FGM, child marriage and adolescent motherhood: Barriers to girls' wellbeing

FGM, child marriage and adolescent motherhood:
Barriers to girls’ wellbeing
Workneh Yadete, December 2022
Parliamentary Standing Committee for Women and Social Affairs, Ethiopia

Outline of Presentation
1
• GAGE overview
2 •GAGE findings on FGM, child marriage, & SRH
3
•Our validation tools
4
•Conclusions and recommendations
5
•Questions?

GAGE Overview
Adolescent girls in East Hararghe, Ethiopia © Nathalie Bertrams / GAGE 2019
Please note that the photographs of
adolescents DO NOT capture GAGE research
participants and consent was gained from
their guardians for the photographs to be
used for GAGE communications purposes.

Gender and Adolescence: Global Evidence (GAGE):
A longitudinal research programme (2016-2026)
By finding out ‘what works,’ for whom, where
and why, we can better support adolescent girls
and boys to maximise their capabilities now and
in the future.
We are following 20,000 adolescent girls and boys - the largest cohort of
adolescents in the Global South

GAGE’s primary longitudinal research sample

GAGE Ethiopia research sites
3 regions:
• Afar, Amhara, Oromia
• plus Dire Dawa City Administration
Research site selection based on:
• Districts with among highest rates of child
marriage as proxy for conservative gender
norms (MOWCA, UNICEF and ODI, 2015)
• Urban and rural sites
• Food insecure and pastoralist sites as a proxy
for economic poverty
• Woreda-based mapping of all kebeles based
on infrastructure and service availability
(vulnerable/ less vulnerable)
• Programming capacities of NGO
implementing partners

GAGE’s Irish Aid funded research in pastoralist regions
Afar
Zone 1
Aysaita
Zone 5
Samurobi
Hadelella
Somali
Fafan
Harshen
Goljano
Jarar
Daror
Quantitative sample
 Total of 2,042 households in 36 kebeles
 In each household, we surveyed both an adolescent and a caregiver
 Approximately 80% of adolesents and caregivers were female
 Adolescents were 10-19, but most were young—the average age was 13
Qualitative sample
 589 individuals in 8 kebeles in 4 woredas
 Purposively selected from the quantitative sample

South Gondar, Amhara
• 32% were cut
• nearly all before their first birthdays
Of younger cohort girls whose female caregivers reported:
Girls reported more risks than advantages
Type 1 is most common
‘They cut the tip of the
clitoris.’
(woreda level KI)
• 72% reported that FGM has risks
• 17% reported that FGM has advantages
Few girls believe that FGM is a religious requirement—or
should continue
• 13% reported that FGM is required by religion
• 12% reported that FGM should continue
‘FGM/C helps her vulva to stretch
to make birth easier.’
(youth leader)

The dominant narrative is progress
Schools spread the word—with cascading impacts
‘They teach us at school about harmful traditional practices …They are working very hard to teach us about FGM.’
(adolescent girl)
‘When there is an educated person in the family, that person tells [the others] that FGM/C is a harmful traditional practice and
they need to avoid it. That person convinces the family and stops them from doing it.’
(woreda level KI)
Health extension workers target women
‘Health extension workers are active in teaching about
FGM … Starting from when they get pregnant, they
have a follow-up with health extension workers. They
teach them when to go for a check-up.’ (teacher)
Religious leaders tailor messages carefully
‘Jesus was baptised with water, not circumcised.’ (Orthodox priest)
‘It is not possible to follow each rule and law provided
by the book. This we should not follow.’ (Muslim sheik)
Most participants report recent elimination
‘It is totally abolished now.’ (16-year-old girl)
Progress is evident in individual families
‘I circumcised my older children. I have two young girls but they
are not circumcised.’ (mother)

But subtexts suggest a need for caution
• ‘There is no girl who is not cut.’ (adolescent girl)
In remote communities, girls are still cut
• ‘The practice of FGM/C is very difficult to sanction since it is practised by mothers/ grandmothers in a very private
and hidden manner.’ (militia member)
Women use ‘hidden practices’
• ‘There is no female genital mutilation … It is prohibited by the government … However, if their families [mother and
father] have the skill, they circumcise their female children in a hidden way. … [His daughter] was circumcised by her
mother … It was me that ordered my wife to circumcise our daughter.’ (father)
Sometimes at men’s order
• ‘These days they will be cut in health centres … the clitoris and the side flesh … If it is cut in the health centre, it
doesn’t take long to heal … In the hospital they give painkillers and they apply ointments on the wound, that is why it
recovers quickly.’ (mother)
There is some evidence of medicalisation
• ‘According to our criminal code of conduct, female genital mutilation is a criminal act … We are not seriously working
on this aspect.’ (teacher)
Kebele level officials are often not engaged

