Providing gynaecological services to Ethiopian women scarred by FGM/C

By Endale Engida

AYSSAITA, AFAR REGION, 24 November 2016 – Asiya’s marriage was meant to be a joyful occasion, but on her wedding night, this 18-year-old found only pain.

Like nearly all young girls in Ethiopia’s Afar Region, she had undergone Female Genital Mutilation/Cutting (FGM/C) at a very young age and trying to consummate the marriage with her husband brought only pain and bleeding.

In the Afar region, a particularly severe form of FGM/C known as Type III or infibulation is practiced whereby the vaginal opening is partially sewn shut, condemning generations of women to pain.

Asiya’s husband, Burhan Helen, was determined to help his wife and he asked around and discovered that the hospital in their woreda (district) had recently set up a gynaecological unit specialized in opening up women who had been subjected to infibulation.

Female Genital Mutilation in Afar
“FGM should stop, I have seen the problem myself, I always struggle when I am on my period, my period doesn’t flow normally so it was very painful. I won’t cut my future daughter. I am very happy to have gone through surgery and I am thankful for the organization working on this.” – Asiya Ali, 18, undergone FGM and currently following up at Ayssaita primary hospital, Afar region, after her surgery. ©UNICEF Ethiopia/2016/Tadesse

FGM/C has long been outlawed in Ethiopia, but is still widespread in the country with an estimated 65 per cent of women between the ages of 15 and 49 (EDHS 2016) having been cut – down from 74 per cent in 2005 EDHA

However, those numbers mask regional variations. In regions like Afar and the Somali it can reach up to 90 per cent while other areas have a much lower prevalence due to different cultural norms in the diverse nation of Ethiopia.

In regions where it is practiced across eastern Africa and up into Egypt, it is believed FGM/C is necessary to ensure a woman stays a virgin before marriage, and many men say they would not marry a woman who hasn’t been cut.

In 2014, the Government of Ethiopia committed to ending the practice by 2025 and has been working on discouraging it through public information campaigns. Penalties for carrying it out range from three to ten years in prison.

For those like Asiya who have already undergone the procedure, the new gynaecological unit established in May 2016 at the Ayssaita Woreda hospital is a life saver.

Female Genital Mutilation in Afar
Dr. Hatse Abrha is a gynaecologist at Ayssaita primary hospital, Afar region. Dr. Hatse Abrha has been assisting girls and women with health complications due to FGM, a project under UNICEF Ethiopia. ©UNICEF Ethiopia/2016/Tadesse

Thanks to the funds from Foundation Espoir through the Luxembourg Committee for UNICEF, the hospital now employs Dr. Hatse Abreha, the only gynaecologist in the hospital.

The hospital, which serves a mostly pastoral population of 90,000, can now treat gynaecological and obstetric cases, including FGM/C reconstructions. By October 2016, the hospital was treating 200 FGM/C cases a month. In many cases, patients can be discharged the same day after the surgery.

Dr. Abreha diagnosed Asiya’s condition and also noted that in addition to pain during intercourse, she suffered discomfort and slow flow during menstruation. She and her husband were counselled about the procedure and then she received the deinfibulation surgery.

“I want to see these innocent girls and women no longer be victims of FGM/C, though these kind of interventions are only part of the solution and will not solve the root cause of the problem,” he said.

After a careful period of outpatient monitoring, Asiya was pronounced cured.

“We have special gratitude to Dr. Hatse Abreha for his friendly care and follow up,” she said during a follow up visit. “We are here to teach our community not to practice FGM/C on their girls and our own children will not be victims of FGM/C.”

 

Volunteers Blast Hygiene Message to Halt Acute Watery Diarrhea

By Bethlehem Kiros

ADDIS ABABA, 30 September 2016 – Mickias Fikre, a taxi driver keeps soap in his car and makes sure to wash his hands thoroughly before he eats. According to him, it is a new habit he developed after he saw his friend suffer from Acute Watery Diarrhea (AWD). “He was so sick that I thought he would not recover,” he remembers. His friend got better after few days and Mickias learned from the local health centre how to protect himself from the disease. Mickias adds, “It is really helpful that volunteers are travelling throughout our community on trucks, spreading the message on how to stay safe.”

