Ayrh Strategy

Youth Conversation on HIV prevention and care over coffee ceremony
Ministry of Health
P.O. Box 1234
Tel. 251-11-5517011

Federal Democratic Republic of Ethiopia

MINISTRY OF HEALTH
NATIONAL
ADOLESCENT AND YOUTH
REPRODUCTIVE HEALTH STRATEGY
2007 - 2015
iii
TABLE OF CONTENTS
Acknowledgements…….......................................................................................................v
Preface................................................................................................................................. vi
Acronyms List................................................................................................................... viii
Executive Summary..............................................................................................................x
Introduction...........................................................................................................................1
Guiding Principles................................................................................................................3
Section I: Context of Youth Reproductive Health............................................................5
Population Dynamics................................................................................................5
Poverty......................................................................................................................5
Education..................................................................................................................6
Status of Adolescent Girls and Young Women.........................................................6
Section II: Adolescent and Youth Reproductive Health in Ethiopia..............................9
Early Sexual Debut...................................................................................................9
Age at First Marriage..............................................................................................10
Early Child Bearing................................................................................................10
Unwanted Pregnancy..............................................................................................11
Abortion..................................................................................................................12
Knowledge and Use of Family Planning Methods.................................................12
HIV/AIDS and STIs................................................................................................13
Section III: Existing Programs and Services..................................................................15
Services...................................................................................................................15
Family Life and Sexuality Education.....................................................................16
Section IV: Strategies for the Reproductive Health of Young People..........................17
Vision......................................................................................................................17
Goals.......................................................................................................................17
Section V: Monitoring and Evaluation............................................................................29
Section VI: The Way Forward.........................................................................................30
Section VII: Annexes.........................................................................................................32
Annex A: Summary of Key Strategies for Different .
Segments of Adolescents
Annex B: List of Illustrative AYRH Indicators
Annex C: Definition of Terms
Annex D: National Adolescent and Youth Reproductive .
Health Strategy Development Committee
Annex E: Bibliography
v
Acknowledgements
The development of the National Adolescent and Youth Reproductive Health Strategy is the
product of many consultative meetings organized and led by the Ministry of Health representing
a wide cross-section of partners and stakeholders, including Ethiopian parliamentarians.
The priority issues are grounded in national and regional demographic data, health systems
information, and qualitative and quantitative research findings. The development of the National
AYRH Strategy is based on program and research evidence from Ethiopia and international
sources.
The Ministry of Health is grateful and acknowledges the support of all those who participated
in these consultations. As youth reproductive health issues are cross-cutting, it is the Ministry’s
wish that close collaboration across line ministries, technical organizations, youth-serving
organizations, UN Agencies, donors and other partners will continue to collaborate in support
this strategy and its operationalization.
The Ministry of Health would like to acknowledge the extensive long-term technical and
financial support of YouthNet/Family Health International, a global USAID-funded program
devoted to improving reproductive health among youth. In addition, very high recognition and
many thanks goes to UNFPA, UNICEF, the David and Lucile Packard Foundation, Population
Council, Pathfinder International, European Commission and all institutions and individuals
who collaborated and contributed to the development of the National Adolescent and Youth
Reproductive Health Strategy. Special thanks go to the members of the Adolescent and Youth
Reproductive Health Development Committee and the peer review group, established to assist
in the development of the National AYRH Strategy.
Lastly, the Ministry of Health would like to recognize all the program managers and technical
assistants in the Family Health Department, who have spent countless hours in developing and
producing this innovative document.
Dr. Tesfanesh Belay CNM, MD, MPH

Head, Family Health Department
Ministry of Health
vi NATIONAL ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH STRATEGY
Preface
The Government of Ethiopia is committed to improving the reproductive health status of young
Ethiopians, 10-24 years old. This adolescent and youth reproductive health strategy reaffirms
that commitment by setting forth its priorities and agenda for the next decade. This strategy
advances the goal of Ethiopia to provide health services to all Ethiopians and to achieve the
objectives of the National Reproductive Health Policy and the Health Sector Development
Plan. The Government also seeks to enhance the effectiveness of the health system in meeting
the PASDEP and the Millennium Development Goals.
The vision of the National AYRH Strategy is:
To enhance reproductive health and well-being among young people in Ethiopia ages
10-24 so that they may be productive and empowered to access and utilize fully quality
reproductive health information and services, to make voluntary informed choices over
their RH lives, and to participate fully in the development of the country.
The National Adolescent and Youth Reproductive Health Strategy builds on notable
initiatives undertaken to serve the health needs of all young Ethiopians. Among these are:.
• The Youth Policy, issued in 2004, calls for major interventions to enhance youth
participation in the development of the country.
• The Policy on HIV/AIDS, launched in 1998, recognizes the increased vulnerability of
young people.
• The Revised Family Laws, amended in 2000, protect young women’s rights such as
against forced marriages.
• The Revised Penal code penalizes sexual violence and many of the traditional harmful
practices.
Youth friendly services and the successful RH strategies can only become realities if there is a
commitment from all partners to develop an action plan that is implemented in an accelerated,
flexible, and participatory manner. Strengthening youth RH is cross cutting and thus requires
a multi-sectoral commitment across line ministries and major stakeholders. The Government’s
vision is to provide youth reproductive health services through the Health Extension Package
at the community level and through other health interventions.
The AYRH development process is the result of many multi-sectoral consultative meetings,
under the leadership of MOH, and line ministries, NGOs, UN Agencies, donors, technical
organizations, and research institutions. The National AYRH Strategy outlines the major
youth RH issues in Ethiopia and charts a way forward.
vii
At this time, it is essential to emphasize that the National AYRH Strategy will require a thorough
and detailed implementation plan with concrete activities. Such a plan needs to be developed at
federal and regional levels to reflect regional priorities and context. The complementary role of
NGOs, partners, and other stakeholders in support of this effort is needed not only at the time
of the implementation plan design, but also in the actual execution of activities.
Finally, on behalf of the Federal Ministry of Health I would like to take this opportunity to
express my gratitude to all partners for their continued support in this endeavor. I also appeal to
all of our partners in health and development to contribute for the successful implementations
of this strategy and use this National Adolescent and Youth Reproductive Health Strategy as a
guiding tool in your future activities.
Tedros Adhanom Ghebreyesus (PhD)

Minister of Health
viii NATIONAL ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH STRATEGY
Acronyms List
ANC Antenatal Care

AYRH Adolescent and Youth Reproductive Health
AIDS Acquired Immunodeficiency Syndrome
BCC Behavior Change Communication .
CBO Community-Based Organization
CBRHA Community-Based Reproductive Health Agents
CHP Community Health Program
CEDAW Convention for Elimination of Discrimination Against Women
CRC Convention on the Rights of the Child
CSA Central Statistics Authority
CSW Commercial Sex Worker
DSW German Foundation for World Population
EDHS Ethiopia Demographic and Health Survey
EOS Enhanced Outreach Services
EmOC Emergency Obstetric Care
EPHA Ethiopian Public Health Association
ESDP Essential Services Delivery Program
ESOG Ethiopian Society of Obstetricians and Gynecologists
FGAE Family Guidance Association of Ethiopia
FGC Female Genital Cutting
FGM Female Genital Mutilation
FHD Family Health Department
FHI Family Health International
FLE Family Life Education
FMOH Federal Ministry of Health
FP Family Planning
FWCW Fourth World Conference on Women
HAPCO HIV/AIDS Prevention and Control Office
HEP Health Extension program
HEW Health Extension Worker
HIV Human Immunodeficiency Virus
HMIS Management Information Systems
HSDPIII Health Sector Development Plan III
HTP Harmful Traditional Practices
ICPD International Conference on Population and Development
IEC Information, Education and Communication
ISAPSO Integrated Services for Aids Prevention Services Organization.
MCH Maternal and Child Health
ix
MDG Millennium Development Goal

MOE Ministry of Education
MOFED Ministry of Finance and Economic Development
MOJ Ministry of Justice
MOH Ministry of Health
MOLSA Ministry of Labor and Social Affairs
MORAD Ministry of Rural and Agricultural Development
MOYS Ministry of Youth and Sports
MOWAO Ministry of Women’s Affairs Office
NRH National Reproductive Health
NCTPE National Committee on Traditional Practice in Ethiopia
NGO Nongovernmental Organization
OSSA Organization for Social Services against AIDS
PAC Post Abortion Care
PASDEP Plan for Accelerated and Sustained Development to End Poverty
PLWHA People Living With HIV and AIDS
PMTCT Prevention of Mother to Child Transmission
RH Reproductive Health
SDPRP Sustainable Development Poverty Reduction Program
SNNPR Southern Nations, Nationalities, and Peoples Region
STIs Sexually Transmitted Infection
TBA Traditional Birth Attendant
TFR Total Fertility Rate
UNAIDS Joint United Nations Programme on HIV/AIDS
UNFPA United Nations Population Fund
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
VCT Voluntary Counseling and Testing
WHO World Health Organization
WMS Welfare Monitoring Survey
YRH Youth Reproductive Health
YSDP Youth Sector Development Plan
NATIONAL ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH STRATEGY
Executive Summary
This document is the culmination of a vision, formulated over years of consultations with
major stakeholders at the national and regional levels in the field of adolescent and youth
reproductive health. Led by the Ministry of Health Family Health Department and undertaken
in collaboration with key partners, the MOH commits itself to increase access to quality
reproductive health services for young people in Ethiopia, ages 10-24 years, and to mobilize
resources to implement the National Adolescent and Youth Reproductive Health Strategy.
Guided by the National Adolescent and Youth Reproductive Health Committee, the process of
formulating the strategy has been very consultative. A multi-sectoral committee, including
members of the Adolescent Reproductive Health Working Group and other members drawn
from relevant ministries, youth associations, non-governmental organizations (NGOs),
UN Agencies and donor representatives met regularly to review the evidence, identify key
priorities, and achieve consensus on the scope of the strategy and the way forward. A smaller
peer review team, representing MOH major partners in AYRH, reviewed drafts in conjunction
with the larger consultations.
Programmatically, this strategy reflects three overriding priorities. It supports the nation’s
commitment to achieving the Millennium Development Goals by 2015 and the National
Plan for Accelerated and Sustained Development to End Poverty; it calls for a multi-sectoral
approach to address the socio-cultural and economic factors that shape reproductive health;
and it builds upon the Health Sector Development Plan III ultimate goal to increase health
services at the primary level through the new and innovative Health Extension Program. In
addition, it reflects the commitment of the National Youth Policy and the Plan of Action from
the Ministry of Youth and Sports to create an empowered young generation. The National
Adolescent and Youth Reproductive Health Strategy aligns its major goals with the National
Reproductive Health Strategy, launched in March 2006.
The strategy is fundamentally grounded in major principles that recognize the

