Survivors of FGM facilitate discussions to end the practice

By Martha Tadesse

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure.

Chifra, Afar, 23 January 2018 – “I had severe period pain, and my labour was a life and death situation,” says Fatuma Abdu, 28, who had undergone Type III FGM/C as a child. Fatuma has two daughters, a 4–year-old and a 20-months-old.

She recalls her first pregnancy experience saying, “I was very weak during my first pregnancy. I was in labour for 24 hours before they took me to the hospital. I gave birth at the hospital. However, because of our tradition, I have stitched again. My menstrual cycle pain was agonizing. I got pregnant again, and it was worse than my first experience. I was in labour for three days until I was unconscious and found myself at Mille Maternity hospital.

The doctor told me I would have suffered from fistula had I stayed home longer than that. I had a stillbirth.  I was physically and emotionally hurt. My third pregnancy was much better because of the surgery at the hospital.”

Zahara Mohammod, 28 discusses about FGM/C with “Unmarried Adolescent Girls’ Club” at Mille Woreda, Afar. © UNICEF Ethiopia /2018/Tadesse

Fatuma learned about the impacts of FGM/C after her first delivery and refused to have her daughters go through the same procedure. She explains how it was difficult to convince her husband on her decision saying, because “The day I went through all that because of my FGM/C procedure was the same day I made that decision. My husband disagreed because we had always thought we were right to practice FGM/C. Mind you, even though he knew how much I have suffered, he still could not make up his mind. I told him I would sue anyone who would touch my daughters and that was it.”

The UNFPA-UNICEF Joint Programme has been working in collaboration with Bureau of Women and Children Affairs (BoWCA) to accelerate the abandonment of FGM/C in Afar region since November 2008. During the implementation of its first phase that ended in 2013, the programme targeted six districts out of the 32 districts in the region, which have declared abandonment of FGM/C presently.

According to the assessment made at the end of this first phase, the programme has resulted in substantial changes in belief and practice of FGM/C in target districts, with a practice decline from 90 per cent in 2008 to 39 per cent after five years of intervention. The second phase of the programme is currently implementing social mobilization interventions in three districts with the aim of improving community knowledge, attitude and practice. The programme heavily focuses on the engagement of community and religious leaders who are the most influential persons in the community. Additionally, the programme promotes community conversations through various discussion groups to create awareness and empower community members for a lasting change.

Fatuma is among the trainers who have been selected to facilitate discussion groups in their communities. The UNFPA-UNICEF Joint Programme has trained 176 facilitators for community conversation and dialogue from 3 districts on FGM/C and early marriage. This community conversation and dialogue on FGM/C is inclusive of girls, boys, men, women, and the youth in the community.

“I hope everyone listens to our suffering and refuses to undergo the FGM/C procedure.”

Sharing her experiences with the training, Fatuma states, “The training was such an eye-opener. I was challenged regarding my wrong beliefs, and it helped me speak up for others.”

According to Sheikh Mohammod Dersa, President of the Islamic Affairs Supreme Council in Afar, the FGM/C intervention by UNFPA-UNICEF has brought a behavioural change in the community.

He states, “We are grateful for what UNFPA and UNICEF have done in our region. We have been working with them hand in hand. But, we still need to work harder, because the issue is deeply rooted in social and religious norms. Social norms are powerful. We need to know that this is a generational issue, as well. It takes a lot of effort and collaboration to challenge communities and achieve the goal of ending FGM/C. We are always ready to teach our community, and we hope the programme continues and expands to other districts.”

Healthy mothers, healthy children, making healthy communities in Ethiopia

Dugem, Tigray REGION, Ethiopia, 21 December 2017 – In the health post at Dugem village, in Ethiopia’s Tigray region, Berhan Zebraruk, 25, gently strokes her child’s cheek and then gives him a sweet tickle on the tummy. Her first born, Awot Kaleab, is quick to respond to her touch. He cracks a beautiful smile displaying his toothless gums and looks his mother right in the eye for the play to continue. The little boy is restless. He grabs his mother’s cell phone and when that is taken away from him, he turns his attention to the baby next to him.