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
ERCS volunteers in Akaki/Kaliti sub-city perform a traditional dance to draw the attention of the community and raise awareness on AWD prevention. © UNICEF Ethiopia/2016/Ayene

Ayantu Dadi, 20, is one of the volunteers who is helping communities protect themselves from AWD. A recent college graduate and an Ethiopian Red Cross Society (ERCS) volunteer of over five years, she has been spending the last three months on the UNICEF and ERCS-supported audio truck that drives around the Nefasilk Lafto sub-city.   Since July 2016, UNICEF and ERCS have been conducting mass public awareness campaigns using 10 audio trucks deployed in each of the 10 sub-cities of Addis Ababa.

Ayantu and seven other volunteers meet early in the morning at the Nefasilk Lafto ERCS branch office, then visit the sub-city health office to obtain instructions on the exact locations they need to cover for the day. These locations are selected based on reported cases of AWD, as well as observed risk factors such as poor hygiene and sanitation practices. The volunteers spend about eight hours reaching out the public with awareness-raising messages on how to prevent AWD and recognize its symptoms. “We play music for few minutes to attract people’s attention and then we broadcast the Public Service Announcements on hygiene and sanitation,” she elaborates.

They also stop at designated priority locations, such as crowded locations where they can reach a large number of people, to distribute flyers, put up posters and have one-on-one talks with people who have questions about AWD. “We especially take time to talk with street food vendors and people in economically impoverished communities where the problem seems to be most prevalent,” she explains. According to Ayantu, the outreach helps prevent new cases of AWD as well as identify existing cases. “It is quite satisfying when you find out that your actions actually impact people’s lives. It is what encourages me to keep passing this message every day,” she says.

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
Ayantu Dadi, 20, an ERCS volunteer, teaches a street vendor about AWD. “I only graduated last month so this is what I do full time.” ©UNICEF Ethiopia/2016/Ayene

Since the AWD outbreak was reported in November last year, 7,769 cases have been identified in Addis Ababa alone.

The coordinated response by the Federal Ministry of Health (FMOH) and partners including UNICEF, cases have now continued to decline however, we should not let our guard down.

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
Sintayehu Tsegaye, who had AWD and has recovered, washes the hands of her son Michael, 3, before she gives him orange. “I always keep soap next to the tap so that I wash my hands when I come from outside or from the toilet. I also try my best to drink boiled water and make the rest of my family do the same.” ©UNICEF Ethiopia/2016/Ayene

Sintayehu Tsegaye 45, is among the thousands affected by AWD and was treated for a week in the local AWD case treatment centre (CTC). A mother of two, she has a small business selling potato chips, flowers and grass that is used in Ethiopian coffee ceremonies. “It is hard to be clean all the time when you touch grass all day, use community latrines and live with a big family that does not have the same hygiene practices as you,” she explains, adding that after her recovery from AWD, she has become more careful about practicing proper hygiene measures such as handwashing with soap.

“People in the community don’t always take the information seriously unless they are personally affected by it, but with repeated teaching, I believe many will listen,” says Sintayehu. “Is especially important to spread the message in communities like mine that use shared latrines.”

In addition to public outreach, UNICEF is also supporting the Government of Ethiopia’s efforts to contain and prevent the spread of AWD  by providing supplies for case treatment centres, technical support for case management and infection prevention, and water treatment supplies to safeguard drinking water for households and communities.

Ensuring every child is accounted for and no one is left behind in Ethiopia

By Hannah Godefa

On August 6th, I was fortunate to be a part of a campaign in Ethiopia when the establishment of the Vital Events Registration Agency (VERA) kicked off throughout the country.

VERA is an incredibly important institution for individuals, societies and government. For individuals, registration can be used as legal documents and proof for identification purposes. Information complied from these areas are then needed for admin applications like public health programmes and the electoral roll.

On the first day of the campaign, I visited the Gulele Sub City, Woreda 9 VERA team. UNICEF supports the campaign to ensure all resources needed for registration like registry, certificates, awareness creation, materials and logistics make it to all regions, all the way to the lowest levels of administration.