rights of all adolescents, including young adolescents to access tailored reproductive
health programs; the diversity of young people and thus the need to develop tailored
approaches to reach different segments of the youth, including the marginalized
and vulnerable groups; and the need to empower youth led institutions to
actively participate in the design and implementation of youth serving programs..
The vision of the strategy reflects the Government commitment to increasing access to
reproductive health services and social services for young people in order to empower them to
participate fully in the development of the country.
Annex A
MOH, 2006c
xi
Vision of the National AYRH Strategy:

To enhance reproductive health and well-being among young people in Ethiopia ages
10-24 so that they may be productive and empowered to access and utilize fully reproductive
health information and services, make voluntary informed choices over their RH lives, and
participate fully in the development of the country.
The National AYRH Strategy delineates four major goals to lead the efforts of the MOH in the
next 10 years:
1. To meet the immediate and long-term RH needs of young people through increased
access and quality of reproductive health services for adolescents and young people of
Ethiopia.
2. To increase awareness and knowledge about reproductive health issues, which leads to
healthy attitudes and practices in support of young peoples’ reproductive health.
3. To strengthen multi-sectoral partnerships and create an enabling positive environment

at all levels, with line ministries, research institutions, technical organizations, and
partners, including communities and young people regarding the reproductive health
needs of young adolescents and youth.
4. To design and implement innovative and evidenced based AYRH programs that are
segmented and tailored to meet diverse needs of youth by marital status, age, school
status, residence, and sex, including younger adolescents and marginalized and most
vulnerable young people in the context of Ethiopian priorities and culture.
There is a need to increase access to quality reproductive health services. Currently youth
have limited access to quality youth friendly services and are at increased risk of negative
reproductive health outcomes. To increase access to such services, the MOH and its partners
will develop the capacity of public health services by:
• Training health care providers at all levels, with a focus on Health Extension Workers.
at the community level
• Mobilizing resources to ensure continuous supplies of commodities for providers to.
provide the services needed
• Engaging its partners and communities to increase demand and knowledge of.
services.
Where needed, existing health facilities will be improved to provide youth friendly services.
Though the MOH is committed to provide youth friendly services, it also acknowledges that
key partners, NGOs, private sector, and social marketing initiatives will play a partnership role
in strengthening youth outreach programs. Tailored outreach programs with strong referrals
xii NATIONAL ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH STRATEGY
to public health facilities will play a major role in reaching adolescents who often are reluctant
to access health facilities, such as young adolescents who migrated to urban areas, young
adolescent girls in rural areas, or young married girls.
Within a life cycle approach, young people need to know about reproductive health so that
they can make informed decisions about their reproductive health and sexuality. Young people
and their communities —parents, peers, and community leaders — have limited awareness
and knowledge regarding youth reproductive health rights and needs. Social mobilization
at community levels is key to increasing knowledge of FP/RH, HIV prevention, and STI
transmission. Mobilization also needs to address the negative community norms that increase
the vulnerability of youth, especially adolescent girls. Community mobilization is essential
to increasing awareness on the negative reproductive health outcomes associated with early
marriage, harmful traditional practices, cross-generational gaps in marriage, gender inequities,
and sexual violence. Working with men and boys on changing their attitudes is key in addressing
negative gender norms that keep young women at increased vulnerability of early marriage,
harmful traditional practices, and limited agency over their reproductive lives.
This strategy recognizes that a multi-sectoral approach is needed to address the underlying
factors that place young people at increased risks of negative reproductive health outcomes.
Keeping boys and girls in school, creating linkages with livelihood programs, addressing the
social isolation of marginalized groups, and strengthening the legal framework to protect
adolescent rights are all strategies outlined to improve the reproductive health status of youth.
The MOH will collaborate with its partners and line ministries to increase linkages between
such strategies and the mandate of the MOH.
Sharing of evidence, program successes, and research findings is key to enhancing the
development of cost-effective youth programs, avoiding duplication, and addressing the RH
needs of the diverse segments of young people. To date, there has been limited information
sharing and transfer of research findings and best practices into youth interventions. Continued
collaboration and coordination among all partners, including research institutions, will be
strengthened.
In order to chart an effective and meaningful course of action, the Ministry of Health will
coordinate implementation of the National Adolescent and Youth Reproductive Health Strategy
and will assume responsibility for its execution, supervision, and monitoring in collaboration
with key stakeholders and the broad membership of the National Reproductive Health Task
Force. The next major steps are to develop operational plans at the federal and regional levels,
develop guidelines, and begin implementation. This process will make possible meaningful
cost estimates that will inform the allocation of resources as delineated in the HSDP III and
will also help harmonize the discussion of resource mobilization among all partners.

Introduction
Adolescents and young people ages 10 to 24 are the largest group ever to be entering adulthood
in Ethiopian history. This cohort of 21 million makes up 30% of total population. This strategy
calls for immediate tailored and targeted interventions to meet the diverse needs and realities
of young people. Ethiopia is at a crucial point, facing a large rapid population growth, 2.6%
per annum, which puts tremendous pressure on the country’s health service infrastructure.
One of the most effective interventions to address the rapid population growth is to empower
young people to make informed choices on their reproductive health, including their desired
fertility.
Young people are assets. Programs promoting gender equity, adolescent empowerment, and
access to education and employment will have a major and long lasting impact on Ethiopian
society as a whole. Investing in the health and well being of this large cohort is vital if Ethiopia
is to meet the poverty reduction goals as stated in the Plan for Accelerated Sustainable
Development for Eradicating Poverty (PASDEP) and the Millennium Development Goals
(MDGs) by 2015. Social investments in education and health, with a renewed focus on
vulnerable and marginalized groups, will build a strong economic base for the country.
Adolescence is a time of transition from childhood to adulthood where new behaviors are more
easily learned than when in adulthood. Thus it is essential to design targeted interventions for
three main reasons: to maximize investments Ethiopia has made on child survival interventions;
to recognize and address the increased health risks faced by adolescents; and to promote and
establish healthy behaviors that can be continues into adulthood.
MOH, 2002
In this document, “young people” refer to those ages 10-24 as defined by the World Health Organization. .
The National Youth Policy defines “young people” as ages 15-29 years. Usually, especially in rural areas,
young women, above age 24 are already mothers and often more than once (DHS 2005). Thus the National
AYRH Strategy focuses on young people 10-24, while acknowledging that adults >24 years also need access
to services.
“What happens between the ages of 10 and 19, whether for good or ill, shapes how girls and
boys live out their lives as women and men—not only in the reproductive arena, but in the
social and economic realm as well.”5
Addressing the reproductive health needs of young people is complex. Youth cannot be defined
as a homogeneous group. They vary by age, sex, education, marital status, and residence.
Adolescents’ health is directly affected by the socio-cultural and economic context in which
they live. The National Adolescent and Youth Reproductive Health Strategy recognizes the
diversity of the Ethiopian adolescents and calls for a wide range of strategies with a focus on
integrated social investment (e.g., health, education, and life-skills) to address the heterogeneity
of young people.
The Government of Ethiopia has adopted far-reaching policies and strategies to address some
of the social, economic, educational, and health problems faced by youth. This National
AYRH Strategy is grounded within the National Reproductive Health Strategy 2006-2015. The
government is also committed to develop health services to reach all Ethiopians as stated as the
major goal of the Health Sector Development Plan III.6
One of the strategies to reach this goal has been the institution of the Health Extension Program
(HEP) to strengthen the delivery of preventive, promotive, and basic health care in the rural
area (HSDP III, 2005) with the health extension workers as the main agents of change for health
in the community. These health extension workers will be pivotal in reaching the adolescents
and youth at the community level.
The National Adolescent and Youth Reproductive Health Strategy represents a further
commitment and a major step forward by the Government to rally resources, to harmonize
efforts and interventions, and to integrate programs across sectors: education, economic,
health, and agriculture with its major partners to see that the adolescent population in
Ethiopia is healthy and thriving. .
.
.
.
5 Mensch B et al. 1998

6 MOH, HSDP III, 2005 Ultimate Goal: “To improve the health status of the Ethiopian peoples through
provision of adequate and optimum quality of primitive, preventive, basic curative and rehabilitative health
services to all segments of the population.”

