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Summary Report of the Baseline Survey in Ethiopia

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Summary Report of the Baseline Survey in Ethiopia ADOLESCENTS 360 OUTCOME EVALUATION: SUMMARY REPORT OF THE BASELINE SURVEY IN ETHIOPIA February 2018 Submitted by Itad in association with the London School of Hygiene and Tropical Medicine Itad 2018 Authors: Christina Atchison1, Emma Newbatt2, Emma Mulhern2, Sue Newport3, James Hargreaves1 and Aoife Doyle1 (1: London School of Hygiene and Tropical Medicine, London, UK; 2: Itad Limited, Hove, UK; 3: Sue Newport Consulting, Brighton, UK) Acknowledgements We are very grateful for the cooperation of all the A360 Consortium organisations in providing us with the information required to develop the study protocols for the outcome evaluation. We would also like to thank MMA Development Consultancy, which conducted data collection in Ethiopia. Disclaimer The views within this document are entirely the responsibility of the outcome evaluation team. ‘Itad’ and the tri-colour triangles icon are a registered trademark of ITAD Limited. Itad 2018 Adolescents 360 Outcome Evaluation: Summary Report of the Baseline Survey in Ethiopia Table of contents Acronyms ......................................................................................................................................................1 Executive summary .......................................................................................................................................2 1. Introduction to the programme and the evaluation .............................................................................5 2. Methods ................................................................................................................................................7 2.1. Study objectives 7 2.2. Study design 8 2.3. Study settings 8 2.4. Study population 10 2.5. Sampling strategy 10 2.6. Sample size 10 2.7. Data collection tools 11 2.8. Data analysis 11 2.9. Ethics 11 2.10. Response rates 12 3. Background characteristics of adolescent girl respondents ............................................................... 13 3.1. Age 13 3.2. Education 13 3.3. Religion 13 3.4. Language 13 3.5. Employment 13 3.6. Access to media 13 4. Sexuality, fertility and fertility preferences of adolescent girl respondents ...................................... 14 4.1. Age at first sexual intercourse 14 4.2. Timing of last sexual intercourse 14 4.3. Teenage pregnancy 14 4.4. Age specific fertility 14 4.5. Age at first birth and planning status of most recent birth 14 4.6. Unmet need for modern contraception 15 5. Family planning ................................................................................................................................... 16 5.1. Current use of modern contraception 16 5.2. Knowledge of contraceptive methods 18 5.3. Myths about contraceptive methods 18 Itad 2018 5.4. Benefits of contraceptive methods 18 5.5. Attitudes towards using contraceptive methods 19 5.6. Source of modern contraceptive methods 19 5.7. Treatment by family planning providers 19 5.8. Intention to use modern contraception in the future 19 5.9. Self-efficacy to access and use contraceptive methods 19 6. Perspectives of husbands/co-habiting male partners ........................................................................ 24 6.1. Relationships to adolescent girls in the household 24 6.2. Age 24 6.3. Education 24 6.4. Religion 24 6.5. Language 24 6.6. Knowledge of contraceptive methods 24 6.7. Myths about contraceptive methods 24 6.8. Benefits of contraceptive methods 25 6.9. Attitudes towards family planning 25 6.10. Attitudes towards self-efficacy of adolescent girls to access and use contraceptive methods 25 7. Conclusions ......................................................................................................................................... 28 8. Programmatic implications ................................................................................................................. 30 9. References .......................................................................................................................................... 31 Appendix A: Sample size calculations ........................................................................................................ 32 Appendix B: Implementation challenges and solutions ............................................................................ 34 Appendix C: Data tables ............................................................................................................................. 