East Hararghe, Oromia
Of older girls who self-reported:
• 73% had been cut
• 62% had wanted to be
cut at the time
Girls are excused from housework and pampered by their
mothers.
• ‘They gave me milk and egg … They prepared for me rice
and macaroni with sauce.’ (12-year-old girl cut at age 10)
• ‘We prepared food and chicken and then the people come
and give you money.’ (14-year-old girl cut at 12)
Girls want to fit in with their peers
• ‘There is an insult for girls who are not circumcised.’
(married 11-year-old girl)
Girls want to show their peers they are old enough to attend
shegoye dances
• ‘They have to be first circumcised. It is after circumcision
that a girl attends shegoye.’ (17-year-old girl)
Why do girls want to be cut?
Girls were cut just before age 10
Types 1 and 2 are most common
Girls slightly more likely to report
that FGM has advantages than
risks: 39% vs 34%
76% of girls believe FGM is
required by religion
49% of girls believe FGM should
continue

Drivers are rooted in girls’ reproductive roles
‘I didn’t find girls who got married without being circumcised. It is shameful here not to be.’ (HEW)
Girls cannot marry without FGM/C
‘During intercourse there is no way to insert the penis if the clitoris is not removed.’ (father)
It is believed that sex is not possible without FGM/C
‘If the girl is not circumcised, she will not get pregnant.’ (younger boy)
It is believed that pregnancy is not possible without FGM/C
‘The sexual desire of women who haven’t had FGM is inflated… We are farmers and engage in tiresome
activities of farming… We cannot handle another responsibility of satisfying our wives because their
sexual desire is heightened if they are not circumcised.’ (father)
It is believed that FGM/C is required to lower girls’ and women’s sex drive

Backsliding is increasing—and set to increase more
‘If we see it and hear about it, we
will put them in jail.’
Officials proclaim progress
‘In the past, during our mothers’
time, they were prohibited to
practice circumcision … Now, it’s
open.’ (13-year-old girl)
But girls report the reverse
‘You go to a health facility. You can
deliver through an operation, for
instance.’ (17-year-old girl)
Awareness raising is falling flat
‘The kebele administrator takes
money from people who circumcise
their girls. He takes (for instance)
up to 200 birr (~$4)… The
administrator stopped now. People
don’t even give him [the money]
even if he asks now. They don’t
listen to him now. They do the
circumcision freely.’ (young woman)
Fines are ignored
‘Girls do not listen to their families
… They just go with boys … They
go with boys to get married. In the
past, we didn’t go after boys
unless we were asked for marriage
because we were circumcised.’
(grandmother)
There are calls to resume more
invasive types
‘There was a female teacher that
used to register the names of
parents who allowed girls to
undergo FGM/C, but since there is
no school, they cut girls and there
is no one to question them.’(kebele
level KI)
Covid has complicated protection
‘Previously it was forbidden, but
now they allow it.’

Afar
Of younger cohort GAGE girls whose mothers are
reporting:
• 88% have been cut
Girls were cut at an average age of 1.5
‘Though we know that female genital cutting harms our
daughters, we are still practising it.’ (religious leader)
Irish Aid research finds even higher prevalence:
• 97% of girls have been cut
• 85% of girls were infibulated with scar tissue
And more nuance regarding drivers:
• 65% report the main driver is cultural identity
• 21% report the main driver is religion
And that legal knowledge is rare:
• 42% of caregivers had heard of a law re FGM
• 19% of those had accurate knowledge
Girls are more likely to report advantages than risks
 53% of girls report that FGM has advantages
 49% of girls report that FGM has risks
Girls support continuation:
• 72% of girls believe that FGM is required by
religion
• 74% of girls believe it should continue
‘It is difficult to have sex with uncircumcised girls since the
clitoris prevents the penis penetrating deep in the girl’s
vagina.’ (14-year-old boy)
‘Girls would misbehave and be disobedient to their parents
unless they were circumcised.’ (mother)