Vital events registration kicks off in Ethiopia

This process is incredibly important because it will ensure that every child will be accounted from the earliest days of life. This means big advancements for accountability when it comes to harmful traditional practices including child marriage, as every individual will have a marriage certificate with the new system from VERA. It will also make it easier for government, non-profit and civil society partners to identify when these practices are occurring.

Birth registration is the first recognition of a child’s existence by the state. Where births remain unregistered, there is an implication that these children are not recognized as persons before the law. The absence of the system of birth registration results in the violation of children’s rights to name and nationality; to protection from abuse, neglect, and exploitation, including early marriage, child labour  and trafficking; to basic social services, including education and health; and the personal rights of orphans and other vulnerable children.

Currently, birth, death, marriage and divorce will be kept recorded from the kebele civil status office to the federal level, so that there is less room for discrepancies and human rights crime.

Participating in the registration process was an incredibly humbling and powerful experience for me, and I am very excited to see how UNICEF will work with VERA and local partners to ensure that every child is accounted for, and no one is left behind.

Early Childhood Development- Investing in the seeds of tomorrow’s fruits

Gillian Mellsop, UNICEF Representative to Ethiopia

‘Children are today’s flowers and tomorrow’s fruit’ is a saying in Ethiopia and there is no better investment that cultivates the fruit and speaks to the ‘right in principle and right in practice’ mantra more than early childhood development.

Parents and communities want the best for their children and understand that the early years of a child’s life are crucial. However, they may not have the means or the knowledge on how to ensure their next generation best thrives.

Last week, the latest offering from the world-renowned Lancet, Advancing Early Childhood Development: from Science to Scale, showed that almost one in two – 43 per cent – of children under five in low-and middle-income countries are at risk of not achieving their cognitive potential. No country can risk losing nearly half of the brain potential of its youngest citizens – low- and middle-income countries least of all.

Advances in neuroscience show that experiences in early childhood have a profound impact on brain development and on subsequent learning and health. Children who are poorly nourished and nurtured, or those who do not receive early stimulation, are likely to learn less in school and go on to earn less as adults.

In Ethiopia, over 5 million children are stunted which has a serious impact on human development and economic growth. And currently, the most disadvantaged children in rural and hard to reach communities are either coming to grade 1 without having the necessary preparation or are enrolling late – under 40 per cent of children in Ethiopia have access to pre-school provision. Once in primary education, many are at risk of dropping out of school too early.

The good news is that early childhood development interventions, including parenting and care programmes, cost as little as 50 cents (US$) per child per year, when combined with existing services such as health – according to the Lancet Series. And much of what needs to be done at the community level can be achieved by mothers and fathers, grandparents, siblings and caregivers.

The findings in the Series underscore the importance of increased global dedication to early childhood development. Earlier this year, World Bank Group President Jim Yong Kim and UNICEF Executive Director Anthony Lake signalled a renewed commitment to prioritizing investments in the youngest children when they announced a new alliance urging global and national leaders to step up and accelerate action and funding for nutrition and early childhood development (ECD) programmes. The Lancet estimates that individuals who suffer a loss of about a quarter of average adult income per year, while countries may forfeit up to as much as two times their current GDP expenditures on health or education. Consequences of inaction impact not only present but future generations.

Drought response in Afar - UK AID
Zebiba Meher feeds her son Ready to Use Therapeutic Food (RUTF) for the past four months. Now the nutritional status of eleven-month-old Bedru has improved from severe to moderate acute malnutrition. He is a much healthier and happier child now. Dubti health center, Afar region, Ethiopia. 25-August-2016 ©UNICEF Ethiopia/2016/Ayene

When children have the opportunity to develop their cognitive capacity, they will pass similar or even better opportunities to their children when they grow up.  Increasing investment in Ethiopia’s young children can break the vicious cycle of intergenerational poverty.

Therefore, prioritizing ECD at the national level is a way for governments to stimulate economic growth. Evidence suggests that every dollar invested in quality ECD programmes brings a return of between US$6 and US$17. Moreover, research by

Nobel Laureate James Heckman found that the rate of return for investments in quality early childhood development for disadvantaged children is 7-10 per cent per annum through better outcomes in education, health, sociability, economic productivity and reduced crime.

