Review of the social context and particular vulnerabilities

Review of the social context and particular vulnerabilities affecting the lives of 10 -14 year olds Engender. Health October 2007 1

Vulnerability of Adolescents … Ø Young people make up a large and critical demographic group in Ethiopia. Ø 60% of the country’s 77 million are under the age of 24 Ø Size of the 10 -14’s = 15% (11, 550, 000) Ø Within the “youth” demographic, there is tremendous diversity Ø Age, gender, school status, marital status, urban rural residence and other factors including religion, culture, etc Ø Urban 12. 3%, rural 15. 3% 2

Vulnerability of Adolescents… The impact of poverty, HIV, and political and social conflict on families and communities have resulted in: Ø broken traditional safety nets Ø Ø Ø increased number of orphans migration of many children and young adolescents to urban settings increased vulnerability of young adolescents. 3

Vulnerability of Adolescents… Traditional patterns of gender inequalities expose girls to: Ø HTP’s like : FGM, abduction, early marriage, etc Ø Heavy domestic responsibilities and duties. 4

Vulnerability of Adolescents … Female genital mutilation: Ø 62. 1% of girls aged 15 -19 have been circumcised (DHS, 2005). Ø among the circumcised in the same age group, 4. 7% of vagina was swan, Ø The practice is typically performed on girls between the ages of 4 and 12. Ø FGC is strongly associated with negative social and reproductive health outcomes, such as infections, obstructed labor, perineal tears, fistula, and infertility. 5

Vulnerability of Adolescents … High prevalence of Child Marriage Ø Overall, 31% of rural girls and 10% of urban girls are married by age 15. Ø 46% of girls in the Amhara region are married by age 15. Ø Sixty-nine percent of the child brides surveyed had their sexual debut before their first menstruation. 6

Vulnerability of Adolescents … High prevalence of marriage by abduction Ø Ø Ø 2. 5% of 15 -19% and 9. 8% of 15 -24 years old girls were married by abduction. Figure is highest (11. 4%) among the 30 -34 years old. Overall 8. 5% rural and 4. 7% of urban women 15 -49 are married by abduction 7

Vulnerability of Adolescents … Early sexual initiation and high prevalence of forced sex: Ø The majority of Ethiopian male and female start sex at early age. Ø In one study, 81% of the girls said that their sexual initiation was forced. Ø A study conducted among street kids in AA showed: Ø Ø Ø The majority initiated sex at age between 10 -14 Among the sexually active adolescents, 43% initiated sexual activity as the result of forcible rape. 15. 6% of female street kids were raped within three months prior to the study date. 8

Vulnerability of Adolescents … Take the case of a young married adolescent in Amhara region: Ø Sexual exploitation Ø Frequent unprotected sex Ø Intense pressure to become pregnant Ø Heavy domestic work load Ø Limited or absent peer network Ø Restricted social mobility Ø Low access to modern media Ø Very low access to school Ø Low access to SRH information and services Ø High SRH risk and poor RH outcome 9

Low access to SRH information and services Sexual exploitation Very low access to school What a Young, Married Adolescent Girl in Rural Amhara Could Face Low access to modern media Restricted social mobility Frequent unprotect ed sex Limited or absent peer network Intense pressure to become pregnant Heavy domestic work load 10

Vulnerability of Adolescents … HIV/AIDS and STIs: Ø Young married adolescents are at an the increased risk of HIV/AIDS and STIs due to: Ø Ø Encounters with older partners Increased sexual frequency (unprotected) Negotiation of safe sex is almost unthinkable Very low access to SRH information and services Ø Studies show that the prevalence of HIV among male youth (15 -24) is between 6 and 9% and between 1013% for women- this age group has also the highest prevalence of sexually transmitted infections 11

Vulnerability of Adolescents … Early pregnancy and related outcomes : Causes Ø Early marriage Ø Little control over one’s sexual rights (forced sex) Ø Limited knowledge of SRH issues Ø Low use of contraceptives, Ø Very limited access to RH information and services. Ø Poor societal support 12

Vulnerability of Adolescents … All of these factors contribute to poor reproductive health outcomes: Ø Unwanted pregnancy, Ø Obstructed labor, Ø Obstetrics fistula Ø Unsafe abortion, Ø Transmission of HIV and sexually transmitted infections (STIs). Ø Poor health of mother and children 13

Vulnerability of Adolescents … Ø A study reported that adolescents aged 15 or younger had higher odds of anemia and death, and of having a child die within its first week of life compared to young mothers, aged 20 -24. Ø Young adolescent mothers are also likely to suffer from severe complications during delivery that result in high morbidity and mortality of both the mother and child. Ø DHS 2005 shows that 2% of 15 -19 girls ever given birth have experienced obstetric fistula 14

Vulnerability of Adolescents … Low access to SRH services: Ø Health seeking behavior of adolescents particularly in relation to their SRH is very low. Ø Absence or very limited YFS cater to the needs of the youth Ø Providers bias against this section of the population Ø Low level of awareness among members of the community on the SRH needs of adolescents 15

Summary Ø Adolescents in Ethiopia represent a critical mass of the country’s population. Ø They are diverse and their needs are also diverse. Ø They are expected to play different roles that does not commensurate with their age. Ø War, poverty, disease including the HIV/AIDS epidemic left many children and young adolescents orphans without close family tie and protection. Ø Leaving school at early age, social isolation, migration to urban areas exposes them to physical and emotional hardship. 16

Summary Ø Exposed to critical sexual risks like early sexual debut, unprotected sex, STIs including HIV/AIDS, and unwanted pregnancy. Ø Exposed to harmful traditional practices like early marriage, female genital mutilation and abduction. Ø Have little access to health services and the existing service outlets are not friendly to them. 17

Need for timely and adequate interventions Ø It is critical for policies and programs to recognize the unique needs and vulnerabilities of those aged 10 -14 although they have typically been neglected by policymakers and researchers and are not reached by most conventional child health, maternal health and women’s empowerment programs. Ø Negotiating this transition successfully (transition from childhood to adult life) requires considerable adaptation and thoughtful, sensitive support from caring adults. 18

Need for timely and adequate interventions Ø The strategic timing of intervention at early adolescence can support and effectively guide young people through important period of transitions, such as puberty, before potentially harmful changes take place, the outcomes of which can negatively and permanently affect the rest of their lives 19

Thank you! 20