Guiding Principles
Recognize the diversity of youth as a target population and therefore segment
interventions by age, life stages, and vulnerability status:
Programs need to recognize that the socio-economic and cultural environment shape adolescent
reproductive health. The Ministry of Health and its partners recognize the need to design
tailored intervention to youth according to their sex, age, school, marital, socio-economic,
migrant and family status. The MOH and its partners also renew their commitment to design
programs and policies that give special attention to vulnerable young adolescents ages 10-14
and those at risk of irreversible harm to their reproductive health and rights (e.g., coerced sex,
early marriage, poverty-driven exchanges of sex for gifts or money, and violence). Special
attention needs to be devoted to young married girls in rural areas and to most vulnerable and
orphaned youth who are abused, orphaned, trafficked, physically or mentally impaired, or
migrating to urban areas. This strategy commits itself to promote a way forward, recognizing
the critical need to develop tailored approaches for young people 10-14 years, 15-19 years, and
20-24 years old.
Programs must be based on development-oriented and rights-affirming principles:

The guiding principles of the National Adolescent and Youth Reproductive Health Strategy
are embedded in the International Conference on Population and Development (1994), which
highlighted the crucial needs to address adolescents’ sexual and reproductive health issues;
the Fourth World Conference on Women (1995); the Convention of the Rights of the Child
(1989); the National Reproductive Health Strategy, and all relevant policies and strategies of the
Ethiopian Government. The strategy is grounded in fundamental human rights and freedoms
related to social, economic, cultural, and religious beliefs and practices.
Address the needs of youth through a holistic approach:

The World Health Organization (WHO) and other international groups support a holistic
approach to address youth reproductive health. This strategy recognizes that the Ministry
of Health alone cannot increase the well being of the adolescent population in Ethiopia.
Collaboration with all relevant sector ministries and all major partners from the public, private
and non-profit sectors is crucial.
The recognition that gender differences are fundamental in framing AYRH:

This strategy recognizes that gender considerations are fundamental to adolescents and youth
because they are important determinants of access to social services and opportunities. This
strategy acknowledges that the Ethiopian socio-cultural context of important gender inequities
calls for different programs and interventions to reach both male and female adolescents, with
a renewed allocation of resources to meet the needs of the adolescent girls, in rural areas, who
are at increased risks of sexual violence including harmful traditional practices.
Look for opportunities to integrate and link reproductive health services with other health
and non-health interventions:
Looking for opportunities to deliver reproductive health services through existing health
services is necessary for increasing effective use of resources. Youth need access to an array
of services: MCH, counseling, family planning, STI including HIV counseling and testing
(VCT), and post abortion care. Hence, seeking out opportunities to link reproductive health
services with the existing referral and delivery of health services is key.
Promote youth involvement, youth leadership, and youth-adult partnerships:

The strategy recognizes the critical role adolescents and young people can play in improving
their own health and development. Adolescents/young people need to be listened to and included
as partners in the development of policies and strategies to address their needs. Hence, youth
participation will be promoted at all stages of program design, implementation, monitoring,
and evaluation.
Design and plan for scale-up and replication:

In an environment where all resources need to be maximized, evidence-based and effective
interventions are critical in order to reach the young people of Ethiopia. The National
AYRH Strategy recognizes that youth interventions need to be designed within the context
of sustainability and scaling up. Programs should not be started without a plan for cost-
effectiveness and scale-up.
SECTION I
CONTEXT OF YOUTH REPRODUCTIVE HEALTH
Section I:
Context of Youth
Reproductive
Health
This section outlines key contextual issues that affect youth RH in Ethiopia.
Population Dynamics
Ethiopia has a very young population; 40% of its 77 million inhabitants are younger than 15
years. Ethiopia faces a very rapid population growth, with an estimated 2.6 million additional
people a year.7 This places serious challenges for poverty reduction and development.8 Early
age at marriage and extremely low use of contraceptives are key behavioral factors contributing
to the high fertility in country.9
Poverty
One of the most important factors influencing RH status of Ethiopians is poverty. Today
it is estimated that 47 percent of the population lives below the poverty line.10 Young
people are among the groups most affected by poverty as they have very limited access to
employment. According to a report by the Ministry of Labor and Social Affairs, 87% of
all registered job seekers are between the ages of 15-29.11 Young people in rural areas are
increasingly migrating to urban centers. Migration increases the risks of exploitation and
sexual violence such as domestic workers, street vendors, or boys. In addition, there are an
estimated 100,000 street children nationwide, with an estimated 40,000 in Addis Ababa.12.
.
7 MOFED. 2005; PASDEP:4

8 MOE. 2006
9 Bongaarts J. 1998
10 MOH.2005a:3; World Bank. 2004
11 CSA. 2004a
12 Moreland S et al. 2001
Education
Education is an important determinant of the quality of life and is strongly associated with
healthy reproductive health outcomes such as seeking out ANC, contraceptive use, and
knowledge of HIV/AIDS. Ethiopia has made enormous strides towards meeting the goal of
universal education by increasing primary school enrolment three-fold over the past decade.
The gross enrolment ratio in primary school reached 79% in 2004-2005.13 Though studies
show remarkable progress, girls still face major disparities regarding access to education.
The gender parity index shows that boys in rural areas are twice as likely as girls to attend
secondary school. It is estimated that half of girls ages 15-19 are literate compared to 75% of
boys in the same age group.14
Girls in rural areas are often not enrolled at grade/age appropriate classes. They often are at
risks of dropping out once primary school is completed. It is estimated that about three-fourths
of the girls attend primary school but only about one quarter attend secondary school.15 When
looking at school drop out rates, more than one quarter of the females above age ten in rural
areas are estimated to drop out of school, due to poverty, limited community commitment to
girls’ education, early marriage practices and the low status of women.16
Status of Adolescent Girls and Young Women

The low status of women in Ethiopia underlies and directly affects the negative RH outcomes
addressed in this strategy. Most Ethiopian young married women (15-24) have limited autonomy
and control of their resources. Only half of married adolescents, 15-19 can decide how their own
earnings will be used. Ten percent of these adolescents have no decision-making power at all
on the use of their resources.17 Harmful traditional practices, abduction, early marriage though
declining still persist. The latest Ethiopian Demographic Health Survey (EDHS) 2005 data show
that there is little change in women’s status: 80% of women and about 50% of men believe that
there are at least some situations in which a husband is justified in beating his wife.18
Female Genital Mutilation/Cutting (FGM/FGC) is widespread in Ethiopia, with more than

half of girls ages 15-19 years having been circumcised.19 Female genital cutting is strongly
associated with negative reproductive health outcomes, such as infections, obstructed labor,
perineal tears, fistula, and infertility. Though the support for this harmful practice is declining,
about one quarter of girls ages 15-24 believe the practice should continue.20
13 MOFED. 2005:77
14 CSA and ORC Macro, 2005
15 Welfare Monitoring Survey, 2004
16 Moreland S et al. 2001
17 CSA and ORC Macro, 2005
18 Ibid
19 Ibid
20 Ibid
SECTION I
Abduction, the unlawful kidnapping and forced seizure of a young girl for marriage, is a
form of sexual violation. The practice is common in certain parts of Ethiopia, especially in the
SNNPR (13%) and Oromia (11%) regions. Young women in rural areas are twice as likely as
women in urban area to be abducted. Nationwide, 8% of married women (15-49) have reported
being abducted.21 In SNNPR, abduction has been singled out as the severest health threat to
young girls.22
Rape is a common occurrence among young women in both rural and urban areas. A study of
adolescents in six peri-urban areas in Ethiopia reports that 9% of sexually active adolescent
girls and 6% of adolescent boys had been raped.23 Another study on street violence among girls
ages 10-24 in Addis Ababa found that 15% of the respondents had been raped, and during their
first sexual activity, 43% had been coerced into sex.24
Polygamy has an impact on the reproductive health of young people. Young women with older
co-wives often play a secondary role in the running of the household, have little autonomy
and occupy a low status in the gender hierarchy.25 This affects their social life, economic
capacity and fertility desire. More importantly, polygamy exposes women to increased risk of
contracting sexually transmitted diseases. In many of the regions, including Oromia, SNNP,
Somali, Benshangul, and Gambela polygamy is widely practiced 5% of women in their teens
and 8 percent of women 20-24 are married to men who have more than one wife.26
Legal and Policy Environment. The Government of Ethiopia (GOE) has adopted a number
of laws and major policies to advance women’s status and social and reproductive rights. The
GOE is a signatory on major international conventions that promote reproductive health in a
broad context of social development. The implementation of these laws and policies, however,
are constrained by the limited capacity of stakeholders for implementation.
The Government of Ethiopia has been highly committed to strengthening the legal policy.
framework to protect the rights of youth. The Ministry of Youth and Sports (MOYS),
coordinates and ensures that youth priorities are addressed by all ministries. The MoYS
launched the Youth Policy in 2004 to call for priority actions for youth development. Among
other priority issues, the Policy emphasizes the need for overall youth participation and the
creation of favorable conditions through capacity building efforts in order for the youth to
have proper access to information, education, counseling, and other services in the areas of
sexual and reproductive health and HIV/AIDS. Based on the Policy, the MoYS has also issued
strategic and action plans for youth development.
21 Ibid
22 WHO. Gender and the Social Context of Reproductive Health
23 OSSA and DSW. 1999
24 Molla M. 2000
25 WHO. Gender and the Social Context of Reproductive Health
26 Govindasamy P et al. 2002
The Policy on HIV/AIDS, adopted in 1998, acknowledges the low status of women and
the increased vulnerability of street children, adolescents engaged in transactional sex,
and AIDS orphans. One of its objectives is to strengthen youth empowerment to enable
them to protect themselves against HIV infection. .
The Government also reviewed major laws to protect women’s rights and strengthen their
role in the economic development of the country. The amended Family Law reiterates that
the legal age of marriage is 18, and marriage can only take place with full consent of the
marrying partners. The New Criminal Code has criminalized harmful traditional practices
and has listed severe penalties for the perpetuators of such practices. The revised code also
allows terminating pregnancy under special conditions including, when the pregnancy is
as a result of rape, if the pregnancy endangers the life of the mother or the child, or if the
pregnant woman is physically or mentally unfit to raise a child. In 2006, the Ministry of
Health launched the National Reproductive Health Strategy before the Prime Minister and
the Cabinet.
SECTION II
ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH IN ETHIOPIA
Section II:
Adolescent and Youth
Reproductive Health in Ethiopia
Limited access to targeted RH care and services for young people contributes to, and exacerbates,
many of the RH problems outlined below. Over a quarter of all pregnant youth and adolescents
feel that their pregnancies are mistimed, reflecting this population’s limited access to FP and RH
services.27 These unwanted pregnancies entail significant risks for maternal health, including
high rates of delivery-related complications and high abortion rates.
Early Sexual Debut
An estimated 94% of girls initiate sex within marriage in contrast to boys who often initiate
sex outside marriage.28 Early sexual debut and limited use of contraceptive methods have been
associated with increased risks of unwanted pregnancy, STI/HIV infection, and maternal health
mortality and morbidity. In Ethiopia, trends in sexual initiation have changed little over the last
five year. Median age of sexual debut for girls is 16 and for boys is 20.29 Urban adolescent girls
initiate sex two years later than their rural counterparts. Women with at least primary education
initiate sexual activity five years later than girls in the same age group with no education.
27 MOH. 2006c
28 Population Council. 2000
29 CSA and ORC Macro. 2005
10 NATIONAL ADOLESCENT AND YOUTH REPRODUCTIVE HEALTH STRATEGY
Age at First Marriage

