Social norms are a sticking point

Major progress made before the COVID-19 pandemic

Ethiopia has set a bold goal of reducing ‘unintended’ adolescent pregnancy rate from 12% to 3% through 2016 to 2020. The following major strategic actions were prioritized to achieve the goal:

• strengthen programs such as safe space programs to delay sexual debut and promote abstinence among adolescents;
• enhance provision of high quality safe abortion and post-abortion care services to adolescents and youth;
• advocate for enforcement of laws and policies to prohibit marriage of girls below 18 years;
• and scale up the provision of Adolescent and Youth Friends sexual, reproductive and maternal health services in 100% of public health centers, hospitals, university clinics youth centers, and selected private health service outlets with defined minimum service packages, even though some were not fully implemented as originally planned [1].

Teenage pregnancy rates

Ethiopia has shown remarkable progress in reducing teenage pregnancy between 2017 and 2019 by achieving 17.6 percentage points reduction. The momentum of teenage pregnancy reduction continued to early years of COVID-19 (2020) as well with 28.6 percentage point’s reduction between 2019 and 2020. However, these hard gained successes of teenage pregnancy reductions seemed to have been reversed with 56.5 percentage point’s increase between 2020 and 2021 (Figure1). The progresses observed in teenage pregnancy reduction was consistently lower among adolescent girls from: pastoral regions, rural residents and those with no or lower education status [2-6].

However, these hard gained successes of teenage pregnancy reductions seemed to have been reversed with 56.5 percentage point’s increase between 2020 and 2021.

Suggested actions to achieve teenage pregnancy reduction targets and sustain gains

It seems difficult and practically challenging to achieve teenage pregnancy reduction targets and sustain gains while the median age at first marriage is lower (16 years in 2000 and 17.1 years in 2016) coupled with social pressure to proof fertility immediately following marriage [7-9]. Thus, teenage pregnancy reduction efforts should also address social norms which supports early marriage and consecutive fertility expectations [10 - Dingeta T. et al., 2021]; contextualizing interventions to specific situations of adolescent girls: educational status, areas of residence or regional contexts and contexts of sexual initiation (marital or pre-marital).

Thus, teenage pregnancy reduction efforts should also address social norms which supports early marriage and consecutive fertility expectations.

References

1. Ethiopian FMOH, NATIONAL ADOLESCENT AND YOUTH HEALTH STRATEGY (2016-2020). 2016.
2. Addis Ababa University School of Public Health; and the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Performance Monitoring and Accountability 2020 (PMA2020) Ethiopia Round 5: Household and Female Survey (Version 3.0), PMA2017/ET-R5-HQFQ. 2017. Ethiopia and Baltimore, Maryland, USA. https://doi.org/10.34976/0vv8-bc40. 2017.
3. Addis Ababa University School of Public Health; and the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Performance Monitoring and Accountability 2020 (PMA2020) Ethiopia Round 6: Household and Female Survey (Version 4.0), PMA2018/ET-R6-HQFQ. 2018. Ethiopia and Baltimore, Maryland, USA. https://doi.org/10.34976/30mn-c910. 2018.
4. Addis Ababa University School of Public Health; and the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Performance Monitoring for Action Ethiopia (PMA-ET) Panel: Cohort 1 Six-Week Follow-up Survey (Version 2.0), PMA2020/ET-C1-6wkFU. 2020. Ethiopia and Baltimore, Maryland, USA. https://www.pmadata.org/sites/default/files/2020-0... 2019.
5. Addis Ababa University School of Public Health; and the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Performance Monitoring for Action Ethiopia (PMA-ET) Panel: Cohort 1 Six-Week Follow-up Survey (Version 2.0), PMA2020/ET-C1-6wkFU. 2020. Ethiopia and Baltimore, Maryland, USA. https://doi.org/10.34976/8r5s-dx31. 2020.
6. Addis Ababa University School of Public Health; and the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Performance Monitoring for Action Ethiopia (PMA-ET) Panel: Cohort 1 Six-month Follow-up Survey (Version 2.0), PMA2021/ET-C1-6moFU. 2021. Ethiopia and Baltimore, Maryland, USA. https://doi.org/10.34976/gvxv-8982. 2021.
7. Central Statistical Authority [Ethiopia] and ORC Macro, Ethiopia Demographic and Health Survey 2000. Addis Ababa, Ethiopia and Calverton, Maryland, USA. . 2001.
8. ICF, C.S.A.C.E.a., Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF. 2016.
9. USAID, DHS STAT compiler. https://www.statcompiler.com/en/.
10. Dingeta T, O.L., Worku A, Berhane Y., Low contraceptive utilization among youngmarried women is associated with perceived socialnorms and belief in contraceptive myths in rural Ethiopia. PLoS ONE, 2021. 16(2). https://journals.plos.org/plosone/article?id=10.13...