“My boy likes to play with everything he holds,” says Berhan. “I have to keep an eye on him, otherwise he put things in his mouth.”

Awot is now 9-months-old and it is time for his measles vaccination, which would complete his set of basic vaccinations for children under the age of 1, as recommended by WHO and the Ethiopia National Expanded Program on Immunization.

It is a special day for Berhan. Shortly after Awot received the vaccine, the health extension worker, Genet Desta, registered his name in the vaccine book. Then she called out Berhan’s name and handed her a certificate, a recognition that is given to mothers when their children complete taking the necessary vaccines.

Maternal and Child Health, TigrayBerhan is applauded by the other mothers in the health post for successfully vaccinating her child. She is also recognized as a role model for her best child feeding practices, including exclusively breastfeeding her son for his first six months.

Berhan attended school up to grade 10. Since she was a little girl, her dream was to become a doctor. Instead, she got married and became a housewife like many other women in her village. Yet, her education is considered an achievement in the eyes of fellow villagers.

“I wanted to become a doctor because I saw health workers treating people in my village,” says Berhan. “That wasn’t meant to happen for me, maybe it will for my son,” she added, gazing down at him.

Berhan understands that her child can only fulfil her unrealized dream if he grows up healthy and well. When she knew that she was pregnant with him, she started her pregnancy follow-up relatively earlier than other mothers.

‘’Berhan attended all of the four antenatal follow-ups and took the iron supplement properly,” says Genet, the health worker. “She was very conscious of her health and that’s why her child is very healthy.”

In Ethiopia, an increasing number of women are receiving care by skilled health workers both during pregnancy and childbirth. In the Tigray region, where Berhan lives, for instance, 90 percent of women receive antenatal care by skilled attendants, at least once, during their pregnancy, which is well over the national average of 62.4 percent.

In addition, 59 percent of the region’s mothers are giving birth in health facilities, instead of the old tradition of home delivery.

The country has seen significant improvement in immunization coverage over the past two decades. In 2000, it was only 14 per cent of Ethiopia’s children under the age of 2 who have received all the basic vaccinations, but in 2016, that number soared to almost 40 per cent.

Owing to its well-established community-based health service provision, Ethiopia is also enjoying a reduction in maternal and child deaths. Maternal mortality which was 871 deaths per 100,000 live births in 2000 has dropped to only 412 in 2016, a reduction by more than half in just 16 years. The same is also true when it comes to child mortality. More children in rural Ethiopia are celebrating their fifth birthday than ever before.

The nearly 40,000 female health workers, together with the women of the Health Development Army, easily access women and children in every household and provide much needed advice and services, including immunization to prevent the most debilitating child illnesses.

UNICEF is supporting the different components of the programme by providing both financial and technical assistance. UNICEF also supports the management of common childhood illnesses including malaria, pneumonia, diarrhoea and severe acute malnutrition at the health post level, contributing to a significant reduction in deaths.

Berhan’s task as a mother, caring and nurturing for Awot, symbolizes the bright future that lies ahead of children in rural Ethiopia. She is well equipped with skills and knowledge that will enable her to provide critical health and nutritional care for her son. Further help is also available since services, even for those in remote communities, are now more accessible.

Against all Odds, South Sudanese Refugees find a way to access education

By Amanda Westfall

On 19 December, 2017, Nyawal John, a South Sudanese 17-year-old girl says that her goal in life is to be educated. After escaping conflict in her village in South Sudan, she is doing whatever it takes to access education in Ethiopia.

Their villages are ravaged as they flee conflict and leave family, livelihoods and education behind. They travel for months, sometimes without food, water, or shelter, to arrive in a new country that offers the basic services required for survival. But when the South Sudanese people spend year after year waiting for the conflict in their country to subside, the time keeps ticking on their education.

