcomes, including HIV infection. Evidence suggests that girls who marry early have increased risk of HIV infection, even compared to their unmarried sexually active peers. A study in Kenya and Zambia revealed that married adolescent girls have 50% higher HIV rates compared with unmarried sexually active girls. Married girls' high infection rates are related to more frequent intercourse, almost no condom use, and husbands who are significantly older, more experienced, and more likely to be HIV-positive compared with boyfriends of unmarried girls.

Few programs, especially OVC programs, have addressed the specific needs of married adolescent girls, including the risk of migration, either escaping marriage or following divorce. Due to social and cultural definitions of childhood, once a girl is married she is no longer considered a child regardless of her age or stage of development. OVC programs working with communities to identify OVC need to take this issue into consideration. This activity will assist OVC programs with meeting the specific needs of adolescent girls who have migrated without adult supervision to urban centers most often to escape early marriage.

This activity will complement the continuing Population Council AB activity and will be undertaken in urban and peri-urban areas of Bahir Dar, Gondar, Debre Markos, Dessie, and Addis Ababa with the latter three being new sites during the current year. All districts are contiguous with the urban centers and along truck routes, where many girls migrate. The objectives of this activity are 1) developing tools and training for OVC programs on meeting the needs of adolescent girls experiencing or escaping from early marriage 2) providing services and referrals to female OVC who have migrated to low income urban centers. Services to be provided include emotional and social support from adult female mentors, non-formal education, HIV-prevention information, livelihoods training including financial literacy and entrepreneurship, and referrals to post-rape counseling, health services, VCT, PMTCT, and ART. Population Council will partner with economic growth programs specializing in livelihoods for vulnerable populations to provide guidance on entrepreneurship training and employment strategies and resources. Linkages with programs addressing exploitive child labor will be made to leverage experience and capacity.

In four urban areas of Amhara Region (Bahir Dar, Gondar, Debre Markos and Dessie) and Addis Ababa, the activity will establish girls' groups for the most vulnerable, out-of-school, migrant girls, including domestic workers. The groups, led by adult female mentors, will provide a safe space for girls to discuss their problems, obtain peer support, and engage with supportive adults. Providing non-formal education to girls in these groups will allow them to catch up with their interrupted or missed education. Different types of livelihood skills training will be given to enable them to work and support themselves and therefore prevent engaging in risky behavior for sustaining themselves.

Over 7,500 of the most vulnerable migrant girls will be reached in COP 2008 through 100 trained female mentors. Groups will be managed by the local ward administrations as well as local NGOs, to be identified. Site selection will be done in collaboration with OVC programs to ensure maximum use of resources and avoid duplication. Female mentors will serve a pivotal role in identifying needs, providing support, and making and following up on referrals. The activity will build on lessons learned from the pilot project "Biruh Tesfa" (Amharic for 'Bright Future') program for vulnerable adolescent girls in the Mercato, area of Addis Ababa. Through this pilot project, the most vulnerable urban girls are recruited house to house by female mentors, who negotiate directly for the girls' participation with gatekeepers, including employers of domestic workers.

Assistance to OVC programs will include provision of technical input on how to improve reach and depth of services to adolescent girls who have migrated to urban and peri-urban areas. South-to-south exchanges will be facilitated between OVC program and activities in Kenya that are addressing the impacts of early marriage and migration of girls.

The activity will focus on vulnerable adolescent girls and therefore increase gender equity in HIV/AIDS programs. The Population Council, through lessons learned from this program, will continue to lead PEPFAR partners in enhancing programming directed to address the needs of vulnerable girls and young women. The program will also include capacity building to partnering ward administration offices and local NGOs to help them recognize the impacts of girls experiencing early marriage and how to address their needs.

The activity will apply the recently drafted Standards of Services for OVC in Ethiopia and conform to the PEPFAR Ethiopia Prevention Strategy of targeting high risk groups. Faith and community structures will be engaged in identifying and providing support to adolescent girls their prospective husbands, their families and communities that support early marriage. The program will link closely with Population Council's Safer Marriage activity in the Amhara Region since that activity will focus on prevention of early marriage and prevention of marital transmission of HIV through messages for the community, use of faith based structures at the community level and promoting faithfulness in marriage.

Adolescent Girls, Early Marriage, and Migration in Amhara Region and Addis Ababa

ACTIVITY UNCHANGED FROM FY2008

46% of girls in Amhara marry by age 15, which makes them vulnerable to HIV infection and divorce. Early marriage is a predictor of divorce with Amhara having one of the highest rates of divorce in the world (Tilson and Larsen, 2000).