Location determines type
‘Currently people cut only the tip of the girl’s clitoris, people stopped cutting the entire part of the inner of the girl’s
genital organ from three directions.‘ (clan elder)
Infibulation is being replaced
‘We work with women doing it and give them alternative income opportunities. And we also organised a reward
programme for champions who stopped doing it.’ (Justice KI)
Because of officials’ efforts
‘Especially, the Sharia persons and religious leaders taught us to change the type of cutting and to use the ‘sunna’ type.’
(clan elder)
And most especially because of religious leaders’ efforts
Type is (probably) shifting in more central communities
‘What we are practising now is what we were practising previously.’
(clan elder)
In more remote communities, there is only stasis

Elimination will require local ownership
PRESENTATION NAME AND DATE
Girls comply to avoid exclusion
‘If a girl is not cut, she will be isolated by the
people. So, the girls themselves agree to
circumcision. They prepare themselves and ask
the mother to do it. It is done based on family
interest and the girl’s willingness.’ (mother)
Caregivers comply to avoid exclusion
‘We are also told that a father who didn’t circumcise his
daughter is considered as lazy and we are also ordered
not to get in the house of a man who didn’t circumcise
his daughter because having a daughter who is not
circumcised is considered haram.’ (clan elder)
‘It becomes risky to speak about stopping FGM among
rural communities and they are afraid to teach about
FGM as a bad practice because it has been a long-held
traditional practice … For instance, there is a midwife
working at Community B and she told us that the
community laugh when she teaches about avoiding
FGM.’ (woreda level KI)
Champions are silenced by exclusion
‘We can change the practice only if we
heard it from religious leaders. We do not
stop because of meetings.’ (grandmother)
Work with religious leaders is key
‘They taught us that it became a big sin if a
female child died without being
circumcised.’ (mother)

Somali
Only 78% of girls had heard of FGM/C. Of those:
• 72% had been cut
• girls were cut at age 9
• 33% had some input into the timing of FGM/C
• 100% of girls were infibulated • Infibulated girls are preferred for marriage.
‘Boys want to marry a circumcised girl and no one
will marry an uncircumcised girl because of our
religious views. Girls who are sewed are good,
boys want them, believe that her dignity is
protected and that of her family since it is closed.
We disregard sunna types.’
(FGD unmarried boys, Somali region)
• Families are shamed if daughters are not cut by marriage.
• The age of cutting is dropping as adolescent-driven
marriage becomes more common.
 54% of girls reported that the main driver of
FGM is cultural identity
 33% of girls reported religion as the main
driver
 34% of caregivers had heard of a law re FGM
 80% believe Type 1 is legal
 16% understand that cutters and parents are
liable
 22% of girls believe FGM has risks
 55% of girls believe FGM has benefits
 68% of girls believe FGM should continue

Infibulation and life-course trauma in Afar and Somali
 Qualitative findings underscore that FGMC is not a
one-off painful experience but ongoing pain and suffering –
urination and menstruation hurt and girls dehydrate
themselves and suffer frequent infections.
• In Afar, the defibulation process at marriage is brutal
and often involves rape and sometimes Viagra. Women are
resewn nearly closed after their first four pregnancies.
• In Somali, defibulation is increasingly medicalised—an
unintended consequence of NGO efforts.
‘During the time of their first sex girls
face severe pain when the boy/man
struggle to dis-virgin her… Newly
married grooms have also been
suffering a lot when they dis-virgin
girls, because the hole is too narrow,
and the scar is also very strong to
dis-virgin, bride grooms were limping
for three or four days after they dis-
virgin their wives, because of the
pain due to the friction while
struggling to dis-virgin girls.’
(older boy, Afar)

Girls from a pastoralist community in Afar. © Natasha Bertrams / GAGE 2018
GAGE findings on child marriage

‘My soul agitated me to get married right way when I
reached puberty... While experiencing this feeling, I
came across a gorgeous girl and wanted to seize the
opportunity to marry her… We competed with a lot of
males for the girl… The competition was fierce... Our
rivals beat us with stones… I beat them and married
her finally.’ (17-year-old boy, who at 14 married a
12-year-old girl, East Hararghe)
Child Marriage
‘Families are afraid that girls might get pregnant and
can have children out of wedlock and for that reason
they are married early. A boy can have whatever
girlfriend that he may wish to have even when he is in
school. But it is a taboo for a girl.’
(15-year-old divorced girl, Aquashmoch)
‘Unless we die, it is our absuma that we are going to
marry.’ (adolescent girl)