Nyawal John, 17, who arrived in Tsore Refugee camp in Benishangul-Gumuz, Ethiopia two years ago, has gone almost three years without formal education. As a young teen, she had to leave almost everything behind in South Sudan – even her parents, who she hasn’t heard from since fleeing, not knowing if they are alive today or not.

Tsore Refugee Settlement offers pre-primary and primary school, but unfortunately, there is currently no secondary school available for Nyawal who says that she should be attending 9th grade right now.

But this did not stop Nyawal in her ambitions for education. She first started working as a translator at the camp health centre. However, she felt detached from education so decided to be a teacher in the camp’s pre-primary school, which is where she is currently working.

At the school, she teaches a total of 85 four-year-old children each day where she is exposed to new UNICEF-supported teaching and learning materials and capacity building programmes. She is able to use the various skills and materials to improve her teaching and also help her gain new knowledge for her own educational growth.

The main thing Nyawal wants right now is to learn. “I need to get knowledge. In the future what I want is to finish my education … If there is a place in my country for this I will be there. But iff it is here, I will be here.”

Nyawal dreams of being a computer scientist one day. When she was a young teenager in South Sudan, her father bought her a computer from Rwanda, which she cherished and managed to carry with her as she fled to Ethiopia. Unfortunately, because of financial needs she had to sell it once she arrived. Still, she has managed to continue practising by going to Tsore’s Administration for Refugee and Returnee Affairs office weekly to use their computers.

Education for Refugee and Host Community Children Benishangu-Gumuz, Ethiopia
Education for Refugee and Host Community Children in Tsore Zone pre school Benishangu-Gumuz, Ethiopia Tsore Zone A Pre School, Assosa. © UNICEF Ethiopia /2017/Tadesse

From site to site in the camp there is an ardent yearn for education. Kemal Olika, an Ethiopian teacher in the refugee primary school in the camp says it best, “Without any training and just by their confidence, they [refugee teachers] still teach and strive for education. I appreciate them. Even the [refugee] students’ respect is very high. South Sudanese respect the teachers. They listen. They really want to learn.”

At the settlement, UNICEF supports the refugee children’s aspirations for education. Through an integration programme with the host-Ethiopian communities, UNICEF supports teacher training programmes and extra-curricular activities including; materials and equipment for sport, play and learning – so that refugees can benefit from their host country’s education system. In addition, UNICEF supports the construction of new classrooms to ease the congestion in schools and advocates for construction of secondary schools for older students, like Nyawal.

When forced away from everything she knows – her home, parents, schooling, and cherished computer – against all the odds, Nyawal continues to strive for education.

Canada partners with UNICEF to improve reproductive health and nutrition among adolescent girls in Ethiopia

8 March 2018, ADDIS ABABA – On the occasion of International Women’s Day, the Government of Canada is pleased to provide CDN$ 14.8 million (US$ 12 million) to UNICEF Ethiopia to improve the reproductive health and nutritional status of adolescent girls. The initiative will reach over four million girls in districts with high food insecurity and a high prevalence of child marriage. It will be implemented between 2018 and 2022.

“As part of our feminist approach, Canada is committed to advancing sexual and reproductive health and rights in order to empower women and adolescent girls in Ethiopia and around the world,” says Ivan Roberts, Head of Cooperation at the Embassy of Canada in Ethiopia.

In Ethiopia, 25 per cent of the population is made up of adolescents (aged 10 to 19 years), of which 11 million are girls.  Adolescent girls experience numerous barriers that hinder them from fully realizing their potential. A significant portion of these barriers is related to their sexual and reproductive health and to their nutrition.

Canada’s contribution will help girls access adolescent-friendly sexual and reproductive health services and nutrition facilities by training health workers to clearly understand the physiological and psychological needs of adolescent girls. This initiative will also leverage gender clubs in schools to provide life skills and sexual and reproductive health knowledge to young people. In addition, adolescent-friendly spaces will be created to ensure out-of-school children freely discuss nutrition and sexual and reproductive health issues and practices including family planning.