Girls who are exposed to early marriage are vulnerable because they tend to migrate into urban areas looking for a better future but often end up in low paying and exploitative domestic work or sex work, which make them susceptible to forced or transactional sex, resulting in negative reproductive health outcomes and exposure to HIV infection. A study in low income areas of Addis Ababa found that 45% of adolescent girls had migrated from rural areas; and the most common reasons given for migration were education, work, and to escape early marriage (Erulkar et. al. 2006). In addition, evidence suggests that girls who marry early may have an increased risk of HIV infection compared to their unmarried sexually active peers. A study in Kenya and Zambia revealed that married adolescent girls have 50% higher HIV rates compared with unmarried sexually active girls. Married girls' high infection rates are related to more frequent sexual intercourse, almost no condom use, and husbands who are significantly older, more experienced, and more likely to be HIV-positive compared with boyfriends of unmarried girls.

Orphan girls are more likely to marry early than non-orphans. Few programs, especially OVC ones, have addressed the specific needs of married adolescent girls, which includes the risk of migration to either escape early marriage or to make a new life after a divorce. Due to social and cultural definitions of childhood, once a girl is married she is no longer considered a child regardless of her age or stage of development. This activity will assist OVC programs to meet the specific needs of adolescent girls who have migrated without adult supervision to urban centers and will complement the continuing Population Council AB activity. It will be implemented in urban and peri-urban areas of Bahir Dar, Gondar, Debre Markos, Dessie, and Addis Ababa, which are along truck routes.

This activity will: 1) develop tools and training for OVC programs to meet the needs of adolescent girls who are escaping from early marriage; and 2) provide services and referrals to female OVC who have migrated to low income urban centers. Services to be provided include emotional and social support; non-formal education; HIV prevention information; livelihoods training (including financial literacy and entrepreneurship); referrals to post-rape counseling, health services, VCT, PMTCT, and ART. The Population Council will partner with economic growth programs specializing in livelihoods for vulnerable populations to provide guidance on entrepreneurship training and employment strategies and resources. Linkages with programs addressing exploitive child labor will be made to leverage experience and capacity.

The activity will establish girls' groups for the most vulnerable, out-of-school, migrant girls, including domestic workers. The groups, led by adult female mentors, will provide a safe space for girls to discuss their problems, obtain peer support, and engage with supportive adults. Providing non-formal education to girls in these groups will allow them to catch up with their interrupted or missed education. Different types of livelihood skills training will be given to enable them to work and support themselves and therefore prevent engaging in risky behavior for sustaining themselves.

Over 7500 of the most vulnerable migrant girls will be reached in FY 2008 through 100 trained female mentors. Groups will be managed by the local ward administrations as well as local NGOs, to be identified. Site selection will be done in collaboration with OVC programs to ensure maximum use of resources and avoid duplication. Female mentors will serve a pivotal role in identifying needs, providing support, and making and following up on referrals. The activity will build on lessons learned from the pilot project "Biruh Tesfa" (Amharic for 'Bright Future') program for vulnerable adolescent girls in the Mercato, area of Addis Ababa. Through this pilot project, the most vulnerable urban girls are recruited house to house by female mentors, who negotiate directly for the girls' participation with gatekeepers, including employers of domestic workers.

Assistance to OVC programs will include provision of technical input on how to improve reach and depth of services to adolescent girls who have migrated to urban and peri-urban areas. South-to-south exchanges will be facilitated between OVC program and activities in Kenya that are addressing the impacts of early marriage and migration of girls.

The activity will focus on vulnerable adolescent girls and therefore increase gender equity in HIV/AIDS programs. The Population Council, through lessons learned from this program, will continue to lead PEPFAR partners in enhancing programming directed to address the needs of vulnerable girls and young women. The program will also include capacity building to partnering ward administration offices and local NGOs to help them recognize the impacts of girls experiencing early marriage and how to address their needs.

The activity will apply the recently drafted Standards of Services for OVC in Ethiopia and conform to the PEPFAR Ethiopia Prevention Strategy of targeting high risk groups. Faith and community structures will be engaged in identifying and providing support to adolescent girls their prospective husbands, their families and communities that support early marriage. The program will link closely with Population Council's Safer Marriage activity in the Amhara Region since that activity will focus on prevention of early marriage and prevention of marital transmission of HIV through messages for the community, use of faith-based structures at the community level and promoting faithfulness in marriage.

FY 2009 NARRATIVE

Preventing Early Marriage in Amhara Region

ACTIVITY UNCHANGED FROM FY2008:

FY 08 ACTIVITY NARRATIVE

Evidence suggests that girls who marry early have increased risk of HIV infection, even compared to their unmarried, sexually active peers. A study in Kenya and Zambia revealed that married adolescent girls have 50% higher HIV rates compared with unmarried, sexually active girls. Married girls' high infection rates are related to more frequent intercourse, almost no condom use, and husbands who are significantly older, more experienced, and more likely to be HIV-positive compared with boyfriends of unmarried girls.

Amhara region has the lowest age at marriage in the country, with 46% of girls marrying by 15 years. Most of these girls have not had sex before marriage and, in this population, the earlier a girl marries, the earlier she has sex. In addition, Amhara region has one of the highest rates of divorce in the world, with early marriage being a predictor of divorce (Tilson and Larsen, 2000). Data from the 2005 Ethiopian Demographic and Health Survey (EDHS) highlights that the HIV epidemic is concentrated among ever-married women, including young women. Ethiopian women who are divorced are a population highly affected by HIV, with 8.1% of divorced women HIV-positive, nationally.