This year, the importance of interventions in early childhood was also recognized by the inclusion of an ECD target in the Sustainable Development Goals – indeed, this is the first time ECD has been explicitly included in global development goals. SDG Target 4.2 aims to increase the percentage of children under 5 years of age who are developmentally on track in health, learning and psychosocial well-being.

For many children, lack of educational support at home is one of the biggest obstacles to reaching their full potential. In light of differing needs of families, a range of early childhood education services are offered in Ethiopia, including kindergarten, pre-primary class (‘O-class’) and several school readiness programmes. Parenting education programmes are also provided so families can learn about the importance of early nutrition, hygiene, care and stimulation.

The evidence presented this past week, combined with the current momentum globally, speaks for itself. We are well versed in the elements that affect the development of children’s brains – good nourishment, stimulated minds, and protection from violence. It is now vital that we use this growing body of evidence to effect real changes for children, at both the community and policy levels.

Early child development has to be put on the agenda for children’s rights. In Ethiopia, UNICEF, with the support from partners, takes an integrated approach to addressing early childhood development within Ethiopia’s Early Childhood Care Education Policy.

We owe it to our future generations to prioritize and invest in young children. It is our moral, economic, and social imperative to enable all children to reach their full potential.

Five in six children under two not getting enough nutrition for growth and brain development – UNICEF

 NEW YORK/ ADDIS ABABA, 14 October 2016 – Five in six children under two years old are not fed enough nutritious food for their age, depriving them of the energy and nutrients they need at the most critical time in their physical and cognitive development, according to a new UNICEF report.

“Infants and young children have the greatest nutrient needs than at any other time in life. But the bodies and brains of millions of young children do not reach their full potential because they are receiving too little food, too late,” said France Begin, Senior Nutrition Adviser at UNICEF. “Poor nutrition at such a young age causes irreversible mental and physical damage.”

UNICEF data show that poor nutritional practices– including the delayed introduction of solid foods, infrequent meals and lack of food variety – are widespread, depriving children of essential nutrients when their growing brains, bones and bodies need them the most. The findings reveal that: 

  • Young children wait too long for their first bites. One in five babies hasn’t been fed any solid foods by the age of 11 months.
  • Half of children aged six months to two years are not fed the minimum number of meals for their age, increasing their risk of stunting.
  • Less than one-third of children in this age group eat a diverse diet – meaning from four or more food groups daily – causing deficiencies in vitamins and minerals.
  • Almost half of pre-school aged children suffer from anaemia.
  • Only half of children aged six to 11 months receive any foods from animal sources – including fish, meat, eggs and dairy – which are essential to supply zinc and iron.
  • The high cost of foods from animal sources makes it difficult for the poorest families to improve their children’s diet. In Sub-Saharan Africa and South Asia, only one in six children from the poorest households aged six to 11 months eats a minimally diverse diet, compared to one in three from the richest households.
  • Improving nutrition for young children could save 100,000 lives a year.

Making nutritious foods affordable and accessible to the poorest children will require stronger and more targeted investments from governments and the private sector. Cash or in-kind transfers to vulnerable families; crop diversification programmes; and fortification of staple foods are key to improving nutrition for young children. Community-based health services that help caregivers learn better feeding practices, and safe water and sanitation – absolutely critical in preventing diarrhoea among children – are also vital.

“We cannot afford to fail in our fight to improve nutrition for young children. Their ability to grow, learn and contribute to their country’s future depends on it,” Begin said. 

Ethiopia has experienced rapid, sustained improvement in under-nutrition during the past 15 years. For example, the country has seen a steady reduction in stunting – the fastest rate of improvement in Africa – and a decline in the percentage of underweight and wasted children. Yet, Ethiopia remains in a precarious situation, with large absolute numbers of affected children: 5.3 million children are stunted and 1.2 million children suffer wasting. UNICEF’s nutrition programme collaborates with the Government of Ethiopia to reduce these numbers further, working on multi-sectoral coordination to improve the nutrition of all children, pregnant and lactating women and their families

The Government of Ethiopia recognizes that addressing malnutrition is essential to achieving sustainable development. It therefore has issued the Seqota Declaration to end child malnutrition by 2030. The Declaration lays out a plan to stop the cycle of under-nutrition by bringing together all sectors of the Government, paying particular attention to the importance of nutrition during pregnancy and in the first years of a child’s life. 

