End-line Report 2020 Preventing child marriage, teenage pregnancy and female genital mutilation/cutting in Bahir Dar Zuria and Kewet districts, Amhara region Results of the Yes I Do programme in Ethiopia Dr. Abeje Kassegne Addis Ababa University Lisa Juanola, Dinu Abdella, Anke van der Kwaak Dereje Tessema Jimma University Royal Tropical Institute, Amsterdam, the Netherlands Belayneh Worku, Almaz Mekonnen, Tensae Deneke Preface YES I DO. is a strategic alliance of five Dutch organizations which main aim is to enhance the decision making space of young women about if, when and whom to marry as well as if, when and with whom to have children. Funded by the sexual and reproductive health and rights policy framework of the Ministry of Foreign Affairs of the Netherlands, the alliance is a partnership between Plan Nederland, Rutgers, Amref Flying Doctors, Choice for Youth and Sexuality and the Royal Tropical Institute. Led by Plan, the alliance members implemented a five-year programme between 2016 and 2020 in seven countries: Ethiopia, Indonesia, Kenya, Malawi, Mozambique, Pakistan and Zambia. The Yes I Do Alliance partners and the Ministry of Foreign Affairs of the Netherlands acknowledge that child marriage, teenage pregnancy and female genital mutilation/cutting are interrelated issues that involve high health risks and human rights violations of young women and impede socioeconomic development. Therefore, the Yes I Do programme applied a mix of intervention strategies adapted to the specific context of the target countries. The theory of change consisted of five main pathways: 1) behavioural change of community and “gatekeepers”, 2) meaningful engagement of young people in claiming for their sexual and reproductive health and rights, 3) informed actions of young people on their sexual health, 4) alternatives to child marriage, female genital mutilation/cutting and teenage pregnancy through education and economic empowerment, and 5) responsibility and political will of policy makers and duty bearers to develop and implement laws towards the eradication of the practices. The programme included a research component to investigate the interlinkages between child marriage, female genital mutilation/cutting and teenage pregnancy and look at what works, how and why in the specific country contexts. The research focused on testing the pathways of the theory of change, underlying assumptions and interventions as well as on looking for mechanisms triggering change and enhancing programme effectiveness. To that end, the research component of Yes I Do undertook several studies, amongst others a base-, mid- and endline study in the countries where the programme was implemented. Each study was conducted by the Royal Tropical Institute, in close collaboration with local research partners. The present report details the endline study of the Yes I Do programme in Ethiopia conducted in two intervention woredas (districts) in the Amhara region, Bahir Dar Zuria and Kewet. The main aim of the study was to assess changes in relevant outcomes over the programme implementation years through a comparison of base-, mid- and endline data. The report gives an introduction to young people’s sexual and reproductive health and rights in Ethiopia and the Yes I Do programme, details the methodology used for the study, presents the main results, and provides general recommendations for future programmes on child marriage, female genital mutilation/cutting and teenage pregnancy in Ethiopia. Recommendations for future research are also shared. The findings and recommendations can be used by different stakeholders working in the Yes I Do programme as well as in other programmes seeking to protect and promote the sexual and reproductive health and rights of young people. RECOMMENDED CITATION Juanola L, Kassegne A, Tessema D, Worku B, Mekonnen A, Deneke T, Abdella D, van der Kwaak A. Endline report 2020. Preventing child marriage, teenage pregnancy and female genital mutilation/cutting in Bahir Dar Zuria and Kewet districts, Amhara region – Results of the Yes I Do programme in Ethiopia. KIT Royal Tropical Institute 2021. CONTACT INFORMATION Anke van der Kwaak: [email protected] Lisa Juanola: [email protected] COVER PHOTO UNICEF/ Tadesse 2 ACKNOWLEDGEMENTS A special thanks goes to our study participants for agreeing to participate in this research. We also extend our sincere gratitude to the community leaders and gatekeepers in Bahir Dar Zuria and Kewet for their unwavering support. We would like to acknowledge the entire team of research assistants for supporting the different phases of the study; revising the data collection tools, going out in the field and ensuring that data were efficiently collected, and engaging in the analysis of all the