Saving a child too thin to be vaccinated

By Bethlehem Kiros

Fatima Yesuf, 25, brings her 8 months old daughter to the Metiya health center for checkup and to receive the Plumpynuts food supplementsAMHARA REGION, Ethiopia, February 2016 – Moyanesh Almerew, a Health Extension Worker in Arara Kidanemeheret Kebele (sub-district) in Amhara Region can testify to how bad the current drought in Ethiopia is for children. She is one of thousands employed as part of the nationwide Health Extension Programme, a community-based programme bringing basic health services to the doorstep of Ethiopia’s large, rural population. According to Moyanesh, they have had seen many more cases of severe acute malnutrition among children this year as compared to previous years and the cases they are receiving are worse. Among them, six-month-old, Fikir, whom Moyanesh saw during a home visit, stands out.

“You would not believe how thin she was when we first found her,” recounts Moyanesh, “She had never been vaccinated so when we tried to give her the vaccines, it was not possible because she was only skin and bones,” explains Moyanesh. When she was first brought to the Arara Kidanemeheret Health Post, the child weighed just 4.5 kg and the measurement of her mid-upper arm circumference – the criteria for identifying severe malnutrition – was 10.5 cm. She was severely acutely malnourished.

Thankfully, after receiving treatment, Fikir has gained 2kg after treatment, which included medicine and therapeutic food for several weeks, and her mid-upper arm circumference grew to 11.8 cm, which puts her in the moderately acutely malnourished range. She continues to receive outpatient treatment at the health post.

Moderately acutely malnourished children are enrolled in the World Food Programme-supported Targeted Supplementary Feeding programme through which they receive fortified blended food and vegetable oil for six months to aid their nutritional recovery. Both this and the UNICEF-supported treatment for severe acute malnutrition are routine responses which are all the more critical in a crisis.

Weynitu Demissie, 34, has a 7 months old daughter who is recovering from acute malnutrition
Weynitu Demissie (far left) walks a long distance to get to Arara Kidanemeheret Health Post where she receives therapeutic food for her seven-month-old malnourished daughter, Mastewal. ©UNICEF Ethiopia/2016/Nahom Tesfaye

Seven-month-old Mastewal is another child who has been treated at the Arara Kidanemeheret Health Post. Her mother, Weynitu, says that the drought has taken quite a toll on her family, especially on Mastewal. The child was extremely emaciated before receiving treatment for severe acute malnutrition. Weynitu walks for more than two hours over steep hilly ground to get to the health post for Mastewal’s treatment but she says it is worth all the hardship since her daughter has shown a lot of progress in the last few of months.

To Moyanesh, it is a relief to see the wonders that therapeutic food treatment does for the children. “I doubt that some of these children would have survived if they didn’t receive this treatment,” she says.

Across the country, 458,000 children are expected to need treatment for severe acute malnutrition in 2016. More broadly, 10.2 million people, 6 million of them children, are in need of emergency food assistance due to the drought. UNICEF, the Nutrition sector lead agency, continues to coordinate the nutrition emergency response. With the support of donors, UNICEF provides supplies for the management of severe acute malnutrition and supports the treatment of malnourished children through the community-based management of acute malnutrition, along with training, quality assurance and monitoring of the nutrition emergency response. UNICEF is also supporting efforts to provide drought-affected communities with access to clean water and health services to address major causes of child illnesses and deaths that have been exacerbated by the drought.

To continue nutrition emergency response activities over the coming months, additional funds of US$5 million are needed, subject to needs-based revisions. A further US$ 42 million is needed over the next four years to strengthen nutrition services and build resilience to future shocks among communities that are worst-affected by the drought.

Priests in Amhara advocate to End Child Marriage

Yazew Tagela and Degu Eneyew are both Priests of the Ethiopian Orthodox Church and members of the UNICEF supported Community Conversation Group against Child Marriage in the Bandani Kebele (neighbourhood) of the Dangla Woreda (district) in Amhara, Ethiopia.

Both are vehemently against child marriage, but come from different perspectives:

Yazew Tagela, 41, has directly experienced financial loss as a result of marrying his daughters as children.