Over the past decade, Ethiopia has seen a steady reduction in stunting from 58 per cent in 2000 to 40 per cent 2014, in the percentage of underweight children from 41 per cent to 25 per cent, and in wasting from 12 per cent to 9 percent (Mini EDHS: 2014) 

These trends indicate an improvement in chronic malnutrition over the past 15 years. Yet, 28 per cent of child deaths in Ethiopia is associated with under-nutrition. In addition to this high contribution to the under-five mortality rate, high prevalence of various forms of malnutrition among vulnerable groups in Ethiopia has serious implications for social development and economic growth. In a study conducted in 2009, the total annual cost of under-nutrition was estimated at US$2,775,000, equivalent to 17 per cent of the country’s GDP in 2009.

UNICEF’s strategies for nutrition ensure the achievements of results in four areas: 1) upstream nutrition policy support and multi-sectoral engagement; 2) improved nutrition knowledge and caring behaviours; 3) strengthening of systems for nutrition service delivery; and 4) strengthening partner capacities to respond to nutrition in humanitarian crises.

To accelerate the reduction of chronic and acute malnutrition, UNICEF is working in partnership with sectoral government counterparts, including in health, agriculture, education, social protection, trade and industry, and women, children and youth affairs.

UNICEF also works with United Nations agencies such as the Food and Agriculture Organization (FAO), United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), World Food Programme (WFP) and World Health Organization (WHO); UNICEF National Committees; donors such as the aid agencies of Canada, Ireland, Japan, the Netherlands, Spain, the United Kingdom and the United States, as well as the European Union; civil society organizations; and local and international academic institutions.

Nearly 385 million children living in extreme poverty, says joint World Bank Group – UNICEF study

NEW YORK/ADDIS ABABA04 October 2016 – Children are more than twice as likely as adults to live in extreme poverty, according to a new analysis from the World Bank Group and UNICEF. Ending Extreme Poverty: A Focus on Children finds that in 2013 19.5 per cent of children in developing countries were living in households that survived on an average of US$1.90 a day or less per person, compared to just 9.2 per cent of adults.  Globally, almost 385 million children were living in extreme poverty.

Children are disproportionately affected, as they make up around a third of the population studied, but half of the extreme poor. The youngest children are the most at risk – with more than one-fifth of children under the age of five in the developing world living in extremely poor households.

“Children are not only more likely to be living in extreme poverty; the effects of poverty are most damaging to children.  They are the worst off of the worst off – and the youngest children are the worst off of all, because the deprivations they suffer affect the development of their bodies and their minds,” said UNICEF Executive Director Anthony Lake. “It is shocking that half of all children in sub-Saharan Africa and one in five children in developing countries are growing up in extreme poverty.  This not only limits their futures, it drags down their societies.”

The new analysis comes on the heels of the release of the World Bank Group’s new flagship study, Poverty and Shared Prosperity 2016: Taking on Inequality, which found that some 767 million people globally were living on less than $1.90 per day in 2013, half of them under the age of 18. 

“The sheer number of children in extreme poverty points to a real need to invest specifically in the early years—in services such as pre-natal care for pregnant mothers, early childhood development programs, quality schooling, clean water, good sanitation, and universal health care,” said Ana Revenga, Senior Director, Poverty and Equity at the World Bank Group. “Improving these services, and ensuring that today’s children can access quality job opportunities when the time comes, is the only way to break the cycle of intergenerational poverty that is so widespread today.”

The global estimate of extreme child poverty is based on data from 89 countries, representing 83 per cent of the developing world’s population.

Sub-Saharan Africa has both the highest rates of children living in extreme poverty at just under 50 per cent, and the largest share of the world’s extremely poor children, at just over 50 per cent.  South Asia has the second highest share at nearly 36 per cent—with over 30 per cent of extremely poor children living in India alone. More than four out of five children in extreme poverty live in rural areas.   