data. The field research team is listed below: Belayneh Worku – Supervisor Dereje Tesema – Supervisor Almaz Mekonnen – Supervisor Alemnew Berhanu – Supervisor Fitih Alemu Meseret Tadesse Tensae Deneke Tsion Amdework Fitsum Dechasa Hiwot Meseret Thanks to the Yes I Do Alliance partners in Ethiopia (Amref Health Africa, Plan Ethiopia, Development Expertise Center (DEC) and Talent Youth Association (TaYA)) and in the Netherlands (Plan Netherlands, Amref Flying Doctors, Rutgers and Choice for Youth and Sexuality) for their cooperation and supporting role in the research project and for their constructive contribution during the virtual validation workshop and update meetings. Great appreciation goes to the Netherlands Ministry of Foreign Affairs for providing the funding that made it possible to conduct the endline study successfully. We also thank Ophelia Chatterjee, Nicole Moran and Maryse Kok for their work in editing the report and contributing to the final writing. 3 Table of contents LIST OF TABLES AND FIGURES 6 ABBREVIATIONS 7 EXECUTIVE SUMMARY 8 1. INTRODUCTION 14 1.1 Background 14 1.1.1 Child marriage, teenage pregnancy, female genital mutilation/cutting and young people’s sexual and reproductive health and rights Ethiopia 14 1.1.2 Yes I Do programme and activities 14 1.2 Aims and objectives of base-, mid- and endline study 15 2. METHODOLOGY 17 2.1 Study type 17 2.2 Study areas 17 2.3 Study methods, sampling and recruitment procedures 18 2.3.1 Quantitative component 18 2.3.2 Qualitative component 18 2.4 Data collection and analysis 19 2.5 Quality assurance 20 2.6 Ethical considerations 20 3. RESULTS 21 3.1 Characteristics of study population 21 3.2 Community context and mobilisation 23 3.2.1 Social and cultural beliefs and norms 23 3.2.2 Roles of gatekeepers 24 3.3 Youth engagement 26 3.3.1 Youth autonomy, engagement and empowerment 26 3.3.2 Discussing sensitive issues and inter-generational communication 27 3.4 Young people’s sexual and reproductive health knowledge, behaviour, information access and service utilization 28 3.4.1 Young people’s issues faced, discussions and worries regarding sexual and reproductive health and rights 28 3.4.2 Sexual behaviour 30 3.4.3 Information and education on sexual and reproductive health and rights 32 3.4.4 Contraception knowledge and use 36 3.4.5 Sexual and reproductive health service provision and use 38 3.5 Teenage pregnancy 40 3.5.1 Prevalence of teenage pregnancy 40 3.5.2 Causes and circumstances of teenage pregnancy 41 3.5.3 Prevention of teenage pregnancy 41 3.5.4 Changes in lives of teenage mothers – consequences 42 3.6 Child marriage 43 3.6.1 Prevalence of child marriage 43 3.6.2 Minimum, ideal and preferred age of marriage 44 3.6.3 Circumstances, reasons and consequences of child marriage 45 3.6.4 Attitudes around child marriage 46 3.6.5 Inter-linkages between child marriage and pregnancy 46 3.6.6 Decision-making dynamics regarding marriage 47 3.6.7 Prevention of child marriage 48 3.7 Female genital mutilation/cutting 49 3.7.1 Circumstances, knowledge, opinions and attitudes regarding female genital mutilation/cutting 49 3.7.2 Awareness of the consequences of female genital mutilation/cutting 51 4 3.8 Education and economic empowerment 52 3.8.1 Access to (higher) education 52 3.8.2 Safety in schools 53 3.8.3 Access to economic empowerment opportunities 53 3.9 Policy and legal issues 55 3.9.1 Knowledge and awareness of laws 55 3.9.2 Local law and policy 55 4. DISCUSSION 57 4.1 Pathway 1 – Community members and gatekeepers have changed attitudes and take actions to prevent child marriage, teenage pregnancy and female genital mutilation/cutting 57 4.2 Pathway 2 – Young women and men are meaningfully engaged to claim their sexual and reproductive health and rights 58 4.3 Pathway 3 – Young women and men take informed action on their sexual health 59 4.4 Pathway 4 – Young women have alternatives beyond child marriage, teenage pregnancy and female genital mutilation/cutting through education and socio-economic empowerment 59 4.5 Pathway 5 – Policymakers and duty bearers develop, reform and implement policies as well as enforce laws on child marriage, female genital mutilation/cutting and teenage pregnancy 60 4.6 Crosscutting strategies 60 4.6.1 Gender transformative thinking 60 4.6.2 Male engagement 61 4.6.3 Girls' empowerment 61 4.6.4 Meaningful youth engagement 61 4.7 Strengths and limitations of the study 61 5. CONCLUSIONS AND RECOMMENDATIONS 62 5.1 Conclusion 62 5.2 Recommendations for future programmes 62 5.3 Recommendations for future research 63 6. REFERENCES 65 7. ANNEXES 66 Annex 1. Theory of Change Ethiopia 66 Annex 2. Overview and description of models 67 5 List of tables and figures LIST OF TABLES Table 1 Summary of quantitative indicators 11 Table 2 Summary