The median age of marriage for women age 25-49 in Ethiopia is 16.1 years, indicating that
for most girls, marriage drives sexual debut. While there has been very little change in the age
at first marriage over the last five years30 age at first marriage does vary according to area of
residence, education status, and region. Urban women marry more than two years later than
rural women. There are also large regional differences: the median age at first marriage is the
lowest in the Amhara region with 14.1 years and highest in Addis Ababa with 21.9 years. Men
tend to enter marriage later in life, with almost eight years later than women.31 These large
age differences between men and women limit the young girls’ autonomy and control of their
reproductive life.
Early marriage for girls is the beginning of high frequency of unprotected sexual relations.
Early marriage increases the risks of young married girls to HIV infection.32 In addition, Child
brides often experience psychosocial problems and constraints related to their loss of mobility,
lack of a supportive environment, and an inability to pursue their education. As a result, almost
half of these early marriages end in divorce or separation and the newly single young women
often migrate to the urban centers in search of work.33
Early Child Bearing

There are high normative expectations for married young couple to bear a child within the first
year of marriage. As seen in Figure 1, motherhood starts early with about one quarter of all girls
18 years old and more than 40% of 19 years old having begun childbearing. The percentage of
teenagers who have begun child bearing increases rapidly with age.34
30 Ibid
31 Ibid
32 Clark. 2004
33 Bruce et al. 2006. NCTPE. 2003:145
SECTION II 11
Figure 1: Teenage Pregnancy and Motherhood 35
Teenage Pregnancy
and Motherhood
50
40
Percentage
30 Percentage
begun child
20 bearing
10
0
15 16 17 18 19
Age
Source: EDHS 2005
A study reported that adolescents aged 15 or younger had higher odds of anemia and death,
and of having a child die within its first week of life compared to young mothers, aged 20-24.36
Young adolescent mothers are likely to suffer from severe complications during delivery that
result in high morbidity and mortality of both the mother and child. Girls, age 15-19 years, are
twice as likely to experience obstetric fistula compared to other women of reproductive age.37
Unwanted Pregnancy
Limited knowledge of sexual physiology, early marriage, limited use of contraceptives, limited
access to reproductive health information and education, and girls’ limited agency over their
sex lives all contribute to the high rate of unwanted pregnancy. In addition to the psychological
trauma associated with unwanted pregnancy, adolescent pregnancy carries its own obstetric
risks.
Unwanted pregnancy is one of the major RH challenges faced by adolescents in Ethiopia. As

seen on Figure 2, 54% of pregnancies to girls under age 15 are unwanted (wanted later or not
wanted) compared to 37% for those ages 20-24. This indicates the need to refocus programs
and prioritize interventions tailored to adolescents under 15 years.38
35 EDHS. 2005:56. Percentage of women ages 15-19, who have .

had a live birth or who are pregnant with their first child.
36 Conde-Agudelo et al. 2005
38 CSA and ORC Macro. 2000, 2005; MOH. 2006
Figure 2: Percentage of Planned Births
10
20-24 27
63
11
Age
15-19 25
64
33
<15 21
46
0 20 40 60 80
Percentage
Wanted Then Wanted Later Not Wanted
Source: CSA Analysis 2002
Abortion
Abortion places many young women at risk as the termination of pregnancy is usually conducted
under unsafe conditions. Most abortions are illegal. Though accurate data is difficult to collect,
as seen on Figure 3, girls under age 15 are three times more likely to end their pregnancies
in abortion compared to those ages 20-24. According to the Ministry of Health, abortion
accounts for nearly 60% of gynecological and almost 30% of all obstetric and gynecological
admissions.39
Knowledge and Use of Family Planning Methods

Despite reported high knowledge of family planning in both the EDHS 2000 and 2005, married
adolescents report very limited use of contraception methods. Fewer than 10% of currently
married girls ages 15-19 report using any modern method; 15% of women ages 20-24 reported
using any modern method. Half of young unmarried women 15-24 reported using some form
of modern contraception. Contraceptive use differ significantly across regions, with about 3%
of women in the Somali region reporting using modern contraception compared to about 60% in
Addis Ababa. Urban women are five times more likely to use contraceptives than rural women.
The most popular modern methods of contraception are implants and the contraceptive pills.
39 MOH. 2006b
SECTION II 13
Figure 3: Percentage of Pregnancies Terminated, by Age
20-24 4
Age at end of
Pregnancy
15-19 6
<15 13
0 2 4 6 8 10 12 14
Percentage
Source: CSA Analysis 2002
Fewer than 1% of currently married adolescents ages 15-19 and 1% of currently married women
ages 20-24 reported using a condom as a family planning method. These findings are dramatic
both in the context of preventing unwanted pregnancy and also in the context of preventing
HIV infection given the scale of the epidemic in Ethiopia.40
Unmet need for family planning is the highest for young married adolescents, 15-19 years
old, with 30% unmet needs for spacing and 8% for limiting. The unmet needs for 15-19 year-
old women are twice as high as the unmet needs for women ages 45-49. Rural women (15-
49) have twice as high unmet needs (39%) than women in urban areas (17%). Education is
positively associated with contraceptive use. Married women aged 15-19 with secondary or
higher education, are five times more likely to use any modern method of contraception than
their peers.41
HIV/AIDS and STIs

The HIV problem in Ethiopia has become a “feminine epidemic.” Girls ages 15-19 years are
seven times more likely to be HIV positive than boys the same age. Women 20-24 years old are
four times more likely to be infected than men the same age.42 In addition to biological factors,
young women are at increased risk of HIV transmission as they have earlier sexual debut
than their male peers and marry husbands older than them. There are also large differentials.

41 Ibid
42 Ibid
between urban and rural women. Urban women are 12 times more likely to be infected than rural
women. Unmarried, sexually active women have the highest risk of HIV infection, with a 9%
prevalence rate. Programmatically, it is crucial to offer dual protection (condom and hormonal
contraception) to unmarried, sexually active women to prevent HIV infection and unwanted
pregnancies. Priority areas include urban and sexually active unmarried women and men.
Despite high awareness of HIV/AIDS, about one in four girls ages 15-19 does not believe there
is a way to avoid HIV/AIDS. In general, knowledge of condoms and the role they can play in
preventing the AIDS virus transmission is limited. Sixty percent of women and 30% of men
are unaware that using a condom during sexual intercourse can reduce the risk of contacting
HIV/AIDS.43
Knowledge of other STIs is much more limited than that of HIV. Only about half of the
adolescents ages 15-19 had some knowledge of STIs and their symptoms. An STI is a useful
marker for unprotected sex and also as a co-factor for HIV transmission. The 2005 EDHS
reports quite low rates of STI prevalence among those ages 15-19 and 20-24.44 Sexually active
girls ages 15-19 are three times (1.4%) more likely to report an STI than sexually active boys
in the same age group (0.5%). Thus young girls are at increased risks of contacting STI, as
they probably engage in unprotected sex due to the limited control they may have over their
sexual lives.
43 EDHS. 2005
44 These are self reported rates from clients coming to the health
facilities and underestimate the STI prevalence.
SECTION III 15
EXISTING SERVICES AND PROGRAMS
Section III:
Existing Services and