Preist Yazew Tagel, member of the conversation group, regrets marrying his two young daughters at a very early age, having learned of the negative consequences of child marriage after the community advocates group was formed. Dangla Woreda, Badani Kebel
Priest Yazew Tagela, 41, has directly experienced financial loss as a result of marrying his daughters as children. He is a member of Bandani Kebele’s Community Conversation Group against Child Marriage, Amhara, Ethiopia ©UNICEF Ethiopia/2016/Mersha

Yazew Tagela comments: “If I had known before what I know now, I could have helped save so many girls. I married both my daughters at age 12 and 16, and I really regret it. I spent 20,000 ETB (around $1,000) on the marriages of my two girls. I could have bought urban land with that, which would now be worth up to 200,000 ETB ($10,000). The girls lead a rural life like me, and do not enjoy life like their peers who were educated.

“Three years later, neither are yet pregnant, but I really worry about that. With the poor living conditions they have, if they give birth life will get more complicated. If I had not married them, they could have contributed a lot to their country through their being educated.

“My own wife was 15 when we married – I was 25. She showed such childish behaviour but I supported her and she became pregnant straight away.”

“As a priest I am responsible for these marriages as I have to marry a virgin girl, so there is so much pressure on the girls being of younger ages. But I am no longer prepared to bless a marriage if a girl is below the age of 18.

“The government has committed to stop child marriage by 2025, but I know we can stop it way before then. This Kebele is a role model for what can be achieved, a learning site. Everyone here shares ideas and supports each other against child marriage.”

Degu Eneyew, 50, has seen first-hand how girls thrive when they are educated.

Preist Degu Eniyew, 50 lives at Dangla Woreda, Badani Kebele, Awi Zone, Amhara Region. He says he values the education of girls after seeing how they can economically improve their own lifestyle as well as their family's, after finishing school.
Priest Degu Eneyew, 50, has seen first-hand how girls thrive when they are educated. He is a member of Bandani Kebele’s Community Conversation Group against Child Marriage, Amhara, Ethiopia. ©UNICEF Ethiopia/2016/Mersha

Degu Eneyew comments: “At the age of 38 in 2003 I went back to school. It was then that I saw the impact education has on the girl – how well she can do in life. But the community sees education negatively as they associate it with a girl’s exposure to risk. We are teaching the community that if a girl is educated she will support the family. Every Sunday I include in my regular preaching to say “no to child marriage” and send girls to school instead.

“Look at the difference between two families – one which is fast to marry its girls too young, one which does not. You can see life’s consequences from child marriage – giving birth early, scarce resources, limited land. You marry a girl before 18 and it is like killing the very life of the girl. Where families are strong enough to send their girls to school the girls have jobs. Her life will be completely different.

“In the past, a priest would bless the marriage of a child. But today, if the girl is under 18 the priest will not be told. The family will conduct a customary marriage instead with any elder, but witnesses to such marriages are criminally liable.

“Hereafter if a marriage involves parties who are under 18 I will denounce it and report it to the police. If the couple are 18 or above I will bless the marriage. I want everyone to condemn the practise as an evil act.”

“I could help my family be free from poverty if I was educated. Not if I am married.” Lakech, 13

By Elizabeth Willmott-Harrop

Lakech, 13 8th grade, wants to be a doctor when she grows up. Out of sheer poverty, her parents arranged her a marriage with a relatively wealthy family. Having heard of this arrangement, the community conversation groups approached her parents and
Lakech, 13, had her marriage cancelled as a result of reporting her parents to the Community Conversation Group in Bandani Kebele (neighbourhood), Amhara, Ethiopia. ©UNICEF Ethiopia/2015/Mersha

Lakech*, aged 13, is from a poor family in the Bandani Kebele (neighbourhood) of the Dangla Woreda (district) in Amhara, Ethiopia. Her father, 55, is frail from ill health and her mother, 45, supports the family on her own.

Although Lakech’s older sisters have been educated, times are now hard. Lakech’s mother had arranged for her to be married, to both benefit from a dowry and to avoid the additional costs of Lakech’s presence in the household.

“We sometimes do not have enough to eat. We do not even have clothing”, explains Lakech’s mother, “I was given this dress by Hebeste the Health Extension Worker. My girls are always asking me: Why do we not have clothing? Why do we not have soap? Life is hard.”

Lakech found out about the planned marriage from school friends. She explains the impact when she found out: “I was determined not to be married. I wanted to run away, to an urban area where I would look after myself. I planned to work as a housemaid and continue my schooling. I could help my family be free from poverty if I was educated. Not if I am married.”

Lakech reported the planned marriage to Girma Demlash, the facilitator of the Community Conversation Group which campaigns against child marriage.

“I felt distrust for my parents during that time. At first my parents were angry when I reported them, as they said they had no capacity to send me to school. But we have been offered help because I reported it. So I am no longer in fear of a planned marriage,” explains Lakech.

