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Trends in Knowledge Attitude and Practices of Harmful Traditional Practices in Ethiopia (1997 to 2007) . 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)

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slide1

Trends in Knowledge Attitude and Practices of Harmful Traditional Practices in Ethiopia (1997 to 2007)

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. EzanaHaddis (BLIE)

Presented by EzanaHaddis (BLIE)

presentation outline
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

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background to the nation ethiopia
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

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cont d
Cont’d

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regions of ethiopia
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

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health status and services
Health Status and Services

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introduction
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

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introduction the surveys
Introduction: The Surveys

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introduction the report
Introduction: The Report

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introduction book amharic adaptation
Introduction: Book [+Amharic adaptation]

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objectives of fus major objective
Objectives of FUSMajor 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".

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specific objectives
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

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slide13

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

.

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methodology adaptation process
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

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assessing change framework
Assessing Change: Framework

Community

  • HTP

Environment

Gov

NGO/CBO

EGLDAM

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slide16
.

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1 literature document review
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

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2 qualitative and quantitative methods instruments
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

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contents of baseline follow up surveys
Contents of Baseline & Follow Up Surveys

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sample population criteria
Sample Population: Criteria
  • Same with baseline as feasible
  • However changesbut 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

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principles for decision in field
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

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study population
Study Population

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discussion kapr 15 htp 2007
DiscussionKAPr 15 HTP 2007

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knowledge fgm by region
Knowledge: FGM by region

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fgm baseline current prevalence by region
FGM, Baseline & Current Prevalenceby Region

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prevalence of fgm by age group baseline bls follow up fus surveys
Prevalence of FGM by Age GroupBaseline (BLS) & Follow up (FUS) Surveys

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important decrease in prevalence prevalence of fgm by age fus
Important decrease in prevalence:Prevalence of FGM by Age FUS

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map prevalence of fgm by region 2007
Map Prevalence of FGM by Region 2007

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fgm harmful effects
FGM: Harmful Effects

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early marriage knowledge bls fus by region
Early Marriage: Knowledge BLS & FUS by Region

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early marriage attitude in bls and fus by region
Early Marriage: Attitude in BLS and FUS by Region

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early marriage prevalence bls fus
Early Marriage Prevalence: BLS & FUS

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em harmful effects in bls fus
EM: Harmful Effects in BLS & FUS

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mba knowledge in bls and fus
MBA: Knowledge in BLS and FUS

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mba attitude in bls and fus
MBA: Attitude in BLS and FUS

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mba prevalence in bls and fus
MBA: Prevalence in BLS and FUS

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mba harmful effects in bls fus
MBA: Harmful Effects in BLS & FUS

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prevalence of uc by age baseline follow up surveys
Prevalence of UC by Age: Baseline & Follow up Surveys

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uc harmful effects in bls and fus
UC: Harmful Effects in BLS and FUS

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mte prevalence in baseline follow up surveys by region ascending order
MTE: Prevalence in Baseline & Follow up Surveys by region (ascending order)

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comparison of knowledge with the baseline result descending order change
Comparison of knowledge with the baseline result(descending order change)

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categorization of food taboos to pregnant women children and the community in bls and fus
Categorization of Food Taboos to Pregnant Women, Children and the Community, in BLS and FUS

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categorization of work restriction to women men and the community by region
Categorization of Work Restriction to Women, Men and the Community by Region

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link htp and hiv aids
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
    • inheritance marriage.

[1] Polygamy, even though identified as HTP in a number of regions, is more a religious rather than purely traditional practice.

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htp and gender and gender based violence
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])

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relationship between htp rh
Relationship between HTP & RH

Major HTP identified by FGD include:

  • FGM
  • Early Marriage
  • Abduction
  • Polygamy
  • Frequent pregnancy
  • Inheritance marriage

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overall gains
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

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institutional framework towards htps
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)

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institutional framework towards htp cont d
Institutional framework towards Htp (cont’d)

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)

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high number of go ngo involved
High number of GO & NGO involved

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challenges
Challenges
  • Progress not commensurate with effort
  • Distribution & prevalence still high (<behavior)
  • Decrease rate less than population growth
  • Resistance & clandestine practice increasing
  • Lack of consistent & coordinated action
  • Little innovation in strategies

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core conclusions recommendations
Core Conclusions & Recommendations
  • There have been reductions in HTP
  • The task ahead – elimination - is not easy but possible
  • Need for
    • Better contextualized: regional/local evidence-base & action
    • Ownership by communities
    • Clearly mandated & resourced leadership

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recommendations
Recommendations
  • Better articulated consistent and sustained ‘education’
    • BCC approach – CC
    • Anticipate challenges
    • Ensure consistency of messages
    • Raise skill of facilitators
  • Increased Legal Measures
    • Avoid ‘necked’ legal measures
    • Educate on laws (pop, practitioners, enforcement agents…)

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recommendations cont
Recommendations (cont.)

3. Coverage by quality health and education services

  • Rapid increase (HEP) but questionable quality – lack of confidence
  • Issues of HTP/HIV link
  • Growth in education but quality, dropout?

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recommendations cont1
Recommendations (cont.)

4. Working thru community & religious leaders

  • Extensive & effective
  • Some HTP still linked to religion

“Perhaps more than any other issue, female genital mutilation has taught us that change cannot be imposed from outside; it must come from within” Obaid 2006

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recommendations cont2
Recommendations (cont.)

5. Regional focus

  • Lessons to be learnt/ best practices
  • Priority regions

6. Better institutionalization & resources

  • Holistic/integrated approach
  • Mandated government organization
  • Improved networking
  • Adequate resources

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recommendations cont3
Recommendations (cont.)

7. Further studies

  • Further exploitation of collected data
  • Community involvement
  • Legal aspects
  • Use of universities’ population ‘labs’
  • Training in research measures

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recommendations htp specific
Recommendations: HTP specific
  • FGM: More targeted interventions based on ethnic/zone specific studies
  • Child related:
    • better articulated educational materials
    • Expansion & quality of health services
  • Marriage related
    • Networking with gender, SRH… organizations
    • Promote girls’ education, implementation of laws

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looking forward
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

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slide73

‘Yichalale!’

Impossible is not Ethiopian!

Thank You!

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gracias
Gracias!!!

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