To improve personal hygiene, the programme will support the local production and supply of sanitary pads, education of girls on pre- and post menstruation, improve sanitary facilities through upgrading and rehabilitation, provide spaces in schools for menstruating girls to rest, enhance counselling and peer-to-peer support, and promote informal discussions among girls on issues that concern them.

“We appreciate the timely support from the Government of Canada which will allow us to address the challenges that Ethiopian adolescent girls face today,” says Gillian Mellsop, UNICEF Representative in Ethiopia. “We believe that this contribution will help adolescent girls break out of discriminatory social and gender norms that hamper their education and hinder their ability to meaningfully contribute to their nation’s development.”

UNICEF will use its strong monitoring and evaluation tools to ensure the success of this programme and invest in regular compilation of health and nutrition data to better understand trends and uptake of services by adolescent girls.

25 million child marriages prevented in last decade due to accelerated progress, according to new UNICEF estimates

 Improving trend in child marriage driven largely by significant reductions in South Asia, but problem persists with over 150 million girls likely to marry by 2030

 NEW YORK/ADDIS ABABA, 6 March 2018 – The prevalence of child marriage is decreasing globally with several countries seeing significant reductions in recent years, UNICEF said today. Overall, the proportion of women who were married as children decreased by 15 per cent in the last decade, from 1 in 4 to approximately 1 in 5.

South Asia has witnessed the largest decline in child marriage worldwide in the last 10 years, as a girl’s risk of marrying before her 18th birthday has dropped by more than a third, from nearly 50 per cent to 30 per cent, in large part due to progress in India. Increasing rates of girls’ education, proactive government investments in adolescent girls, and strong public messaging around the illegality of child marriage and the harm it causes are among the reasons for the shift.

“When a girl is forced to marry as a child, she faces immediate and lifelong consequences. Her odds of finishing school decrease while her odds of being abused by her husband and suffering complications during pregnancy increase. There are also huge societal consequences and higher risk of intergenerational cycles of poverty,” said Anju Malhotra, UNICEF’s Principal Gender Advisor. “Given the life-altering impact child marriage has on a young girl’s life, any reduction is welcome news, but we’ve got a long way to go.”

According to new data from UNICEF, the total number of girls married in childhood is now estimated at 12 million a year. The new figures point to an accumulated global reduction of 25 million fewer marriages than would have been anticipated under global levels 10 years ago. However, to end the practice by 2030 – the target set out in the Sustainable Development Goals – progress must be significantly accelerated. Without further acceleration, more than 150 million additional girls will marry before their 18th birthday by 2030.

Worldwide, an estimated 650 million women alive today were married as children. While South Asia has led the way on reducing child marriage over the last decade, the global burden of child marriage is shifting to sub-Saharan Africa, where rates of progress need to be scaled up dramatically to offset population growth. Of the most recently married child brides, close to 1 in 3 are now in sub-Saharan Africa, compared to 1 in 5 a decade ago.

New data also point to the possibility of progress on the African continent. In Ethiopia – once among the top five countries for child marriage in sub-Saharan Africa – the prevalence has dropped by a third in the last 10 years.

“Each and every child marriage prevented gives another girl the chance to fulfill her potential,” said Malhotra. “But given the world has pledged to end child marriage by 2030, we’re going to have to collectively redouble efforts to prevent millions of girls from having their childhoods stolen through this devastating practice.”

World is failing newborn babies, says UNICEF

Babies from the best places to be born up to 50 times less likely to die in the first month of life

NEW YORK, ADDIS ABABA, 20 February 2018 – Global deaths of newborn babies remain alarmingly high, particularly among the world’s poorest countries, UNICEF said today in a new report on newborn mortality. Babies born in Japan, Iceland and Singapore have the best chance at survival, while newborns in Pakistan, the Central African Republic and Afghanistan face the worst odds.

“While we have more than halved the number of deaths among children under the age of five in the last quarter century, we have not made similar progress in ending deaths among children less than one month old,” said Henrietta H. Fore, UNICEF’s Executive Director. “Given that the majority of these deaths are preventable, clearly, we are failing the world’s poorest babies.”