Programs
Services
Most of the youth RH programs that have been implemented in the last decade serve adolescents
enrolled in school and those living in urban or peri-urban centers. Most young people live in
rural areas, and only 15% are enrolled in secondary school.45 Thus many adolescents living in
rural areas are not currently being reached by the on-going YRH programs.46 Even within urban
areas, new research suggests that existing coverage is limited, with only 12% of young people
sampled in Addis Ababa visiting youth centers and only 20% reached by peer educators.47
A national study conducted by MOH identified providers’ attitudes and community norms as
a major barrier to the provision of youth friendly services. The study reported on the limited
provision of AYRH services in four major regions: Oromyia, SNNPR, Tigray and Amahara.
The study also noted that respondents preferred seeking services from the private sector or
from the community traditional healer than visiting the public sector.48
In addition, most programs for young people in Ethiopia, as well as in sub-Saharan Africa
generally, tend to deliver generic, age- and gender-blind messages that fail to recognize the
distinct needs of girls and boys at different ages, as well as the unique needs of married
45 PASDEP:19. In rural areas, about 15% of both boys and girls are enrolled in secondary school. The gross
enrolment ratio has increased from 7% in 2000 to 15% in 2005. In urban areas, about 65% of boys and girls
are enrolled in secondary schools, nearly five times more than the youth in rural areas.
46 MOH. 2006a; Mekbid et al. 2005
47 Erulkar et al. 2006. The study reported that of all adolescents (10-19 yrs) surveyed, 11.9% attended youth
centers and 19.6% were reached by peer educators. When disaggregating by gender, boys (20%) were three
times more likely to attend youth centers than girls (7.2%), and boys (26%) were much more likely to be
reached by peer education programs than girls (15%).
48 MOH. 2006a
adolescent girls.49 Generally, youth programs tend to view youth as a homogenous group and
programs. For example, behavior change communication/IEC materials and youth services
have little regard to the different segments of youth.50
Very few youth programs deal with life skills, gender dynamics, livelihoods, and the social and
economic factors that frame adolescents’ decision-making processes.51 The reports indicated
that the more privileged in school youth and a very small proportion of girls 10-14 years (less
than 0.5%) living apart from their parents were reached by such programs.52
Family Life and Sexuality Education

Though students at the primary level are introduced to family life topics such as personal
hygiene, harmful traditional practices, menstrual hygiene, and environmental hygiene, among
others, there is very limited information on reproductive health topics such as physiology,
reproduction cycle, and life skills. From grade 7 onwards, Family Life Education (FLE) is
integrated in the natural and social sciences with RH issues mainly incorporated in biology. At
this time, the Ministry of Education is integrating HIV prevention programs into all subjects
but there was no reported link or integration with RH topics.53
Other initiatives are being developed by the Government and its partners to reach young
people in- and out-of-school and those enrolled in anti-HIV clubs, RH clubs, and girls clubs.
However there is limited harmonization and inclusion of best practices in many of these
programs.54 Although many stakeholders − notably, the Ministry of Education, National Office
of Population, and NGOs − are promoting the implementation of FLE in-school and out-of-
school, no responsible body oversees the proper implementation of the program. In view of
the gravity of the current RH problems, and as MOE is the sole responsible body for the RH
education and services in the schools, it is very important for it to review the effectiveness the
program.
49 Ibid
50 Giorgis et al. 2001; DSW 2003
51 Bruce et al. 2006
52 Erulkar et al. 2004
53 Conversations with the director of the Institute of Curriculum .
Development and Research, Addis Ababa
54 Conversations with Pathfinder International, FHI, and FGAE
SECTION IV 17
STRATEGIES FOR THE REPRODUCTIVE HEALTH OF YOUNG PEOPLE
Section IV:
Strategies for the

Reproductive Health
of Young People
Vision
To enhance reproductive health and well-being among young people in Ethiopia ages 10-24 so
that they may be productive and empowered to fully access and utilize quality reproductive
health information and services, to make voluntary informed choices over their RH lives, and
to participate fully in the development of the country.
Goals:
access and quality of reproductive health services for adolescents and young people of
Ethiopia.
2. To increase awareness and knowledge about reproductive health issues, which lead to
healthy attitudes and practices in support of young people’s reproductive health.
3. To strengthen multi-sectoral partnerships and create an enabling positive environment

at all levels, with line ministries, research institutions, professional organizations, and
partners, including communities and young people regarding the reproductive health
needs of young adolescents and youth.
4. To design and implement innovative and evidence-based AYRH programs that are
segmented and tailored to meet diverse needs of youth by marital status, age, school
status, residence, and sex, including younger adolescents and marginalized and most
vulnerable young people in the context of Ethiopian priorities and culture.
Goal 1: To meet the immediate and long-term RH

needs of young people through increased access and
quality of reproductive health services for adolescents
and young people in Ethiopia.
Priority Issues:
• The health sector has limited capacity to provide youth friendly services. Inconvenient
hours or location, unfriendly staff, and lack of privacy are among the main reasons many
adolescents and young adults give for not using RH and HIV services. (MOH, 2005)
• Guidelines need to reflect the current realities of youth and the new legal framework on
family laws.
• Teen pregnancy among rural youth is high, half of the pregnancies are unintended, and
existing health services do not reach youth adequately.
• Contraceptive use among married adolescents is low, and the unmet needs for
contraception are high.
• Rural adolescent girls are vulnerable to unintended pregnancies due to early marriage,
abduction, rape, and intergenerational and transactional sex.
• Youth migrating to urban areas are at increased risks of trafficking, sexual violence, and
transactional sex.
Objective 1.1: To improve access to quality reproductive health and

STI/HIV services.
Strategies:
Build the capacity of health services at all levels to deliver youth friendly services
Health care providers at all levels need pre-service and in-service training on AYRH to
increase their understanding of the psychological, social, nutritional, and reproductive health
needs of youth to ensure access to quality services. Providers should be non-judgmental,
respect privacy, and know how to communicate with youth. Health extension workers also
need training on providing AYRH services and should recognize that many adolescents in
rural areas are already married. To ensure the quality of training, health training institutions
will need to revise their curricula to include AYRH.
SECTION IV 19
Commodities are needed. Continuous mobilization of resources for RH services (STI testing
and treatment, family planning, and HIV prevention programs) at each level is needed to ensure
providers have resources they need. Continuous supplies of HIV testing kits, pregnancy testing
kits, and contraceptives (including emergency contraception) need to be available.
Facilities. Existing public health facilities and youth serving institutions can be rehabilitated,
as a cost effective measure, to offer youth friendly services. These facilities can also offer
linked and integrated services such as PMTCT, VCT, FP, nutrition, and immunization with
strong referrals to higher level public health facilities. Research has shown that youth prefer
many services under one roof.55
Box 1: Example of Tailored Approaches
Young adolescent girls (10-14) Highly vulnerable groups in urban areas

in rural areas In urban areas, marginalized groups of
Health extension workers should adolescents (e.g., street adolescents and
collaborate with youth serving HIV orphans) have very limited access
organizations at kebele level, including to reproductive health services if they are
women’s associations and community- sexually active. This group is at increased
based reproductive health agents and risks of unintended pregnancy and STI/HIV
other community leaders, to protect young transmission. Health care providers need to be
adolescent girls from early marriage, trained to provide non-judgmental services to
FGC, and other harmful traditional these highly vulnerable groups.
practices.
Develop and revise national guidelines and standards

All national documents should be reviewed to ensure that youth RH needs are clearly and
adequately addressed, including PMTCT, VCT, ANC, emergency obstetrics, and others. The
AYRH guidelines must delineate clearly which RH services will be provided to different
sub-groups of adolescents by age and must reflect the New Legal Code. The Family Health
Department should establish a task force to harmonize all guidelines.
Develop outreach programs

As adolescents are reluctant to access public health facilities, programs need to reach out to
young people. Following are several strategies for this program.
55 This strategy calls for modifying the existing health structures, rather than build new ones, to ensure that
young people feel welcomed and that their privacy is respected.
Box 2: Examples of Outreach Programs

Programs Description
Health care providers can go to where adolescents are, such as

