seminar on the right to decide sexual and reproductive rights practices that affect the health of...

SEMINAR ON THE RIGHT TO DECIDE Sexual and Reproductive Rights Practices That Affect The Health Of Women And Children 9-10 December 2009 Vitoria-gasteiz (SPAIN) Prepared by Mr. Abate Gunduffa (EGLDAM) and Mr. Ezana Haddis (BLIE) Presented by Ezana Haddis (BLIE)

Presentation Outline Background about the Ethiopia Introduction Discussion of trends The 15 HTP Detail discussion in the major HTPs Institutional framework and actors in the Fight Against HTP Challenges Conclusion December 2009Presenation to Haurralde Foundation2

Background to the Nation (Ethiopia) 73.9 million with only 16% urban population Covers about one million square kilometers Found in the horn of Africa b/n 3 and 15 degrees North latitude And 34 and 48 degrees East longitude Has more than 80 ethnic groups It is a federal country, where there are autonomous nine regional states and two city administrations December 2009Presenation to Haurralde Foundation3

Contd December 2009Presenation to Haurralde Foundation4

Regions of Ethiopia 1- Addis Ababa 2- Afar 3- Amahara 4- Benishangul Gumz 5- Dire Dawa 6- Gambella 7- Harari 8- Oromiya 9- Somali 10- South Nations, Nationalities and Peoples (SNNPR) 11- Tigray December 2009Presenation to Haurralde Foundation5

Health Status and Services Indicator2006 Data Life Expectancy at birth54 Infant Mortality Rate per 1000 live birth77 Maternal mortality rate per 100,000 live births870 Immunization Coverage75.6 % Contraceptive usage36% Population growth rate2.7% Primary Health Coverage77% December 2009Presenation to Haurralde Foundation6

Introduction This presentation is prepared based on two surveys the Baseline Survey (1997) and Follow-up Survey (2007) Which were conducted on the Harmful Traditional Practices in Ethiopia by NCTPE/EGLDAM December 2009Presenation to Haurralde Foundation7

Introduction: The Surveys Baseline SurveyFollow Up Survey Date19972007 ImplementerNCTPEEGLDAM Management Support OSSEREASCN-E FundingNORAD Team Fisseha Yayehyirad Amare Fisseha Yayehyirad Amare December 2009Presenation to Haurralde Foundation8

Introduction: The Report Baseline SurveyFollow Up Survey Date19982008 ImplementerNCTPEEGLDAM Management Support OSSEREASCN-E FundingNORAD Team Fisseha Yayehyirad Amare Fisseha Yayehyirad Amare December 2009Presenation to Haurralde Foundation9

Introduction: Book [+Amharic adaptation] Baseline SurveyFollow Up Survey Date20032008 ImplementerNCTPEEGLDAM Management Support OSSEREASCN-E FundingNORAD Team Dehab Yayehyirad Asmelash Fisseha Yayehyirad Amare December 2009Presenation to Haurralde Foundation10

Objectives of FUS Major Objective "to examine/measure changes observed on prevalence, knowledge, attitude, intention and behavior......... towards HTP at national level and to recommend appropriate strategies in future directions". December 2009Presenation to Haurralde Foundation11

Specific objectives Assess change & current : Prevalence, knowledge, attitude, intention & behaviour Reasons, harmful effect & victims Impact on HIV Identify Major actors in HTP Activities by different actors Achievements so far December 2009Presenation to Haurralde Foundation12

.. December 2009Presenation to Haurralde Foundation13 Framework for Methodological Development Follow up survey, therefore, as much as feasible same method with the baseline survey However, adapted because of: Need to asses the changes over time New objectives interventions & organizations Approaches: Literature/documents review Questionnaire surveys FGD

Methodology Adaptation Process Conceptualization of the follow up Framework for social change analysis [Dr Yeraswork] The nature of change in culture and tradition Factors/determinants of change and how they interact The role of change agents (traditional leaders, FBOs, NGO, government etc) and possible assessment of their (differential) impact Models/methods of assessing changes and their applicability to HTP in Ethiopia Framework for statistical analysis [Prof Ayenew & Behayelu] Sample frame in line with the baseline study Sample size to ensure quantification of prevalence change for, at least, FGM in the stronghold nationalities December 2009Presenation to Haurralde Foundation14

Assessing Change: Framework Community HTP Instrument - Lit/Doc -Q2 & FGD - Q1 & FGD December 2009Presenation to Haurralde Foundation15 Environment Gov NGO/CBO EGLDAM

. Environment Geography & demography Political decentralization, High number of Organizations/NGO Economy poverty Socio-cultural gender, children Education Health & health services Actors: Government NGO Private EGLDAM Changes in: Knowledge, Attitude, Reasons, Harm, Intention, Behaviour, Practice, Prevalence Other issues: Problems faced HTP & HIV HTP & SRH Future interventions December 2009Presenation to Haurralde Foundation16

1. Literature/Document Review Geared towards change in the last ten years and new developments Background Geography & demography Political decentralization High number of NGO Economy poverty Socio-cultural gender, children Education Health & health services HTP (5 years because NCTPE 2003) FGM Marriage related Children related Taboos/prohibitions Others December 2009Presenation to Haurralde Foundation17