Globally, in low-income countries, the average newborn mortality rate is 27 deaths per 1,000 births, the report says. In high-income countries, that rate is 3 deaths per 1,000. Newborns from the riskiest places to give birth are up to 50 times more likely to die than those from the safest places.

The report also notes that 8 of the 10 most dangerous places to be born are in sub-Saharan Africa, where pregnant women are much less likely to receive assistance during delivery due to poverty, conflict and weak institutions. If every country brought its newborn mortality rate down to the high-income average by 2030, 16 million lives could be saved.

Unequal shots at life[1]

Highest newborn mortality rates Lowest newborn mortality rates
1. Pakistan: 1 in 22 1. Japan: 1 in 1,111
2. Central African Republic: 1 in 24 2. Iceland: 1 in 1,000
3. Afghanistan: 1 in 25 3. Singapore: 1 in 909
4. Somalia: 1 in 26 4. Finland: 1 in 833
5. Lesotho: 1 in 26 5. Estonia: 1 in 769
6. Guinea-Bissau: 1 in 26 5. Slovenia: 1 in 769
7. South Sudan: 1 in 26 7. Cyprus: 1 in 714
8. Côte d’Ivoire: 1 in 27 8. Belarus: 1 in 667
9. Mali: 1 in 28 8. Luxembourg: 1 in 667
10. Chad: 1 in 28 8. Norway: 1 in 667
  8. Republic of Korea: 1 in 667

More than 80 per cent of newborn deaths are due to prematurity, complications during birth or infections such as pneumonia and sepsis, the report says. These deaths can be prevented with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition. However, a shortage of well-trained health workers and midwives means that thousands don’t receive the life-saving support they need to survive. For example, while in Norway there are 218 doctors, nurses and midwives to serve 10,000 people, that ratio is 1 per 10,000 in Somalia.

This month, UNICEF is launching Every Child ALIVE, a global campaign to demand and deliver solutions on behalf of the world’s newborns. Through the campaign, UNICEF is issuing an urgent appeal to governments, health care providers, donors, the private sector, families and businesses to keep every child alive by:

  • Recruiting, training, retaining and managing sufficient numbers of doctors, nurses and midwives with expertise in maternal and newborn care;
  • Guaranteeing clean, functional health facilities equipped with water, soap and electricity, within the reach of every mother and baby;
  • Making it a priority to provide every mother and baby with the life-saving drugs and equipment needed for a healthy start in life; and
  • Empowering adolescent girls, mothers and families to demand and receive quality care.

“Every year, 2.6 million newborns around the world do not survive their first month of life. One million of them die the day they are born,” said Ms. Fore. “We know we can save the vast majority of these babies with affordable, quality health care solutions for every mother and every newborn. Just a few small steps from all of us can help ensure the first small steps of each of these young lives.”

About Ethiopia

 Ethiopia is the second largest country in Africa with a total population of 94 million, out of which 13 million are under five years of age. Despite making overall progress in child survival, deaths among newborn babies still remain high. At 29 deaths per 1,000 live births, newborn mortality accounts for 44 per cent of all under five deaths. The new UNICEF report indicates that in 2016 alone, 90,000 newborn babies died in Ethiopia, ranking the country among 10 high burden countries globally.

Recognizing the need to accelerate newborn survival, the Government has put newborn survival at the centre of the Health Sector Development Plan. It has developed the Newborn and Child Survival Strategy (2015-2020) to strengthen the capacity of the health system and the skills of health workers to deliver quality health care to every mother and newborn baby. This includes the provision of quality antenatal care, skilled delivery, essential newborn care, postnatal care and neonatal intensive care for sick neonates.

UNICEF’s support to the newborn care programme includes;

  • Antenatal care, delivery, postnatal care, child care;
  • Health posts, health centres, and tertiary level hospitals; and
  • Integrated management of neonatal and childhood illnesses, immunization, community-based neonatal care, newborn care corners, and neonatal intensive care units.