South Gondar--progress, from a low base
Nearly all marriages are arranged, and two-thirds of married girls would have rather married later.
The age of marriage is increasing—
and girls have some space to argue for
delay—but most girls are still married
as children.
‘My first marriage proposal was at the
age of 13 but my father refused as I
was a teenager and then I got married
at age 15.’ (married 17-year-old girl)
Parents’ interest in child marriage is
driven by needs to prevent premarital
sex.
‘We are afraid that they will start a
sexual relationship before marriage.’
(mother of married girl)
Girls often feel they must say ‘yes’ to
their parents—even when they do not
want to marry yet.
‘I would have been cursed and my
parents would feel sad.’ (married 15-
year-old girl)

South Gondar– the youngest girls are at risk of forced marriage
 Girls who are to be married to priests are made to marry
especially early—because there must be no doubt of virginity.
‘To be the wife of a priest she will be engaged at 7 or 8 years. To be the wife of a
farmer she will be engaged when she is older than that.’ (12-year-old boy)
‘I had no idea that I was going to get married. And then the day approached and
they told me... I said no way. I was even tempted to flee. But I had nowhere to go. So
I got married not to disobey my parents.’ (married 12-year-old)
 The youngest girls have the least input.
 Parents report that they are sometimes forced—by the broader
community-- to marry their daughters.
‘If I refused to marry my daughter the cow would be looted, crops and house would
be burnt and people would be beaten.‘ (father of a married girl)
At baseline, 2% of 10–12-
year-old girls were
already married.
At midline, 4% of 12–14-
year-old girls were
already married.

East Hararghe--complicated and shifting patterns
‘They get married because it is in their interest. You can’t enforce them not
to marry if they want to marry.’ (12-year-old girl)
Respondents report that child marriage is increasingly adolescent-
driven.
‘If a girl is able to carry a 20 litre jerry can, they (the parents) think she is
ready for marriage. They assume she can also manage a man if she is
capable of lifting and carrying a 20 litre jerry can.’ (KI)
But child marriage has always been common.
‘For the child, it is husband and wife decide together for the child. Father
and mother construct house for the boy and the boy searches a girl who is
suitable for him. Then after he marries.’ (19-year-old boy married to a 12-
year-old girl)
The “old” and the “new” are mixing to increase incidence and
decrease the age at marriage. Parents suggest to boys that they
marry—and boys choose the youngest girl they can find to say yes.
At baseline, 2%
of 10–12-year-
old girls were
already married.
At midline, 8% of
12–14-year-old
girls were already
married.

East Hararghe--why do girls choose marriage?
Girls “choose” to marry because they have few other options, to escape violence, and
are pressured by both older boys/young men and their female peers. This narratives
about girls’ ‘choice’ are more complex than they first appear.
‘I got married because they
[referring to friends] got
married’.
(married 13 year old girl)
‘Girls prefer marriage than to
simply sit idle.’ (father of a
married 12 year old girl)
‘I beat the elder girl when she
played with boys…Then she went
to Boko town again and started
living with a boy. She was 11
years old.’
(father of a girl married at 11)
Melke)
‘Boys try to lure her to go out
and then beat her… with sticks
and the leaves of a plant that
makes you itch.’
(local youth leader, East
Hararghe)
‘The reality of what is being
done in shegoye place is that
the boy gives 1,000 birr for a
person who plays a role of
mediating between the girl and
the boy. Girls can be easily
deceived by the money.’
(teacher)
‘According to our culture that
males better marry with their
younger females. Males are not
interested in females who are
older.’
(younger cohort boy)

Zone 5—largely static, due to absuma traditions
• Nearly all marriages are arranged, and two-thirds of married girls would have rather married later.
• Girls have no say in who or when they will marry.
‘I cannot refuse. If I refuse the man who was going
to marry me, he would be given permission to take
me by force.’ (17-year-old girl)
‘We have our own peculiar culture and tradition
with regard to marriage practice… It is the
absuma marriage tradition.’ (father of a married
girl)
‘If my daughter married to someone outside of our
kinship, our family line would discontinue.’ (father)
‘If we teach them directly to stop early marriage and
cross-cousin marriage, we will provoke conflict.’
(teacher)
At baseline, 1% of 10–12-year-
old girls were already married.
At midline, 3% of 12–14-year-
old girls were already married.