Shashe Gebre, 45, decided to arrange marriage to her daughter Lakech 13, 8th grade, because she couldn't afford to send her to school or provide her food in the house. But after having a conversation with the community conversation groups, she decid
The Mother of Lakech, 13, agreed to cancel her daughter’s planned marriage as a result of an intervention by the Community Conversation Group in Bandani Kebele (neighbourhood), Amhara, Ethiopia. ©UNICEF Ethiopia/2015/Mersha

Lakech’s mother was relieved when the marriage was cancelled. “The Community Conversation Group told me about the legal consequences. I have been supported by the community since. My friends are very happy that Lakech will not be married,” she says.

The family has been able to access a UNICEF supported Revolving Fund to prevent child marriage. So-called because when funding is paid back by beneficiaries it is reinvested into the next family who needs it, so it circulates within the community. Families can start a business, make money and send their girls to school. Plus the fund gives support for education materials including uniform and clothing.

Meseret Debalkie, Child Protection Officer, UNICEF Ethiopia, says of the fund: “For the wealthy family you just have to change attitudes. That is relatively easy. But for the poorer families, if you do not offer any other life options, what will they do? You have to give them alternatives.”

Atalele Abera, 35, is a member of the Women’s Development Group and of the Community Conversation Group. Atalele says of Lakech’s cancelled marriage:

“The girl’s family received 1,000 ETB ($47) as a gift from the husband’s family, but we made sure they gave it back. I am following up with Lakech. I didn’t trust the parents to stick to their decision to cancel. So I visited them four times in the aftermath and continue to collect information from the neighbourhood on whether the marriage plans have really stopped.”

Lakech, 13, and her Mother.
Lakech, 13, and her Mother. Lakech’s planned marriage was cancelled as a result of an intervention by the Community Conversation Group in Bandani Kebele (neighbourhood), Amhara, Ethiopia. © UNICEF/ESARO 2015/Elizabeth Willmott-Harrop

Lakech’s mother explains that she had ambiguous feelings over educating Lakech: “I was worried that I will lose my daughters if I educate them as there are no schools nearby. My eldest daughter went to school some miles away and we have lost contact with her. So I was worried that when we face a challenge due to poverty that my other girls will do the same thing – they will leave and find a life elsewhere.

“But now we have the fund to help us. We will get 5,300 ETB ($250), I will buy sheep. It will cost me around 900 ETB ($43) to by one sheep if she is pregnant, so then I will have two. I will prepare local whisky and the leftovers from that will feed the sheep.”

*Name changed to protect identity

Elders advise against child marriage in favour of education in Amhara

Ato Zelalem Belay, 70, influential community leader at Dangla Woreda, Badani Kebele, Amhara region.
Zelalem Belay, 70, Elder, speaks in front of Bandani Kebele’s Community Conversation Group against Child Marriage, Amhara, Ethiopia. ©UNICEF Ethiopia/2015/Mersha

Zelalem Belay, 70, is a respected Community Elder and member of the Community Conversation Group against Child Marriage in the Bandani Kebele (neighbourhood) of the Dangla Woreda (district) in Amhara, Ethiopia.

He stands in front of the gathered crowd and speaks with absolute humility and sincerity as he discusses his personal regrets over marrying his daughters when they were children: “At my age I have to tell the truth. Why hide when I can stand here and tell the truth for the betterment of my community,” Zelalem says.

“At first I opposed the change in culture away from chid marriage. I was resisting what the role of the poor girls could be. What options do poor children have? I thought. But I have since become convinced child marriage is not right. I have changed my mind. By supporting poor girls with economic incentives so they can continue their education, there is a different future for them and for their families”, explains Zelalem.

“I was married at 18, to a ten year old girl, but she kept running back to her family. She wanted no physical attachment to me. So three months later I had a second marriage to a 15 year old – it was easy to arrange quickly as my father was wealthy. My first wife, her parents sent her back to school and she married again a few years later.”

Ato Zelalem Belay, 70, has 2 boys and 5 girls
Zelalem Belay, 70, Elder, a member of Bandani Kebele’s Community Conversation Group against Child Marriage, Amhara, Ethiopia. ©UNICEF Ethiopia/2015/Mersha

Zelalem continues: “So you see, in my former life, I had good assets, with family land and property, but then we did not see education as important. But now, those who are educated, they have a higher position than those with just land. A district judge, a school principle – they educate their children so that they have a position in society, they dress well.

