Enhancing Youth Contraception Rights in Ethiopia: DSW’s Outreach Success

2. Responding to the contraception needs and rights of young people DSW’s Youth to Youth Program The Case of Ethiopia Tirsit Grishaw

3. Outline of the Presentation • Background about the Youth • International declarations that promote access to supplies and services • Reproductive rights Ethiopia signed and committed • Dynamics of RH of the Youth • DSW’s Y-2-Y program contribution to improve access to supplies and services • Concluding remarks

4. Background about the Youth • Young people aged 10-24 constitute 35% of the total population in Ethiopia • Young women still suffer high rates of maternal injury and death due to childbirth without skilled assistance and unsafe abortion. • Persistent gender inequalities and traditional harmful practices, including female genital mutilation (FGM) and child marriage, in addition to limitted access to contraception contribute to these significant health challenges.

5. Background about the Youth…….continued • Among Ethiopia’s young women ages 20-24, the median age at first sex is 16.2 years • Young women and men have very little information and access to Sexual and Reproductive Health information and services compared to Adults ( 86% of adult women know about contraceptives compared to 26 % of young women aged 15-24) • A national survey taken over the past decade demonstrated that the unmet need of adolescents is over two times higher than that of the general population in the country.

6. International declarations that promote access to supplies and services • ICPD at its core promoted healthy, voluntary and safe sexual and reproductive choices for individuals and couples, including decisions on family size and timing of marriage. • ICPD adopted the goal of ensuring universal access to reproductive health by 2015 as part of its framework for a broad set of development objectives. • The Millennium Declaration and Millennium Development Goals set priorities that are closely related to the ICPD goals • Leaders ratified the understanding or importance of attaining ICPD goals to achieve most of MDG goals in the 2005 World Submit.

7. Reproductive rights Ethiopia signed and committed Reproductive rights Ethiopia ratified as derived from international human rights instruments specifically includes the following core issues: • Rights to the highest attainable standard of health including a right to have access to health care as well as access to SRH services and information • Right for family planning: to decide on the number and spacing of their children and to have access to information and services to do so.

8. Reproductive rights Ethiopia …… continued • Rights to the benefits of scientific progress: everyone should have access to available technology in reproductive healthcare, including quality contraceptive options • Rights of adolescents and unmarried women to receive SRH information and to freedom of thought : to have access to family planning information and services • Rights to non-discrimination on the basis of age: young people should have the same rights to confidentiality as adults with regard to their reproductive healthcare.

9. Dynamics of Reproductive Health of the Youth • While the unmet need for contraceptive reduced to 34% for the general population of Ethiopia, Young people’s unmeet need remains twice bigger than the general population. • In a country like Ethiopia where the unmet need is very high and source of funding for supply of contraceptives is totally donor –dependent, ensuring contraceptive security specifically for the most vulnerable groups such as unmarried youth is very challenging • Most Young people engage in sex at an early age: One in six women aged 15-19 years already had their first child and one fifth of this population is sexually active.

10. Dynamics of Reproductive Health…. continued • 45 percent of the total births in the country occur among adolescent girls and young women, which highly expose them to different reproductive health problems including fistula • According to the HIV sentinel surveillance of mothers seeking antenatal care, HIV/AIDS prevalence is 11 percent among women age 15-19, and 15 percent among those age 20-24 • Unintended pregnancy and unsafe abortion is also very high among teenage girls.

11. DSW’s Y-2-Y program contribution to improve access to RH services and supplies DSW in Ethiopia has started to run a nation wide Youth to Youth program since 2000 This comprehensive nation wide program with seven components has two components that aim at improving the access of the Youth to contraceptive and RH supplies and services • Promoting behavioral changes among the youth regarding their sexual and reproductive health • Through increasing awareness • through intensive education and communication • Capacity building – improving life skills, build young people self esteem, improve their negotiation skill.

12. DSW’s Y-2-Y program contribution to improve access to supplies and services ……. continued • Improving access to SRH services including contraceptive supplies, VCT, provision of youth friendly services • Provide condoms and contraceptive supplies through social marketing scheme • Train and deploy peer counselors • Provide hotline counseling through trained health professionals • Provide youth friendly services through model clinics • Carry out outreach services • Facilitate referral linkages with public and private clinics

13. Provide condoms and contraceptive supplies through social marketing scheme DSW’s Y-2-Y program ….. continued • DSW in collaboration with DKT introduced condom, oral contraceptives and Sanitary Pad social marketing • This scheme is found to be very useful to reach the unreachable such as sex-workers, house maids, married adolescent girls and others who have no access to such commodities • Young marketers of the condom/Sanitary pad social marketing scheme took the commodities to the beneficiaries. • They also prepare events where young people could come and get information and commodities with affordable prices • Young marketers also visit small shops . local bars, small restaurants and hotels. They provide information and the commodities at the right time and place for the beneficiaries.

14. Train and deploy peer counselors DSW’s Y-2-Y program ….. continued DSW through its well recognized youth development training center train peer councilors who are capable enough to council their own peers • The training is given using nationally recognized peer counseling manual • Young people prefer to divulge their issues to their age mate than to adults, hence peer counselors play vital role • The peer counselors address young people problems via the youth clubs • The counselors are well trained to address the problem of the youth either by using model clinics and/or via facilitating referral arrangements

15. DSW’s Y-2-Y program ….. continued • Provide hotline counseling through trained health professionals • This strategy is very useful to increase access of young people to SRH services and information • Hotline counselling is a toll free call that could be made from any where to professionals deployed to handle the calls • Hotline is very convenient for young people who are not willing to talk face to face • The hotline counselling is undertaken by male and female professionals who are attached to the youth clubs. The youth clubs through their mass edutainment activities announce the numbers and encourage young people to call and get the necessary information and services

16. Provide youth friendly services through model clinics DSW’s Y-2-Y program ….. continued • Model youth friendly clinics are also the other important strategy that the Y-2-Y program implemented to improve SRH access to the youth • Model youth friendly clinics are small clinics mostly attached to the youth clubs. Due to this fact, they become very important places for the young people to come and get the necessary services • Model youth friendly clinics are extremely cost effective and efficient in addressing youth SRH including contraceptive supplies and services needs as they work very closely with the peer councillors • Model youth friendly clinics are very suitable for rural and semi-urban settings where health posts are very far from the community

17. DSW’s Y-2-Y program ….. continued Carry out outreach services • Outreach is another strategy to reach the most unreachable young girls, married adolescent girls and young women who face various constraints to use the on the spot services • Outreach services when accompanied by necessary information bring tremendous results mostly in rural areas where most community live more than 5 km away from health centers • This strategy is very good in creating demand as well as providing supplies close to the beneficiaries.

18. DSW’s Y-2-Y program ….. continued Facilitate referral linkages with public and private clinics • The other important strategy of Y-2-Y is facilitation referral services to beneficiaries. • Peer counselors after counseling young people facilitate a referral service for advanced services • Peer counselors send beneficiaries to health posts and or clinics together with referral slip (voucher) so that they could get the service easily.

19. Concluding remarks • young people constitute one third of the total population. All the efforts made to improve the wellbeing of the society need to give special attention to this group • Youth are diverse groups that should get various services as per their categories such as sex, age, rural and urban setting, in and out of school etc • The current health facilities need to integrate youth friendly RH services and provision of supplies • Youth access to RH services and supplies very much constrained by cultural, traditional and economic situations. • Addressing the RH needs and rights of the youth including supply of contraceptive contribute a lot to sustainable growth of the country

20. THANK YOU