2. Qualitative and Quantitative Methods & Instruments Cross-sectional sample survey [Q1] Adult pop (F & M), general info on 20 HTP [Q1a, 100 households from each Kebele] Prevalence of 5 HTP [Q1b, 20 HH from each Kebele] Info from opinion makers (20 from Woreda; educated, informed) Info on 20 HTP (Q2a, mostly close-ended) Others mostly Food/Work Prohibition (Q2b, open- ended) FGD, 2 per Woreda (District): Capital Kebele/Farmers Association December 2009Presenation to Haurralde Foundation18

Contents of Baseline & Follow Up Surveys BaselineFollow up Identification Legal Knowledge- Information- Occurrence/Magnitude Attitude Future Trend Perpetrators Actors- December 2009Presenation to Haurralde Foundation19

Sample Population: Criteria Same with baseline as feasible However changes but no up to date data Zones (sub-regions) some new ones Woredas (districts) some merged, some new, special Kebeles (the smallest local admin) some merged, some new names etc December 2009Presenation to Haurralde Foundation20

Principles for decision (in field) Cover all zones (sub-regional entities): 2 woredas (districts) per zone Use the same woredas (district) & Kebeles (the smallest local admin) as baseline (i.e. same locality) Include Dire Dawa & zones in Somali Include additional ethnic groups December 2009Presenation to Haurralde Foundation21

Study Population BaselineFollow up Ethnic groups6981 Farmer Associations (rural local admin)110132 Woredas (District)112132 Kebeles (Urban local admin)6772 Towns2223 Zones (sub-regional administrations)5874 Total pop Q1a Total pop Q1b 25,309 15,710 34,000 19,000 Total pop Q21,9302,500 Total pop FGD1,2321,500 December 2009Presenation to Haurralde Foundation22

Discussion KAPr 15 HTP 2007 December 2009Presenation to Haurralde Foundation23

Comparison of knowledge towards the 15 HTP in BLS and FUS December 2009Presenation to Haurralde Foundation24

Knowledge: FGM by region December 2009Presenation to Haurralde Foundation25

FGM, Baseline & Current Prevalence by Region December 2009Presenation to Haurralde Foundation26

Prevalence of FGM by Age Group Baseline (BLS) & Follow up (FUS) Surveys December 2009Presenation to Haurralde Foundation27

Important decrease in prevalence: Prevalence of FGM by Age FUS December 2009Presenation to Haurralde Foundation28

Map Prevalence of FGM by Region 2007 December 2009Presenation to Haurralde Foundation29

FGM: Harmful Effects December 2009Presenation to Haurralde Foundation30

Early Marriage: Knowledge BLS & FUS by Region December 2009Presenation to Haurralde Foundation31

Early Marriage: Attitude in BLS and FUS by Region December 2009Presenation to Haurralde Foundation32

Early Marriage Prevalence: BLS & FUS December 2009Presenation to Haurralde Foundation33

EM: Harmful Effects in BLS & FUS EffectBLSFUS Harm to the uterus and the body in general54.341.2 Problems in delivery45.742.6 Loveless marriage often ending in divorce30.427.9 Girl not mature enough to run a HHd26.126.5 Early pregnancy17.419.1 Psychological Problems13.033.8 High expenses for marriage8.78.8 Discontinuation of education-14.7 Exposure to prostitution-10.3 December 2009Presenation to Haurralde Foundation34

December 2009Presenation to Haurralde Foundation35

MBA: Knowledge in BLS and FUS December 2009Presenation to Haurralde Foundation42

MBA: Attitude in BLS and FUS December 2009Presenation to Haurralde Foundation43

MBA: Prevalence in BLS and FUS December 2009Presenation to Haurralde Foundation44

MBA: Harmful Effects in BLS & FUS EffectsBLSFUS Mistreatment of girls61.554.9 Conflict/feud b/n family, community, ethnic group61.529.4 Unhappy marriage42.323.5 Psychological stress11.519.6 Heavy expenses (as compensation)10.3- Dropping out of school9.017.6 Rape5.15.9 Exposure to HIV/AIDS-39.2 December 2009Presenation to Haurralde Foundation45

UC Baseline & Current (ascending order) Prevalence by Region December 2009Presenation to Haurralde Foundation46

Prevalence of UC by Age: Baseline & Follow up Surveys December 2009Presenation to Haurralde Foundation47

UC: Harmful Effects in BLS and FUS EffectBaselineFollow- Up Infection/poisoning due to unclean instruments50.022.6 Heavy bleeding46.937.7 Speech problem/distortion25.018.9 Death17.819.8 Injury (pulling of) the tongue16.714.2 Pain/excessive crying14.617.0 Teneta (Passing of fluid into the trachea)10.48.5 No harm (if well performed)8.30.9 December 2009Presenation to Haurralde Foundation48

MTE: Prevalence in Baseline & Follow up Surveys by region (ascending order) December 2009Presenation to Haurralde Foundation49