Zelalem’s gaze is firm, his voice unwavering as he explains the impact on one of his children: “One daughter, I married her at 15, she gave birth immediately but she is now divorced. I sent her back to school. But she did not perform well. Her life was disturbed and miserable.

“So I strongly advise against child marriage. It is a bad experience for the boy and the girl. If there is a young girl and older man, she will not be responsible for the house and he will always be out spending his money on other women.”

The day before, a neighbour had come to consult Zelalem over marrying his 11 year old daughter. Zelalem explains: “I told him the law and that the marriage may not work out. That he will have lost property in agreeing to a marriage that does not last – divorce when people marry as children is common. I told him his daughter will probably run away. If she runs away to the city she could end up as a sex worker, trying to support herself. Many end up in cities working in local bars. They have nothing to fall back on.

“My life experience tells me that if you marry with an equal age and love each other – when it is a choice – and you share household responsibilities equally, then the marriage will prosper. They can run a business together, the husband can source raw materials and the wife can use them to make local beer to sell. It is a better life.

“I dream to get back to be like a child, and to live such a life.”

Health workers create awareness on the consequences of child marriage in Amhara

“I go to visit new mothers seven days after giving birth to give them iron, and it is then I will refer them to hospital if they are suffering from fistula. I referred two women recently,” explains Hebeste Admas, 26, a Health Extension Worker at a local health post in the Bandani Kebele (neighbourhood) of the Dangla Woreda (district) in Amhara, Ethiopia.

Hebeste continues, “Child marriage results in so many other health consequences including miscarriage and stunting of the child. A girl’s uterus may be damaged from intercourse and she will suffer great psychological distress. I have seen all of this.”

Yitayesh Akalu, Expert at the Dangla Women, Children and Youth Affairs Office comments: “The problem of fistula is so huge we have dedicated fistula health centres. Fistula happens mostly to child and adolescent mothers as a result of intense and prolonged labour – their bodies are simply not developed enough to give birth. We have community ambulances so that fistula cases can be treated straight away. A girl will be transported by youth groups carrying her on a bed until they get to an accessible area where the ambulance will collect her.”

Hebeste has been a Health Extension Worker since she was 17, and her role includes teaching community members about the health consequences of child marriage.

Hibist Admas, 26, has worked as a health extension worker for 9 years. She witnesses a major decline in child marriage over the past few years. She says she doesn't face any hardship regarding her fight against child marriage as she works closely with gov

“In my 9 years as a Health Extension Worker I have seen a decline in child marriage as a result of community awareness, and I do believe the practice will stop. I report cases to the police. There is no confidentiality as they are breaking the law. However people hold alternative ceremonies in secret to hide that it is a child marriage – at night or at dawn. Then the girl disappears and the family say she has gone to live with an aunt.”

Hebeste continues: “But local health workers like me know every pregnant woman and the Women’s Development Groups and Health Development Groups who look after the wellbeing of girls and prevent them marrying, operate at the village level. So we know. The development armies report to me and I report cases to the health centre and police.”

Hebeste notes the way girls who are forced to marry are not as able to protect their own health and plan their families. She explains: “There is a real difference between older and younger women who are married. Adult women come to me for family planning services without the knowledge or consent of their husband. Whereas when girls marry as children, they do not understand the consequences of sex, they are not empowered to seek advice, and so they do not come to me.

“I have had parents bring their daughter to me ahead of marriage saying they want contraceptives for her to try and avoid the complications of childbirth. The girl told me she was really scared to be marrying an adult man. I reported them.”

Determined men and women form a community to end child marriage

Community advocates of Amhara region, Awi Zone, Badani Kebele, Dangla Woreda. All working hand in hand to transform child marriage practices in Amhara.
A meeting of the Bandani Kebele Community Conversation Group which advocates against child marriage, Saguma village, Bandani Kebele, Dangla Woreda (District) ©UNICEF Ethiopia/2015/Mersha

“We are not just talking about change, we are stopping children from marrying.” A group of determined men and women from various villages in the Dangla Woreda (District) of Amhara, Ethiopia, sit under a tree among a verdant landscape of hills and pasture. Cattle, donkeys, goats, and the steep banks of a river in view. There is a food surplus in this area, the harvest having been plentiful. The talk is lively and incessant as the group discuss their antipathy towards child marriage and their unified commitment to see the practise eliminated in the Kebele (neighbourhood) of Bandani. Known as the Community Conversation Group (CCG), the 35 men and 35 women come from many of the 550 households in Bandani. All are considered influential community members, be that as elders, health workers, religious leaders or members of the Women’s Development Group.