Strengthen linkages between
schools, non-formal education settings, adolescent clubs such as RH
the health system and venues
clubs, anti HIV/AIDS clubs, sporting and recreational venues, youth
where adolescents congregate
centers,56 bus stations, market booths, work places, and safe places.57
Create linkages between Community volunteers can seek out the adolescents and provide
community volunteers and counseling, information. and education. Strengthen linkages
the HEWs between the HEWs and community members.
Review existing models Offer tailored services at the youth clubs/centers disaggregated by
of youth centers to ensure age and sex. Renew efforts to reach young adolescents <15 years
provision of tailored services old.
Services need to be provided along the migration routes or at
Create mobile clinics or
contacts where pastoralists rest. Mobile clinics could reach nomads
teams in areas where transient
along their migration routes. Mobile clinics, for example in a bus,
youth congregate. Transient is
could reach young people, who migrated to urban areas and who
defined as either pastoralists
usually have limited access to health facilities. Youth who migrate
or youth who migrated to
to urban centers have no access to public health services as they do
urban areas but have no
not have a resident card. Offer RH services through mobile clinics
resident status.
or “health kiosks” with a strong referrals to a nearby health center.
Integrate RH counseling A pilot project in one region could test whether FP/STI counseling
with an Outreach Enhanced could be integrated during one EOS campaign with referrals for
Strategy (EOS) services to the nearby health post.
Expand peer promoters Peer promoters who provide information can also provide condoms
responsibilities and refer to youth friendly health facilities.
Hotlines are mostly appropriate in urban areas, where adolescents
Institute hot lines
can gather information and counseling.
Increase the role of the Pharmacies offer an opportunity for providing reproductive health
private sector for expanding information and services to youth, especially contraceptives and
youth services referrals to services for STIs.58
Increase the role of social
Urban adolescents have reported liking the access of contraceptives
marketing for expanding
through social marketing as it protects their privacy.
youth services
56 Youth centers have been built in several regions in urban areas under the auspices of the MOYS and the
financing of the World Bank. At this time questions are raised about their effectiveness in reaching their in-
tended audience. Conducting research to identify the barriers that limit access to these youth centers is critical
to develop more effective programs. (Conversation with UNICEF, July 2006)
57 Research has shown that highly vulnerable groups that have lost either the protective factor of family or
school are at increased risks and vulnerability. (Hallman K et al. 2004) The concept of safe place is a place
where adolescents can meet, discuss their aspirations and worries. A constellation of programs might be of-
fered: life-skills, livelihoods, literacy, and reproductive health information. (Bruce J. 2005)
58 YouthLens No. 17. 2005
SECTION IV 21
Review ANC, delivery procedures, and post-partum care in health facilities and
strengthen training of HEWs to focus on the first time mothers
As pregnant adolescent girls and young women are at increased risks of morbidity and mortality,
it is essential that young pregnant girls attend health facilities during pregnancy. Review
procedures to identify the barriers that limit rural young women’s attendance to health facilities.
Review ANC and post-partum services to ensure they offer nutrition and FP services.
Enlist participation of boys/men, gatekeepers such as mothers-in-law or other family

members
All programs need to include men and gatekeepers as women have very limited decision
making power. Young adolescent boys can be sensitized early on about gender inequities,
HTP, and sexual violence. Programs engaging young married men will increase the chances of
young women’s agency to decide on their reproductive lives.
Develop a cadre of health workers at the community level (health center) to provide
emergency obstetric care services
Engage professional organizations such as Ob/Gyn Association, the midwife association, and
the Public Health Association to strengthen in-service and pre-service training programs in
obstetric care for existing nurses and health extension workers. There are more than 17,000
nurses and more than 30,000 HEWs; this is an opportunity for the country to increase access to
basic and emergency obstetric care services at the community level.59
Goal 2: To increase awareness and knowledge about

reproductive health issues, which lead to healthy
attitudes and practices in support of young people’s
reproductive health.
Priority issues:
• Parents, care givers, and community members have limited knowledge to discuss RH
with adolescents.
• Despite the reduction in HTP, some communities still need to address these issues.
• Community members are unaware of the negative reproductive health outcomes
associated with HTP including early marriage.
• The low status of young girls and women is one of the main factors for perpetuating some
of the harmful practices negatively associated with reproductive health outcomes.
59 In alignment with one of the major goals of the National Reproductive Health Strategy. 2006
• Though there is a high awareness of HIV/AIDS, there is still limited knowledge among
youth to protect themselves.
• Young people have limited knowledge of their human rights and legal structures.
• Young people have limited access to sexual and reproductive health information.
Objective 2.1: To influence community norms and attitudes to

support adolescent reproductive health.
Strategies:
Community sensitization and dialogue with community members to promote social
change
Identify respected influential community members and engage them in community dialogues
on adolescent RH, harmful traditional practices, and gender inequities. Ensure that youth are
active participants in these community dialogues as they are essential in identifying the RH
issues they face and in promoting ways forward.
Engage parents, family members to enhance family dialogue on reproductive health

Parents and family members are the obvious mentors for young adolescents. Promote parents/
adolescents reflections on AYRH and the rights and responsibilities of adolescents. Develop
programs to increase parents’ knowledge on ARH (physiological and psychosocial) and
communication skills. Young adolescence (age 10-14) is the time when boys and girls learn
behaviors that will become more fixed in the later years; thus it is crucial to engage parents and
family members in discussing ARH.
Establish channels of communication between adolescents and adults

Develop mentorship models for linking young adolescents with adults who provide guidance
not only in reproductive health issues but also in life skills and livelihoods.
Objective 2.2: To increase knowledge and information about

reproductive health to empower youth in making
healthy choices.
Strategies:
Promote targeted messages to reach different segments of the youth population
Develop targeted RH behavior messages. Develop and promote messages informing adolescents
about their bodies (physiology), healthy reproductive life choices, and their rights. Integrate
life-skills to empower adolescents to make decisions on their reproductive life. Address gender
concerns and inequities and the low status of girls. During adolescence boys begin to establish
patterns of sexual behavior based on expected gender roles.
SECTION IV 23
Box 3: Segmented Approach to Behavior Change Communication
Young Adolescents Sexually Active Youth
• Emphasize delay of sexual debut • Emphasize messages to reduce HIV

(abstinence) and pregnancy risks: be faithful and
• Emphasize practical skills: negotiating, consistent condom use
problem solving, planning • Strengthen messages about the positive
• Engage adolescents in reflecting on the attributes of condoms
role of girls/boys and gender inequities • Concentrate on building confidence
• Engage adolescents in assessing their in youth on obtaining condoms and
own future risks and planning for making negotiating consistent condom use for
healthy reproductive health choices both boys and girls
• Build social support (peers, family, and • Integrate life skills to empower both
community). boys and girls to make informed
“Messages encouraging abstinence decisions on their reproductive lives
appear to work best when aimed at • Build social networks (e.g., young
younger youth who are not yet sexually married girls, domestic female
active, especially girls.” (Global Health workers, young street boys, and youth
Technical Brief) in school)
Harmonize and strengthen peer promoters and educators programs

Review and harmonize the training guidelines for all peer promoters by setting up a task
force that regroups all the NGOs engaged in peer promotion. Align the peer promoter training
programs with best practices. In addition to the existing peer promoters programs that reach
mostly adolescents in school in urban areas, promote the development of peer promoters
programs to reach the most marginalized and vulnerable groups such as youth that migrated to
urban areas, commercial sex workers, and HIV orphans.
Integrate SRH within the formal and non formal education sectors
Create a task force that regroups the Ministry of Education, Ministry of Youth and Sports, and
other NGOs to develop reproductive health curriculum based on best practices to be taught at
grade appropriate levels in the formal and nonformal education sector.
Strengthen the role of media and edu-tainment for youth

Promotion of healthy RH behavior needs to take place through multi-media channels such
as community leaders, policy makers, mentors, peer educators, parents, teachers, HEWs,
CBRHAs, and media including traditional folklores. Engage youth serving institutions and
young people at all levels to develop appropriate IEC materials as young people know best how
to communicate with each other.
Goal 3: To strengthen multi-sectoral partnerships

and create an enabling positive environment at all
levels, with line ministries, research institutions,
professional organizations, and partners, including
communities and young people regarding the
reproductive health needs of young adolescents and
youth.
Priority Issues:
• There is limited implementation of the new legal framework that protects and enhances
the role of youth and young women in society.
• Unemployment and poverty in the rural areas are driving youth urban migration. Youth
migrating to urban areas are at increased risks of sexual violence and have no recourse to
reenter the formal education system.
• Gender inequities across all sectors limit young girls and young women’s empowerment.
• Despite the increased numbers of youth associations, the active participation of youth in
designing policies, programs, and interventions in the field of RH is limited.
• There is limited harmonization among all FMOH partners in designing and implementing
AYRH interventions.
Objective 3.1: Increase the knowledge and awareness and change the
attitudes of policy makers on sexual reproductive
health issues of adolescents:
Strategies:
Continue advocacy and social mobilization for improving community and political
support towards AYRH issues
Increase policy makers’ knowledge regarding AYRH. Develop positive and supportive
attitudes about AYRH as political commitment is essential to develop effective adolescent RH
programs. At all levels, develop programs to inform policy makers, law enforcers, women’s,
and youth serving organizations regarding RH rights for youth and the role of policy makers’
in engaging their constituencies to ensure that the laws are disseminated and respected.
SECTION IV 25
Objective 3.2: Decrease risks and vulnerability of adolescents and

empower them to make healthy transitions to
adulthood
Decreasing risks and vulnerability of adolescents require a multi-prong approach from all
sectors. However, the MOH and its health partners can also play a major role in decreasing
adolescent vulnerability.
Strategies:
Provide information and skills to strengthen what young women can do to protect
themselves from HIV infection and unwanted pregnancy
Give clear tailored messages:
• Delay sexual debut if not sexually active (abstinence)
• Use dual protection (consistent condom and hormonal contraception)
• Reduce numbers of partners (faithfulness)
• Counsel young women about their rights over their sexual lives
• Engage adolescents in evaluating their own risks perceptions and address the
misconceptions
• Encourage social support for engaged couples to jointly seek premarital counseling
and HIV testing. For example, provide counseling and VCT services to young married
couples so that young married girls know their HIV status and their husband’s status.
Strengthen linkages to referral facilities that provide services for abused youth
Health extension workers in the rural communities and health care providers in health facilities
need to provide counseling and referrals to health facilities where women can receive medical
and psychological services when abused − counseling, prophylactic treatment against HIV,
emergency contraception, treatment of other ailments, and referral to legal system or groups
that protect women’s rights.
Multi-sectoral strategies
The following strategies are examples of cross-cutting areas that require a multi-sectoral
approach and require the commitment of all actors: line ministries, religious groups, training
institutions, and civil society.
Box 4: Cross Cutting Strategies
Lead
Strategy Remarks
Ministry
Education level is strongly associated with positive RH

