Fostering Hope: Documenting Interventions Targeting Ethiopian Child Brides Lynn Clark Callister, PhD, RN, FAAN


lthough multiple programs focus on improving the health of women and children globally, there is a paucity of outcomes evaluations conducted. It was refreshing and helpful to read a recent study conducted by the International Center for Research on Women documenting outcomes related to reaching Millennium Development Goal (MDG) #3, which relates to promoting gender equality and empowering women, and MDG #4 focusing on universal educational opportunities for men and women (Edmeades, Hayes, & Gaynair, 2014). Child brides are among the most marginalized and invisible women globally. Nearly 70 million girls are married before the age of 18, with an estimated 142 million more such marriages over the next 10 years (Edmeades et al., 2014). Early marriage is most common in South Asia and Africa, with negative outcomes

The TESFA (Towards Economic and Sexual Reproductive Health Outcomes for Adolescent Girls) program in Amhara, Ethiopia, was established in 2010 with 5,000 child brides participating in the program. The word “tesfa” means hope in Amharic. This program brought hope to married adolescents. TESFA focused on (1) empowering married adolescents with education, skills, and support, (2) providing essential health education and services, and (3) providing basic financial and income generating skills. TESFA built on the Village Savings and Loan Association model, with participants divided into three groups with peer facilitators. Married adolescents received either a combined intervention, one of two different types of interventions, and a control group for whom the combined intervention was delayed. The documented outcomes proved significant in all three intervention groups as compared to the

Child brides are among the most marginalized and invisible women globally. such as poverty, gender inequality, lack of schooling, risk for intimate partner violence and sexually transmitted infections including HIV, as well as complications related to premature childbearing. This practice is a growing concern in Ethiopia. Adolescent marriage is illegal in Ethiopia but the practice continues, with 41% of women now 20 to 24 years of age married before the age of 18 and 16% of women in this age group married by age 15. It is estimated that the majority of these women had no choice who they married (90%), and 75% did not consent to their marriages (Edmeades et al., 2014). Such marriages violate basic human rights, and many of these young brides are forgotten in global health policy efforts. September/October 2014

control group, with the greatest differences documented in the combined group. One facilitator of the economic empowerment group noted, “Before TESFA we did not have any information. After the TESFA project, they taught us about different income-generating opportunities. They informed us about animal fattening (sheep, ox and poultry). They told us how we can make changes even by saving a little and involving in selling items little by little from what we have.” There was a significant increase in use of modern family planning and knowledge of sexually transmitted infections. This knowledge had an

influence on the women’s behaviors, with a significant reduction in the incidence of HIV. Life skills education helped the women communicate more effectively and participate in family decision making, with a decrease noted in intimate partner violence, and improvements in emotional health among married adolescent women. Although decreasing the number of child brides was not a goal of the TESFA intervention, this was a positive outcome. Village elders, religious leaders, and health workers referred to as “gatekeepers” received education about the project. Such community engagement was critical to program success. Seventy adolescent marriages were prevented, which may be related to increased knowledge in the communities of the negative consequences of child marriage and a commitment to improving outcomes for the young women in their community. Proposed projects include learning how to reach adolescent women who are either divorced or widowed; effectively working with married couples to improve the lives of the wives; how to more effectively meet financial needs; and assessing the long-term effects of interventions. Such outcomes evaluations are exemplary in documenting improvements in socioeconomic status, health, and well-being of married adolescents and their families. ✜ Lynn A Clark Callister is a Professor Emerita, College of Nursing, Brigham Young University, Provo, UT, and an Editorial Board Member of MCN. Dr. Callister can be reached via e-mail at [email protected] The author declares no conflict of interest. DOI:10.1097/NMC.0000000000000065 References Edmeades, J., Hayes, R., & Gaynair, G. (2014). Improving the lives of married adolescent girls in Amhara, Ethiopia. Washington, DC: International Center for Research on Women. MCN

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Fostering hope: documenting interventions targeting Ethiopian child brides.

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