In addition, the report reveals that even at higher thresholds, poverty also affects children disproportionately.  About 45 per cent of children are living in households subsisting on less than $3.10 a day per person, compared with nearly 27 per cent of adults.

UNICEF and the World Bank Group are calling on governments to:

  • Routinely measure child poverty at the national and subnational level and focus on children in national poverty reduction plans as part of efforts to end extreme poverty by 2030.
  • Strengthen child-sensitive social protection systems, including cash transfer programs that directly help poor families to pay for food, health care, education and other services that protect children from the impact of poverty and improve their chances of breaking the cycle in their own lives.  
  • Prioritize investments in education, health, clean water, sanitation and infrastructure that benefit the poorest children, as well as those that help prevent people from falling back into poverty after setbacks like droughts, disease or economic instability.   
  • Shape policy decisions so that economic growth benefits the poorest children. 
  • UNICEF and the World Bank Group are working with partners to interrupt cycles of poverty and to promote early childhood development – with programs ranging from cash transfers, to nutrition, healthcare and education.

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 Ethiopia specific information:

  • There are 13 million Ethiopian children who live in poor households, 2 million of whom live in extreme poverty.
  • Children are more severely affected by poverty (32.4 per cent) and extreme poverty (5.2 per cent) than adults (29.6 per cent and 4.5 per cent, respectively).
  • The poorest children are found in households whose head is employed in the informal sector. 13.1 per cent of these children live in extreme poverty.

UNICEF and WFP Regional Directors visit El Niño driven drought response in Ethiopia

Afar Region – Ethiopia Ms Leila Pakkala and Ms Valerie Guarnieri, UNICEF and WFP Regional Directors for Eastern and Central Africa, have visited the ongoing government-led drought response where UNICEF-WFP are closely collaborating. The drought is affecting six regions in Ethiopia, and 9.7 million people are in need of urgent food relief assistance including approximately 5.7 million children who are at risk from hunger, disease and lack of water as a result of the current El Niño driven drought.

In Afar Region, where an estimated 1.7 million people are affected by the drought, including 234,000 under-five children, the Regional Directors visited UNICEF/WFP/Government of Ethiopia supported programmes. These included the targeted supplementary feeding programme (TSFP) and an outreach site where one of Afar’s 20 Mobile Health and Nutrition Teams (MHNTs) provides preventive and curative health, nutrition and WASH services to a hard-to-reach community in Lubakda kebele.

Ms Leila Pakkala and Ms Valerie Guarnieri, UNICEF and WFP Regional Directors for Eastern and Central Africa in Ethiopia visit

The Mobile Health and Nutrition Team provides Outpatient Therapeutic Programme (OTP) and targeted supplementary feeding programme (TSFP) services to remote communities. The TSFP is integrated with MHNT services that address under five children and pregnant and lactating women with moderate acute malnutrition, and link them to TSFP when they are discharged from OTP. This solves the challenge in addressing the SAM–MAM continuum of care and preventing moderate acute malnourished children deteriorating into severe acute malnutrition.

The Directors also visited a multi-village water scheme for Afar pastoralist communities in Musle Kebele, Kore Woreda (district) which suffers from chronic water insecurity.

“Valerie and I are hugely impressed by the work of the WFP and UNICEF teams in Afar,” said UNICEF’s Pakkala.  “The quality of the work being done in such difficult circumstances – from the mobile health and nutrition teams, to WASH, protection, education and advocacy – is remarkable. We were also immensely impressed with the national level partnership between UNICEF and WFP, and our credibility with government and donors. The relationship and collaboration is a model for other countries to learn from and emulate.”

“Ethiopia is showing us that drought does not have to equal disaster,” said Valerie Guarnieri of WFP.  “We can clearly see the evidence here that a robust, government-led humanitarian response – supported by the international community – can and does save lives in a time of crisis.”

UNICEF and WFP continue to support the Government in responding to the current drought with a focus on the most vulnerable and hard to reach communities by using proven context specific solutions and approaches.