Promote girls’ MOE,
outcomes such as delaying marriage, delaying pregnancy,
education MOYS
and use of contraceptives.
Develop livelihoods
Livelihoods opportunities strengthen adolescents and
programs for youth
MOYS, young people’s economic and social capacities and help
(urban youth included)
MOLSA them gain some autonomy and control over their lives,
with linkages to RH
including their RH lives.
services.
MOYS, Social isolation and poverty have been associated with

religious increased risks of sexual violence.60 Design programs to
Develop social institutions, reduce social isolation of marginalized and vulnerable
networks NGOs, groups so that youth can meet and discuss their issues,
MOWA, aspirations. Link such social networks to mentorship
MOE programs and referrals to health facilities.
MOYS, Create places where youth can meet safely and places
Create safe places MOLSA, where tailored services for the different segments of the
NGOs highly vulnerable groups are offered.
Promote youth participation in identifying priority issues

Promote youth MOYS, and in designing and implementing YRH interventions.
participation NGOs Strengthen youth leadership programs for young people to
be actively engaged in YRH programs.
60 In a study of female adolescents 10-24 years old girls living on the streets of Addis, girls living alone were ten
times more at risk to experience sexual violence. (Molla M. 2000)
SECTION IV 27
Objective 3.3: Increase coordination and collaboration among all

partners
Collaboration, partnership, coordination among line ministries, research and training
institutions, technical organizations, implementing partners, professional organizations,
CBOs, religious organizations, and donors
Within the Ministry of health at the federal, regional, and woreda levels assign a AYRH focal
person to lead and coordinate AYRH interventions. This focal person will liaise closely with
the Ministry of Youth and Sports and the Ministry of Women’s Affairs to ensure that youth RH
rights are respected at all levels including the community.
Revitalize the Adolescent Reproductive Health Working Group at federal level to ensure
harmonization and collaboration among all ministries and partners. Ensure that youth
representatives are members of this working group.
Create task forces that include line ministries and partners to work on the priorities identified
in the strategy: Redesign existing health care facilities; Strengthen tailored outreach programs;
Develop National AYRH guidelines; Develop training and training plan for health care
providers on AYRH; Develop AYRH curriculum for the formal and non formal education
sectors.
Goal 4: To design and implement innovative

and evidence-based AYRH programs that are
segmented and tailored to meet diverse needs
of youth by marital status, age, school status,
residence, and sex including younger adolescents
and marginalized and most vulnerable young
people in the context of Ethiopian priorities and
culture.
Priority issues:
• There is limited information on the reasons that continue to drive the cultural norms that
are associated with negative reproductive health outcomes, such as early marriage, rape,
coerced sex, and other forms of sexual violence.
• There is limited research on the most vulnerable and at risk groups of adolescents: young
married girls, adolescents who migrated to urban centers, and young unemployed boys.
• Data collection from existing youth interventions is often not disaggregated by age (10-
14, 15-19, 20-24), socio-economic status, living arrangement, migration, education, and
marital status.
• There is very limited sharing and dissemination of research findings from international
and national reproductive health partners.
Objective 4.1: Conduct program research and evaluation to design,

implement, and monitor effective programs addressing the diversity
of the young people in Ethiopia.
Strategies
Dissemination and utilization of tools, materials, and best practices
There is a wealth of existing tools, materials, and evidence regarding best practice in youth
RH. Sessions to share evidence-based studies need to be held so that the research findings can
be transferred into programs.
Sharing of information among youth-serving organizations

Sharing information and lessons learned among youth-serving organizations is needed to
develop skills and organizational capacity to become actively and constructively engaged in
designing youth programs.
Conduct socio-anthropological research

Strengthen the evidence base and data collection methods to increase understanding of
the sociocultural factors related to barriers and opportunities for adolescents to access RH
services. Identify factors that perpetuate HTP, early marriage, and low status of girls. Ensure
that research findings are well disseminated and that an ARH library is set up at different
levels within Ethiopia’s research institutions.
Collect disaggregated data for all youth programs

Clearly identify the different segments of youth targeted by youth interventions and collect
disaggregated data to monitor program effectiveness. Redesign registers in youth friendly
public health services to identify clearly who is being met by such services. Review HEWs and
CBRHA data collection tools to ensure that a youth component is part of community outreach
programs in rural areas.
SECTION V 29
MONITORING AND EVALUATION
Section V:
Monitoring and
Evaluation
The Government of Ethiopia considers monitoring and evaluation (M&E) crucial for planning,
monitoring and measuring results. AYRH indicators and data disaggregated by age, sex, school,
marital, residence, education, and living arrangement need to be instituted and integrated
throughout the national data systems. (See Annex D for a list of illustrative indicators.)
The AYRH M&E Framework will be further developed in the operational plan and will use
national and regional data sources for setting targets and planning. Formative assessment and
program research will be used to guide and inform program interventions.
The targets and key indicators will need to be integrated with the HSDP III, PASDEP and other
national goals stated in the development agenda. The data collection and recording at the health
facilities need to be harmonized with the on-going HMIS and health related indicators. There is
currently limited capacity of the existing national data management systems and careful work
to ensure a feed back mechanism links back into the monitoring and evaluation of existing
interventions.
One of the most important steps to be taken by the MOH will be periodic assessments of
strategy implementation. This will further identify strengths, weaknesses, and if necessary, the
need for adjustments. It will also chart process and successful results. Furthermore, steps will
be taken to establish a system of AYRH indicators incorporated into the national HMIS and
DHS to ensure effective monitoring of RH services.
Section VI:
The Way Forward
This National AYRH Strategy aims to formulate the vision, goals, objectives, and strategies,
and it provides a basis for future work and efforts in Ethiopia. This strategy took into
consideration an exhaustive consultation process representing an array of stakeholders,
groups, and organizations. The document also synthesizes key findings outlining the context,
challenges and opportunities that young people face regarding their reproductive health.
While this document will serve as a foundation, it represents only the first step in a larger
process that will see the proposed strategies evolve into concrete programs, initiatives, and
results.
To lead these efforts and actions, the Ministry of Health will coordinate the implementation
of the National AYRH Strategy and assume responsibility for its execution, supervision and
monitoring in collaboration with key stakeholders.
The next major step in the process will be to disseminate the strategy and formulate action
plans with active input from the central and regional levels. This process will make possible
the meaningful cost estimates that are in line with existing HSDPIII and the realization of the
MDG’s and PASDEP. It will also identify priority areas and gaps where donors, technical
organizations, and implementing partners can contribute. Once action plans are completed,
immediate efforts will be made to explore and identify opportunities to mobilize resources and
buy-ins from donors and key national and international partners.
SECTION VI 31
THE WAY FORWARD
To coordinate and harmonize youth RH activities and to facilitate the sharing of information, the
MOH will establish an adolescent RH interagency committee. This group will meet quarterly
to share information, to update on progress, and provide feedback and recommendations to
the MOH. It is proposed that the MOH appoint an AYRH national coordinator to facilitate the
work of this group.
The MOH will create multi-sectoral technical working groups made up of experts, stakeholders,
and implementing partners to advance key areas within youth RH. In some cases of linked
and cross-cutting priorities, other line ministries may take the lead. Immediate key priorities
include:
• The development of guidelines and national standards
• Exploring models of youth friendly services within the current context
• Training of health care providers and HEWs.

SECTION VII:
ANNEXES
• Annex A: Summary of Key Strategies for Different Segments of Adolescents
• Annex B: List of Illustrative Indicators
• Annex C: Definition of Terms
• Annex D: National Adolescent and Youth Reproductive Health Strategy

Development Committee
• Annex E: Bibliography
ANNEX A: Summary of Key Strategies for Different Segments of Adolescents
Strategies and Key Actions for the Different Segments
No. Segments Main Issues /RH risks Strategies Key Actions

.
10 to 14 • Train/sensitize community leaders,
1 • Sexual harassment /abuse,
boys and 1. Advocacy, awareness creation through religious leaders, kebele officials,
rape community mobilization at all levels
girls/urban, parliamentarians on SRH to
• Trafficking 2. Create safe spaces in kebele, churches, advocate on access to information
living
• Unwanted pregnancies, mosque (other suitable places); assign and services for 10 to 14
without
parents/
abortion (girls) mentors; and provide family life and sex • Select & train mentors from the
guardians, • STI/HIV/AIDS, boys and education community
out of girls (more likely girls) 3. Organize this cohort in RH/HIV and • Train peer promoters from this
school • Alcohol, chat, substance appropriate clubs segment (equal number of boys
abuse (boys) 4. Select and train peer promoters from the ad girls) on SRH to disseminate
• Gender inequality group and SRH and provide non-prescriptive
5. Provide youth friendly services at contraceptives in clubs and
community and facility levels different venues
6. Create referral linkage of RH/HIV/AIDS • Provide age appropriate family
clubs to health facilities at all levels. life education in clubs and other
7. Provide contraceptive services in health venues where this group gather,
facilities and outreach and clubs to • Train health professionals to
provide adolescents with dual protection provide youth friendly services to
against STIs /HIV/AIDS and pregnancy. this segment
8. Strength adult adolescent partnership • Provide outreach services through
9. Set up kebele AYRH committee with the Health Extension Program
members from all stakeholders and the • Awareness creation/sensitization at
youth all levels on the New Family Code
10. Provide youth friendly services at and Penal Code
community and facility levels. • Monitor and follow up
ANNEXES
SECTION VII
11. Mobilize mass media to promote implementation of SRH at the