Atalil Abera, 35, chair of women's development group . She works closely with community conversation groups to prevent child marriage.
Atalele Abera, 35, a member of the local Women’s Development Group and of Bandani Kebele’s Community Conversation Group against Child Marriage, Amhara, Ethiopia. ©UNICEF Ethiopia/2015/Mersha

Atalele Abera, 35, a member of the Women’s Development Group, comments: “Our group influences other women and most women want to engage in discussions on child marriage. There were 130 child marriages in this Kebele last year. School is far away and parents fear violence against their children and defilement if they send them on the long journey to school. Many cannot afford to educate their children. I have three children and limited the size of my family by using contraception, so I could ensure they would all be educated.”
Almost every member of the CCG was themselves married either as a child or to a child. They have also faced the decision whether or not to marry their own pre-pubescent daughters and sons. Those who did, now openly regret it, because of the resulting family poverty and the compromised life particularly their daughters now live.

The CCG has “Eyes” and “Ears” members who are tasked with reporting what they see and hear regarding child marriage, prior to a fortnightly meeting, hosted by the Community Conversation Facilitator, Girma Demlash, 30.

The CCG is part of a comprehensive programme against child marriage involving multiple stakeholders. The programme is run by the local government, the Dangla Women, Children and Youth Affairs Office (WCYAO), supported by UNICEF.

Yitayesh Akalu, Expert at the Dangla WCYAO comments: “We have undertaken several trainings with community members on how to implement the UNICEF social mobilisation project against child marriage. That includes how to establish a change group known as a Community Conversation Group. We have trained 10 male and 10 female Community Conversation Facilitators so far. This is the first time we have conducted a comprehensive programme in Dangela Woreda. It is a multi-sectoral programme involving health, education, justice, the community and livelihoods, in the form of a fund to support parents to educate their girls instead of marry them.”

Girma Demlash, Community Conversation Facilitator, comments: “We are very grateful to UNICEF for helping us facilitate the community conversations. Everyone who takes part is committed to ending chid marriage. We have just prevented two marriages – those of a 10 year old and a 13 year old girl – from going forward as a result of the girls reporting to us that their parents were in the process of arranging their marriages. We are not just talking about change, we are stopping children from marrying.”

Gonder and Samara to spearhead Girls’ Empowerment Races

Addis Ababa, Gonder, 17 September 2015 – UNICEF Ethiopia, in partnership with the Amhara Bureau of Women Children and Youth Affairs (BoWCYA), the Gonder City Administration Culture, Tourism and Sport Department and the Great Ethiopian Run, are organising a mass participation 5 km race in Gonder on Sunday 20 September 2015, and in Samara on 4 October 2015, to promote Girls’ Empowerment.

A total of 5,000 adults and 1,250 children are expected to participate in the running events, while over 10,000 thousand spectators are expected to attend the event and the messaging. Besides, two community outreach programmes are planned in both locations and expect to reach thousands. In addition, a photo and art exhibition and media roundtable discussion will take place on the eve of the race.

The twoPoster- Great Ethiopian Run in Gondar races will focus on themes relevant to each region. In Gonder, the focus will be on “Ending Child Marriage” while in Samara, the emphasis will be on “Ending Female Genital Mutilation/ Cutting (FGM/C).”

In Ethiopia, one in every five girls is married before the age of 18 and this practice is prevalent across all the regions. In Amhara nearly half of the girls are married before the age of 18 (44.8 per cent, EGLDAM, 2008). Nearly 60 per cent of cases of Female Genital Mutilation/Cutting is practiced in the Afar Region.

“UNICEF strongly believes that by 2025, Ethiopia will no longer have cases of child marriage, but this will only happen if we all work together – the government, civil society, religious and community leaders, women, men, boys and the girls themselves,” said Gillian Mellsop, UNICEF Representative to Ethiopia.

The event will be attended by high-level government dignitaries, representatives from the UN, NGOs, CSOs and members of the media. In addition, Abelone Melesse, UNICEF National Ambassador to Ethiopia, and renowned artists and sport personalities including Haregwoine Assefa and athlete Gebeyaneshe Ayele respectively (winner of the 15 km Dasani Road Race in Addis Ababa in June and winner of Millennium half marathon in Accra Ghana two weeks ago) will be attending the activities in Gonder to support the messaging around Girls’ Empowerment.