Zone 5—glimmers of progress
Irish Aid sample
• 62% of girls would prefer to marry at 18+
• Some adults are supporting ‘choice’ marriage to reduce
IPV and divorce
• Some girls are reporting planned marriages to BOWSA
offices at woreda level or to teachers
‘Nowadays, absuma marriage culture is declining….The
process is like if a girl reach’s puberty, then the parent will
start looking for a guy that can marry their child. They
support (the groom and bride if they are first cousins but if
it is marriage by love it will be arranged between the girl
and the guy who wants her.’ (16-year-old girl, Afar)
Married girl, Afar, Ethiopia © Nathalie Bertrams / GAGE 2020

Somali--old norms drive new practices
 4% of adolescent girls have ever married. Of these:
 Girls married at age 15.6
 22% of girls married before age 15
 21% of girls were married by parental arrangement
 97% of girls reported that they were ready to marry
 Only 2% of adolescents reported knowing that 18 is the
legal age for marriage
 Female caregivers married at an average age of 17.4 years
‘Every girl want to marry in that age category as most other
females also do the same. The female would not be happy to
stay beyond the age of 16.’ (younger girl, FGD)
‘In the past, parents were arranging the marriage but now
adolescents choose and decide when and who to marry.’
(older boy, FGD)
Risk factors are evolving in ways that are encouraging child marriage:
 Drought means that grooms and their families cannot provide bride price—so adolescents choose
one another and have no reason to delay marriage
 Mobile phones and education are leading to more adolescent interaction—and marriage is the
only sanctioned place for sex
‘Previously, child marriage was not that much practiced in
real life, and the community believed that they should wait
till they are responsible and old enough.’ (school director)

Marriage marks the end of most girls’ educational careers
‘In this area, I haven’t seen any person who
continues to go to school after getting married.’
(15-year-old girl, EH)
‘It is difficult [to combine marriage and school];
you can’t concentrate since your thoughts are
divided thinking about [other] issues.’ (15-year-
old girl, SG)
 In S. Gondar, 40% of
ever married girls are
enrolled in school.
 In East Hararghe and
Zone 5, however,
fewer than one in
ten married girls is
enrolled.
 Most married girls report that their husbands will
not allow them to attend school.
 Even in S. Gondar, few girls are able to combine
school and marriage once they begin living with
their husbands—because work loads are too high.
Now I have given birth to children and I am
raising them. My morale has been broken by
them.’
(18-year-old mother, EH)
In Somali, 43% of girls
in our sample had
NEVER been to
school.

Child marriage often leads to IPV
Can begin on
the wedding
night
• ‘When I hugged her, she refused and
shouted and then tried to leave the
room… I forcefully had sex at first as she
refused to do so.’ (19-year-old married to
a 12-year-old, S. Gondar)
Is seen by
men as their
‘right’
• ‘I don’t beat [my wife] with something
that hurts. I beat her with electric wire.’
( 19-year-old husband, East Hararghe)
•Is meted out
for
infractions
large and
small
• ‘If I go to someone’s home or if I visit my
friends, my husband beats me.’
(married 17-year-old, East Hararghe)
48% of adolescents
agree that a man’s
violence towards his
wife is private
84% of adolescents
agree that a woman
should obey her
husband in all things

Child marriage leaves girls lonely and distressed
‘Hahahahaha
! We don’t
talk much… I
didn’t count
how many
times I beat
her.’ (18-year-
old married
boy, Z5)
‘The only
thing that I
am worried
about is fear
of getting
married and
interrupting
my
education.’
(12-year-old
girl, SG)
In South
Gondar and
Zone 5, girls
are afraid of
being forced
into marriage.
Many
married
girls lose
access to
friends.
‘I used to
spend more
time with my
peers before I
got married…
We used to
meet at school
and in our
neighbourhood
s.’ (15-year-old
girl, EH)
‘I miss
my family
very
much.’
(19-year-
old girl,
Zone 5)
Some
married
girls lose
access to
family.
Many married
girls are
distressed—
some are
suicidal.
Few married
girls are in
supportive
relationships
‘‘I was not
happy that I
was
married… I
wanted to kill
myself .’ (14-
year-old girl,
Z5)

GAGE findings on
sexual and
reproductive health
and adolescent
motherhood
Young girl, Ethiopia © Nathalie Bertrams /GAGE 2019