35 Appendix D: DHS mCPR definition and results table……………………………………………………………………………….44 Itad 2018 REPORT A360 Outcome Evaluation: Baseline Summary Report in Ethiopia Acronyms A360 Adolescents 360 ASFR Age-specific fertility rate CHW Community health worker DHS Demographic and Health Survey EDHS Ethiopia Demographic and Health Survey HCD Human-centred design HEW Health extension worker HH Household HIV Human Immunodeficiency Virus IUD Intrauterine contraceptive device LAM Lactational Amenorrhoea Method LSHTM London School of Hygiene and Tropical Medicine mCPR Modern contraceptive prevalence rate PPS Probability proportional to size PSI Population Services International PSU Primary Sampling Unit SDM Standard Days Method SNNPR Southern Nations, Nationalities and Peoples’ Region SRH Sexual and reproductive health Itad in association with the London School of Hygiene and Tropical Medicine Page | 1 February 2018 REPORT A360 Outcome Evaluation: Baseline Summary Report in Ethiopia Executive summary Introduction surveyed a subgroup of husbands/male partners. The innovative, interdisciplinary Adolescents 360 (A360) programme being rolled out across The survey collected baseline information on Ethiopia, Nigeria and Tanzania uses human- key background characteristics and sexual and centred design (HCD) to create context- reproductive health (SRH) indicators. Only specific multi-component interventions with married girls who reported sexual intercourse the aim of increasing voluntary modern within the 12 months preceding the survey contraceptive use among adolescent girls were asked questions regarding use of aged 15–19 years. contraception and family planning services. Therefore, our primary outcome (mCPR) was There is a lack of evidence on the health measured only in sexually active married girls impact of projects that employ HCD. The A360 aged 15–19 years. Husbands and male evaluation comprises an outcome evaluation, partners were asked about community a process evaluation and a cost effectiveness acceptance and social support for adolescent study. The primary objective of the outcome girls to adopt healthy SRH behaviours. evaluation is to assess the impact of the A360 programme on the voluntary use of modern In Oromia, 1,198 married girls aged 15–19 contraception (the modern contraceptive years (Ware Jarso 417; Lome 270; Ada’a 263; prevalence rate (mCPR)) among sexually Fentale 248) and 142 husbands (Wara Jarso active girls aged 15–19 years. A baseline 54; Lome 31; Ada’a 33; Fentale 24) were survey is being conducted prior to the scale- successfully interviewed. up of the programme’s interventions, with an Key findings endline survey planned for late 2019. This report details the findings from the baseline Background characteristics of adolescent girl survey in one of the three A360 countries— respondents Ethiopia. The median age of married adolescent girl Methods respondents was 18 years (range 15–19 years). In Ethiopia, we are conducting a pre- and post- population-based cross-sectional survey About a third of respondents had no design. Baseline surveys took place between 1 education, and for 54.7% primary September 2017 and 20 October 2017, prior education was the highest educational to the scale-up of A360 activities, so that level attained. baseline conditions in one region in Ethiopia Among married adolescent girls, 36.6% targeted for A360 roll-out could be owned a mobile phone. documented. We conducted baseline surveys Sexuality, fertility and fertility preferences of in four woredas (districts) (Wara Jarso, Lome, adolescent girl respondents Ada’a, and Fentale) in Oromia region. Overall, 98.9% of respondents reported The target population for the study, married being sexually active during the previous girls aged 15–19 years, was in line with the 12 months. The median age of first sexual main focus of the programme in Ethiopia. intercourse was 16 years (range 11–19 A two-stage sampling design was used. A years). probability sample of 57 kebeles (wards) was A total of 805 (68.3%) married girls selected across the four study woredas with surveyed had ever been pregnant. probability proportional to population size. All in these kebeles households were visited, Unmet need for modern contraception was from which all eligible girls were invited to 20.5% in married adolescent girls, made up take part in the survey. In addition, we almost entirely of unmet need for spacing. Itad in association with the London School of Hygiene and Tropical Medicine Page | 2 February 2018 REPORT A360 Outcome Evaluation: Baseline Summary Report in Ethiopia Family planning challenging for the programme to achieve its projected impact on the primary Overall, 90.3% of married adolescent girls outcome. To inform programming had heard of contraception. The majority decisions, the programme should reflect of married adolescent girls aged 15–19 on the baseline results, including the years knew the benefits of modern likelihood of variability in mCPR across the contraception. However, many target regions. respondents also had misconceptions
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