UNICEF will continue to support the Ministry of Health to expand the availability of essential newborn care in the 800 health centers across the country, establish Newborn Intensive Care Units (NICUs) in hospitals, and strengthen the link between community-based and facility-based maternal, newborn, and child health programmes.

 

UNICEF and UNFPA to speed up their efforts to end the violent practice of Female Genital Mutilation/Cutting (FGM/C)

Addis Ababa, 06 February 2018 As the world observes International Day of Zero Tolerance on Female Genital Mutilation/Cutting (FGM/C), UNICEF and UNFPA in Ethiopia commit to accelerate their joint efforts to end the violent practice of FGM/C.

Given the rising number of girls at risk, the two agencies believe that with increased investment and redoubled political commitment, with greater community engagement and more empowered women and girls, it is a race that can be won.

The Sustainable Development Goals recognize that female genital mutilation undermines progress towards a more equal, just, and prosperous world. They set an ambitious target of eliminating all such harmful practices against girls and women by 2030.  UNICEF and UNFPA globally devoted the theme of the year 2018 – “Ending Female Genital Mutilation is a political decision” – to engaging government bodies and policy makers to join efforts.

In Ethiopia, the Government expressed its commitment to ending FGM/C and child marriage by the year 2025 at the London Girls’ Summit in 2014 and committed itself to reducing the practice to 0.5 per cent by 2020 in the Growth and Transformation Plan. The Government has also taken key programmatic actions which include  endorsement of the National Strategy and Action Plan on Harmful Traditional Practices against Women and Children as well as establishment of the National Alliance to End Child Marriage and FGM/C. 

“To accelerate the elimination of the practice , we need to work at grassroots level, at scale and hand-in-hand with communities – boys and girls, women and men, and most importantly, traditional and religious leaders –  to reach the hearts and minds of millions of people,” said UNICEF Representative in Ethiopia Gillian Mellsop. “We also believe that it is important to address the health and psychological complications caused by FGM/C by providing the necessary health services to help survivors lead a healthy life,” she said.

“We have seen that rates of female genital mutilation can drop rapidly in places where the issue is taken on wholeheartedly by governments, by communities, by families. Where social norms are confronted, village by village. Where medical professionals come together to oppose the practice, where laws are enacted to make it a crime and where those laws are enforced. Where wider access to health, education and legal services ensure sustainable change. Where girls and women are protected and empowered to make their voices heard,” said Ms. Bettina Maas, UNFPA representative to Ethiopia.

The 2016 Ethiopia Demographic and Health Survey shows a declining  trend in FGM/C from 74 per cent in 2005 to 65 per cent in 2015  in the age group 15-49 years, and from 62.1 per cent to 47 per cent  in the 15-19 year old age group. The survey also shows a more significant decrease in the younger age cohort compared to the older: prevalence is 75 per cent in the age group 35-49 years, 59 per cent in the 20-24 year age group, and 47 per cent in the age group 15-19 years. FGM/C prevention and care Afar

UNICEF and UNFPA have been working  together for many years in Ethiopia on programmes to end FGM/C. One such programme is in the Afar Region which has recently been expanded to the SNNP region. The programme has a social mobilization component which aims to increase community knowledge and change attitudes towards the practice through religious and clan leaders as well as youth and adolescent girls who convene community dialogues. Tailored messages through radio and television also reach a wider audience.

UNICEF and UNFPA also work together to improve enforcement of the law through increasing legal literacy, strengthening special units in the law enforcement bodies, and supporting community level surveillance in tracking cases of FGM/C for better reporting and management of cases. The programme has facilitated the declaration of abandonment of the practice in 6 districts in Afar Region. 

Globally, the prevalence of FGM/C has declined by nearly a quarter since around 2000. In countries where UNFPA and UNICEF work jointly to end female genital mutilation, girls are one third less likely to undergo this harmful practice today than they were in 1997. More than 25 million people in some 18,000 communities across 15 countries have publicly disavowed the practice since 2008.