Adolescents’ access to puberty education varies
• Boys mostly feel pride at growing up.
• Girls are more conflicted—because menarche is stigmatized and,
in some communities, means that girls must soon marry.
‘I saw blood on their cloth when we played together and when I asked
them what it was, they warned me not to tell.’ (12-year-old girl, Zone 5)
• Three-fourths of adolescents have a source of information about puberty.
“I didn’t know anything about menstruation and when my sister said she saw
her period for the first time; I told her not to give me with her hand and
considered her as a prostitute.” (Mid adolescent girl, Debre Tabor)
‘I know the name, but they don’t tell us about that. I heard it from children in
this neighbourhood. When they have headache, they say “I am on
menstruation”. But I don’t know what it means.’
(12-year-old girl, East Hararghe)

Adolescents’ SRH knowledge is often inaccurate
PRESENTATION NAME AND DATE
‘If a girl wears the pants of a male person and
if there is sperm on the pants of that person,
that girl can become pregnant.’
(11-year-old girl, EH)
‘The educators teach that adolescents
shouldn’t begin to have sexual intercourse
before getting married…..He taught us that
our life span will decrease otherwise.’
(12-year-old boy, EH)
‘We learned that there is an egg in our uterus
and the egg will break when men have
intercourse with us. After the egg breaks,
blood will emanate from it and the blood will
grow into a child. I don’t remember anything
else.’ (16-year-old girl, Zone 5)
Girl in East Hararghe © Nathalie Bertrams / GAGE 2020

Adolescents’ contraceptive knowledge varies
• Health Extension Workers are central to disseminating information in
urban areas and S. Gondar. They teach in the community and in schools.
‘Health extension workers are doing great in this regard. They are creating
awareness in each school.’ (educator, Debre Tabor)
‘All these things you are talking about are new for us. We don’t know these
things in our locality, because as you know there is no school or health
institution here.’ (older boy, Zone 5)
• Services and education are more limited in E. Hararghe and Zone 5.
• Misinformation is common—even in S. Gondar.
‘If you take penicillin, then there's no problem.’
(older girl, Aquashmoch)

Adolescents' contraceptive uptake differs across locations
‘We have to teach young girls to use contraceptives …I took my daughter to the health centre and made her use
contraceptives. She has no [boy]friends but I did it for safety.’ (Father)
In S. Gondar, even unmarried girls often use contraception.
‘There are no people using contraception… It is because people do not want to use contraception because it is regarded as
haram’. (17-year-old married girl)
In Zone 5, girls often emphasized that contraception is forbidden by religion.
‘They fear their husbands. They are discouraged to use it for their husbands expect that they will give birth.‘
(13-year-old girl)
In E. Hararghe, girls are afraid of being branded infertile.
• Of sexually active girls (nearly all of whom are married)—only 42% have ever used conception.
• Uptake is higher in urban areas (42%) versus rural areas (23%).
• Uptake is higher in S. Gondar (54%) versus Zone 5 (9%) and E. Hararghe (4%).

Adolescent motherhood is linked to contraceptive uptake
• In S. Gondar, 25% of married girls have
been pregnant…despite 62% of older
girls having been married by age 18.
• In Zone 5, 43% of married girls have
been pregnant… 57% of older girls were
married by age 18.
• In E. Hararghe, 38% of married girls have
been pregnant… 49% of older girls were
married by age 18.
‘Now I have given birth to children and I am
raising them. My morale has been broken
by them.’ (18-year-old girl, EH)
An adolescent mother, Ethiopia © Nathalie
Bertrams /GAGE 2020

Purpose of the validation tools
Verify woredas’ and kebeles’ readiness to eliminate child marriage and FGM.
Inform tailored action plans to accelerate progress.
•Tools have been developed and piloted by GAGE.
Tools build on previous evidence from MOWCY and MoH.
Tools triangulate perspectives from different stakeholders at different levels.
Tools are engaging for participants.

Three level sample
Woreda level:
WCYA Education Justice Police Health Religious Council
Kebele level:
administrators educators HEWs Women’s Association militia/security
religious leaders youth leaders parents adolescents
Regional level:
WCYA Education Health Justice

Tablet-based surveys….
 Surveys will be completed on tablets or phones.
 Interviewers will read questions to respondents in
the local language.
 Respondents will choose their answers based on
picture cards.
 Interviewers will enter respondents’ answers into
the survey.
 Interviewers will collect administrative data
related to child marriage, FGM/C, and school
enrolment from kebele administrators, HEWs, and
school officials.

….Paired with easy to “read” cards
How common? How fast?