The HIV epidemic in Ethiopia is concentrated in urban areas of the country; however, it disproportionately affects migrants to urban areas, rather than natives. Many young women migrate to urban areas following divorce, to pursue educational or livelihoods goals, or to escape early marriage. A study by Population Council (PC) in low-income areas of Addis Ababa found that 45% of adolescent girls had migrated from rural areas; among the most common reasons given for migration were education, work, and to escape early marriage (Erulkar et al., 2006). Though migrants hope for a better future in urban centers, many end up highly vulnerable, often in lowly paid and exploitive domestic work or in sex work. Being economically vulnerable and socially isolated, such girls and young women are highly vulnerable to forced or coerced sex, transactional sex for daily or periodic support, and negative reproductive health outcomes, including HIV infection. Indeed, among young, urban women below the age of 30, 6.8% of migrants to the urban center are HIV-positive compared to 2.8% of young women who are native to the urban area; likewise 16% of urban women who are divorced and migrated to the area, are HIV-positive (PC tabulations of 2005 EDHS).

The gender, early marriage and HIV infection activity addresses the HIV risks associated with early marriage, as well as those associated with divorce and migration. Communities often erroneously assume that marrying girls off will prevent premarital sex and HIV infection. Understanding the HIV risks of marriage and knowing each other's HIV status beforehand may help delay marriage, prevent transmission, and/or foster long-term faithfulness. Delaying marriage may result in lower rates of divorce and related migration following divorce. Few programs have addressed the HIV risk of pre-married and married adolescent girls, including the risk of migration, either escaping marriage or following divorce. This activity implements community awareness and premarital voluntary counseling and testing (VCT) interventions in Amhara to promote later, safer, chosen marriage and marital fidelity. In view of unequal marital relationships, this activity develops interventions encouraging married men to remain faithful. Key faith and community leaders will reinforce these messages.

This expansion of a continuing activity will be undertaken in urban and peri-urban areas of Bahir Dar, Gondar, Debre Markos, Dessie, and Addis Ababa; the latter are being new sites during the current year. All districts are contiguous with the urban centers and along truck routes, where many girls migrate in the event of divorce and where many husbands go on market days, often representing an opportunity for drinking and/or engaging in extramarital relations. Strategies include: 1) educating communities on the risks associated with early marriage, marital HIV transmission, and promoting faithfulness, 2) promoting premarital VCT for engaged couples and VCT for married couples, and 3) supporting and educating married adolescent girls and their husbands through clubs.

Religion is a powerful force in Ethiopia, and for many communities the church may be their only sustained institutional contact. An additional 1,000 religious leaders will be trained through 'Days of Dialogue,' to reach congregations and community members with prevention messages, tailored to the nature of HIV risk in Amhara. Over 1,000,000 individuals will be reached with prevention messages related to HIV, delaying marriage, male norms and behaviors, faithfulness, and premarital VCT. During the current year, core messages will integrate information on linkage between early marriage, divorce, migration, and vulnerability, as well as male norms and risks associated with market days and other types of short-term movements. Two hundred selected religious and community leaders from the new project sites will be trained as VCT promoters to promote premarital VCT and refer couples to VCT sites. Clients testing positive will be provided ongoing support and referral to existing care and support services.

This activity will establish married girls' clubs to reach over 15,000 married adolescent girls, providing venues through which girls can receive information, advice, and social support, including in instances where they feel their husbands pose HIV risk or when they are contemplating migration. The clubs will include livelihood and mentoring opportunities, as well as informal education and HIV information and referral. In collaboration with EngenderHealth's Male Norms Initiative, the activity will establish married men's clubs, reaching 12,000 men, as a venue through which to discuss male roles and gender norms, gender-based violence, and faithfulness, among others.

This activity will be part of the HVAB 10521 activity, but with more focus on the male behavior change and will include condom promotion. This activity will be closely linked to Engender Health's Male Norms Initiative in establishing men's clubs to promote faithfulness in marriage and creating a positive male role in gender norms and gender-based violence; this will contribute to reduction of violence. The activity will also be linked to counseling and testing programs through referrals for pre-marital VCT. The focus of the program will be young girls (married and unmarried,) thereby addressing gender equity in HIV programming. It will also increase the girls' access to income and productive resources through the informal education and livelihood skills training that they receive through their clubs. The faith-based organizations, Amhara Regional Youth & Sports Bureau, and other local organizations partnering with Population Council will have their capacity built in through trainings directed at addressing the problem at the community level.

The program conforms to the PEPFAR Ethiopia Prevention Strategy of targeting high-risk groups; and uses existing faith and community structures to reach the young women (especially those at risk of migration), husbands or prospective husbands, their families, and communities that support early marriage.