Comparison of knowledge with the baseline result (descending order change) December 2009Presenation to Haurralde Foundation50

Categorization of Food Taboos to Pregnant Women, Children and the Community, in BLS and FUS ProhibitionHighestLowest BLSFUSBLSFUS 1.Pregnant Women Amhara ( 41.2 ) SNNPR ( 35.6) Oromia ( 31.9 ) Amhara ( 39.7) SNNPR ( 25.7 ) Tigray ( 24.5 ) Somali ( 0.0 ) Gambella ( 18.2 ) A.A ( 23.2 ) Somali ( 3.3 ) Gambella ( 3.5 ) A.A (0) 2.Children A.A ( 51.8 ) SNNPR (46.8) Oromia (43.7) A.A (44.5) Oromia (38.8 SNNP (31.5) Somali (2.9) Gambella (9.5) Benishangul/Gu muz (19.4) Somali (1.7) Harari (10.5) Gambella (9.5) 3.Communi ty Gambella(59.1 Harari (55.0) Affar (44.8) Gambella (23.8) Afar (24.7) Harari (40.4) Somali (5.7) Benishangul/Gu muz (6.0) Amhara (17.1) Somali (7.5) Benishangul/G umuz (11.1 Amhara (13.6 December 2009Presenation to Haurralde Foundation51

Categorization of Work Restriction to Women, Men and the Community by Region RestrictionHighestLowest BLSFUSBLSFUS 1. For Women Gambella Amhara Oromia Amhara Oromia Gambella Benishangul/G umuz Somali Addis Ababa Benishangul/Gumuz Somali Addis Ababa 2. For MenGambella Amhara SNNPR Amhara AA Dire Dawa Benishangul/G umuz Somali Harari Benishangul/Gumuz Somali Afar 3. For Community Amhara SNNP Affar Amhara SNNP Dire Dawa Gambella Benishangul/G umuz Addis Ababa Gambella Benishangul/Gumuz Addis Ababa December 2009 Presenation to Haurralde Foundation 52

Link: HTP and HIV/AIDS In the opinion of FGD participants HTPs suspected by the FGD participants to transmit HIV/AIDS Highest frequency mentioned: FGM (104) followed by Uvula cutting, milk teeth extraction, Abduction followed rape, polygamy [1] and[1] inheritance marriage. [1][1] Polygamy, even though identified as HTP in a number of regions, is more a religious rather than purely traditional practice. December 2009Presenation to Haurralde Foundation53

HTP and Gender and Gender Based Violence Relationship identified by FGD participants: sexual harassment, Abduction followed by rape, undermining the status of women, early marriage, excessive work load on women, denying equal property rights to women, FGM, Polygamy, divorce with out sufficient reason, Inheritance marriage and Wife beating (Hitting [DEBDEBA]) December 2009Presenation to Haurralde Foundation54

Relationship between HTP & RH Major HTP identified by FGD include: FGM Early Marriage Abduction Polygamy Frequent pregnancy Inheritance marriage December 2009Presenation to Haurralde Foundation55

Overall gains High level of awareness and declared support to elimination of HTP Strong legal frameworks nationally and internationally Strong policy level (political) will/mood internationally & in country High number of government and non-government organizations involved December 2009Presenation to Haurralde Foundation56

Institutional framework towards HTPs Internationally Universal Declaration of Human Rights Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages 1964 International Convention on Economic, Social and Cultural Rights 1966 International Convention on Civil and Political Rights 1966 Convention on Elimination of All Forms of Discrimination against Women 1979 The African Charter on Human and People Rights (1981) Convention on the Rights of the Child 1989. African Charter on the Rights and Welfare of the Child (ACRWC, 1999) Eradication of Violence Against Women and Children (1998) Protocol on the African Charter on Human and Peoples Rights on the Rights of Women in Africa (2003) December 2009Presenation to Haurralde Foundation61

Institutional framework towards Htp (contd) In country FDRE Constitution (1995) Penal Law of the country National Policy on Women (1993) National Health Policy (1993) Health Strategy HIV/AIDS Strategy Reproductive Health Strategy Education and Training Policy (1994) December 2009Presenation to Haurralde Foundation62

High number of GO & NGO involved Government almost all Womens Affair Health Education Law Enforcement International Bilateral NORAD USAID Multilateral: WHO, UNICEF.. NGO National: EGLDAM. FGAE International: NSC, Pathfinder FBO: EOCDICAC, Islamic Affairs, EECMY CBO: Idirs Associations: Womens, Youth ENMA, EMA, EPHA, ESOG.. December 2009Presenation to Haurralde Foundation63

Challenges Progress not commensurate with effort Distribution & prevalence still high (

Looking Forward " The question of excision will not be solved in international forums; it will be solved in the zones where it is practiced. That is... in the villages of the most distant areas." Mottin-Sylla December 2009Presenation to Haurralde Foundation72

December 2009Presenation to Haurralde Foundation73 Yichalale! Impossible is not Ethiopian! Thank You!

Gracias!!! December 2009Presenation to Haurralde Foundation74

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