Ready set go!
Health worker, Amhara © Nathalie Bertrams /GAGE 2020
Entrenched—will take significant
effort to begin making progress
First signs of change—but from a
low base and slow
Gradual progress over time
Significant progress thus far—
need to maintain trajectory
Eradicated/abandoned

Recommendations for policy and programming

Recommendations for strengthening sector policies
1
• Strengthen coordination and collaboration among sector offices at federal, regional and woreda levels to protect girls from harmful
practices and to expedite generational change.
2
• Work with religious leaders to promote abandonment of FGM/C and CM and to shift gender norms that lead to SGBV
3
• Allocate sufficient human and budget resources to tackle these widespread norms and practices that jeopardise girls’ and women’s
empowerment and enjoyment of their rights
4
• Invest in evidence-based monitoring and evaluation of programme interventions and the impacts they are having over time on child
marriage and FGM with a particular focus on remote communities where prevalence is highest
5
• Promote a coalition to advocate for and to ratify the Family Law, especially in Afar and Somali regions (on age of marriage) and the
Criminal Code (which bans undertaking or procuring FGM)
6
• Strengthen SGBV rehabilitation centres (one stop centres) by involving key stakeholders and work with health officials to ensure girls
and women whose health is compromised by FGM/C have access to appropriate and affordable medical care
7
• The social and women standing committee of the parliament to provide supportive supervision on the implementation of the laws and
polices.
8
• The social and women standing committee of the parliament to support the sector Ministries to secure sufficient budget approval for
activities related to eliminating child marriage, FGM and SGBV .

Recommendations regarding FGM
1
• Address underlying gender norms through context-tailored approaches incl. working with religious leaders, parents,
and adolescents—and addressing risks and perceived advantages.
2
• Raise awareness of the criminalization of FGM/C—considering transparently levied and bottom-up fines on a
community-by-community basis and providing girls with uncut role models to counter peer pressure.
3
• Engage with health care providers to encourage their work with new mothers, prevent medicalization, and ensure
that cut girls are treated sensitively.
4
• Adopt a long-term lens that recognizes that change is non-linear and that continuous pressure is required over time
to prevent hidden practices and resurgence.

Recommendations regarding child marriage
1
• Invest in approaches to support girls
2
• Tailor child marriage programming to local drivers.
3
• Empower girls with knowledge and skills –developing broader aspirations and strengthening voice and agency.
4
• Build—and publicise-- reporting mechanisms to have marriages canceled.
5
• Work with parents and communities to shift gender norms that favour child marriage over education.
6
• Work with traditional and religious leaders to develop messaging.
7
• Step up enforcement and prosecute adults involved in child marriage.

Recommendations to improve married girls’ wellbeing
1
• Use the HEW programme to spread awareness to married girls and women of their right to
be free of violence--and when and how to seek help.
2
• Work with religious and traditional leaders to develop messages—for boys and men—
about alternative ways to demonstrate masculinity (rather than violence).
3
• Establish safe house for girls and women experiencing IPV.
4
• Ensure that formal justice mechanism are brought into play—and that perpetrators face
consequences for their actions.
5
• Develop opportunities and venues for married girls to get together with one another—and
access near peer mentors—for guidance, support, and recreation.

Recommendations regarding SRH and adolescent motherhood
1
• Provide school- and community-based age-appropriate, comprehensive sexuality education to adolescents—ensuring
information is detailed, accurate, and tailored to local concerns about the effects of contraception
2
• Ensure that adolescents are aware of the health and economic risks of early parenthood—and how adult parenthood
benefits themselves and their children.
3
• Ensure adolescents have confidential access to SRH information and services.
4
• Work with religious and traditional leaders—including both women and men—to build support for family planning. This
should include attention to delaying first pregnancies as well as spacing subsequent pregnancies.
5
• Address underlying gender norms that value girls and women for the children they produce and leave them with limited
control over their own fertility.

About GAGE
WEBSITE: www.gage.odi.org
TWITTER: @GAGE_programme
FACEBOOK: GenderandAdolescence
 Gender and Adolescence: Global Evidence
(GAGE) is a nine-year (2015-2024) mixed-
methods longitudinal research programme
focused on what works to support
adolescent girls’ and boys’ capabilities in the
second decade of life and beyond.
 We are following the lives of 20,000
adolescents in six focal countries in Africa,
Asia and the Middle East.
Download the report:
www.gage.odi.org/publications/

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