adolescent RH using multi media community level by establishing
33
channels • Training on gender and its effects

on RH
No. Segments Key Issues/RH Strategies Key Actions
34
2 10 to 14 Same as above but to limited extent • Apply strategies 1, 3, 4, 5, 6, 8, 9, 11 • The above key actions apply
boys/girls /. • Create good communication between to this group
urban in young adolescent and parents • Provide training to parents
school • Provide age appropriate family life and guardians on RH ,
living with education in schools communication skills to
parents enhance communication
between parents and their
children
• Conduct TOT of teachers on
SRH
• Revise Family Life Education
3 10 to 14 • Early marriage. • Strategies 1 to 11 are applicable. • Key actions for the first group
girls rural in • Early child birth, leading to • Create Parent /teachers association apply to these groups as well
school/ out of pregnancy complications in schools and kebele committee to • Provide technical/material
school including fistula advocate, follow up on enrollment, support to parent and teachers
• Sexual violence including FGC, retention rate of female (male) students association
abduction, polygamy and rape for • Advocacy against early marriage and • Provide technical and material
girls other, gender violence and other HTPs. support to create safe space to
• Limited ANC, post natal and • Create safe places (church, mosque, child brides
postnatal care, unskilled delivery kebele) where the groups meet, support • Provide SRH training
leading to high MMR each other, exchange information and and family life education,
• Vulnerable to STI including receive SRH information and services. negotiation and assertiveness
HIV/AIDS (boys and girls), girls • Promote ANC, post natal and skilled skills to girls age 10 to 14
at increased risk of STI including delivery about to be married and who
HIV/AIDS, because of lack of • Encourage and provide incentives to have already married
economic resources and unequal bring married girls and boys (drop out • Train health extension
power relations with spouse, of school) back to school workers / CBRH to seek out
unable to negotiate condom use • Make schools gender sensitive (i.e. child brides and persuade
with older spouses separate toilets for girls and boys, them to come to health
• Boys are at risk of dropping out of reduce harassment of girls on the road facilities for ANC, post natal
school to work to schools) and delivery
Migrate to urban areas to live on • Organize RH/HIV/AIDs clubs in-
the street school and out-of-school
No. Segment Key Issues/RH Strategies Key Actions
. .
4 15 to 19 • RH risks (girls) - sexual • Strategies 1 to 11 apply to these • Key actions for age 10
girls/boys in- harassment, rape, abduction & groups. to 14 also apply to these
school /out- FGC and polygamy. • Youth friendly services at community groups
of-school/ • Risk of dropping out of school and facility levels • Training /sensitization
urban /rural due to poor performance (boys, • Family life education in schools/out of of parents /community
girls) due to work load (girls) school members/faith based
lack of support • Provide parents communication organizations on
• RH risks unwanted pregnancy, skills and sensitize them on SRH of SRH on HTP, gender
abortion, (girls) STI/HIV/AIDS. adolescents. based violence and
• Early marriage, early pregnancy • Advocacy on sexual violence and communication skills
and pregnancy communications HTP using community conversations • Training of health care
and unsafe abortion and dialogues providers to provide
• Migration to urban area only to • Create referral linkages between youth friendly services at
engage in transactional sex to schools and health facilities and community and facility
exchange sex for money or gifts outreach services level
(girls) and to live as street kids • Organize youth/ in school/out of • TOT of peer providers
(mostly boys but also girls) school RH/HIVAIDS clubs /gender and teachers on SRH
clubs • Training of SRH in clubs
• Provide contraceptives in places and community meetings,
where adolescent ages 15 to 19 informal gatherings,
congregate where young people
gather
ANNEXES
SECTION VII
35
No. Segments Key Issues/RH Strategies Key Actions
36
5 Young people 1. Unemployment, • Most strategies listed above apply to • Key actions identified above
20 to 24 2. Gender based violence, (rape, these groups apply to these group as well
in school abduction) • Skills and vocational training for • TOT for peer educators
(vocational 3. Unwanted pregnancy abortion gainful employment • Sensitization of community
training, 4. Exchange sex for money or gifts • Provide youth friendly services members on need of SRH
university), at 5. At risk of STI including HIV/ in vocational training schools and to young people married or
work or out- AIDs universities and colleges) and unmarried
of-school and workplaces, and where these group
not employed congregate and provide adequate
supply of contraceptive
• Peer education on SRH
• Strength referral network among health
providers and health providers and
young people.
• Integrate RH/HIV AIDS and livelihood
skill training
6 Orphans and Lack of parental support. Create a safe place where they can Key actions listed above apply
• • •
vulnerable • At high risk of STIs, HIV/AIDS meet support each other and obtain RH to these groups as well
adolescents • Lack financial resources to sustain information and services • Skill training for gainful
(10 – 19) themselves • Select and train from the group to serve employment
• Vulnerable to risky behavior: as peer providers • Provide credit for self
engaging in sex for gift/money, • Create livelihood opportunities employment
and exposed to life on the street • Train health providers (HEW, CBRH) • Train peer providers to
to seek out for them and provide them disseminate SRH information
information and services and services
• Create a network of referrals
ANNEX B: List of Illustrative AYRH Indicators
access and quality of reproductive health services for adolescents and young people of Ethiopia.
Objective 1.1: To improve access to quality reproductive health and STI/HIV services
Indicator Responsible
Illustrative Indicators Indicator Definition/Notes Data Source
Number Entity
Number of health facilities that offer youth friendly
1.1.1 In existing health facilities Program MOH
services.
% of health care providers at all levels trained on
1.1.2 Attitudes, services, new guidelines Program MOH
AYRH
% of adolescents who attend health facilities for RH/ Disaggregate by age (10-14, 15-19, 20- Survey; health
1.1.3 facilities MOH
FP/HIV prevention services. 24), gender, schooling, marital status registries
Number of referrals made to youth for RH, HIV
1.1.4 Effectiveness of outreach programs MOH
prevention, counseling and testing and other services.
Assessing the linkages between HEW Health
1.1.5 Referrals by health extension workers. facilities MOH
and other health facilities registries
Married and unmarried; area of
1.1.6 Contraceptive prevalence rate (CPR) DHS, HMIS MOH
residence, education, age
Married/unmarried, area of residence,
1.1.7 Condom ever use DHS CSA
age, education
For spacing, for limiting: age, marital,
1.1.8 Unmet need DHS CSA
residence, education, region
Focus on young married girls in rural DHS; health
1.1.9 % of adolescents who seek ANC facilities CSA MOH
areas registries
Focus on young married girls in rural DHS; health
1.1.10 % of adolescents who seek delivery care at facilities facilities CSA MOH
areas registries
Number of programs providing emergency obstetric . Accelerated training of nurses and
ANNEXES
SECTION VII
1.1.11 Program MOH

care at the community level health officer in midwifery skills
1.1.12 % of pregnant women tested for HIV HMIS HAPCO
37
1.1.13 Prevalence of STI Registry HAPCO

DHS CSA
1.1.14 HIV prevalence surveillance
sentinel sites HAPCO
2. To increase awareness and knowledge about adolescent reproductive health issues, which lead
to healthy attitudes and practices in support of young people’s reproductive health.
38
Objective 2.1: To influence community norms and attitudes to support adolescent reproductive health.
Indicator
Illustrative Indicators Indicator Definition/Notes Data Source Responsible Entity
Number
% of teachers, religious leaders, influential MOWA, MOYS,MOH,

Program
2.1.1 community members or mentors trained on AYRH, MOE CBOs, religious
research
sexual violence and gender inequities organizations, NGOs
Number of programs developed to encourage
MOWA, MOYS,MOH,
communities to discuss social norms associated Program
2.1.2 MOE CBOs, religious
with negative RH outcomes (HTP, sexual violence, research
organizations, NGOs
gender inequities)
MOWA, MOYS,MOH,
Program MOE, CBOs,
2.1.3 % of parents sensitized on YRH
research religious organizations,
NGOs
MOWA, MOYS,MOH,
Number of programs strengthening adults’ Program
2.1.4 MOE, CBOs, religious
communication skills on AYRH with adolescents research
organizations, NGOs
MOWA, MOYS,MOH,
Number of programs specifically involving men on Program
2.1.5 MOE CBOs, religious
AYRH, gender inequities and sexual violence research
organizations, NGOs
MOYS, MOWA, MOE,

2.1.6 Number of youth serving organizations Program
NGOs
Number of youth organizations reporting

2.1.7 involvement in program design and Program MOYS, MOE
implementation
Objective 2.2: To increase knowledge and information about reproductive health to empower
adolescents in making healthy sexual choices.
Number Entity
% of adolescents who know about sexual reproductive
2.2.1 Operational MOH, MOE
health (fertile period, STI/HIV prevention messages)
% of adolescents who know how to protect themselves Knowledge of AIDS, HIV prevention,
2.2.2 DHS MOH, MOE,
from unintended pregnancies. fertile period
% of adolescents who know how to protect themselves DHS Sentinel MOH /
2.2.3
from HIV and STI. sites Survey HAPCO
Area of residence, marginalized and Program MOE,
2.2.4 Number of youth reached by peer education programs
vulnerable groups Survey MOYS, MOH
Number of teachers trained on Family Life Education
2.2.5 Program MOE
(FLE) curricula.
2.2.6 Number of schools implementing FLE curriculum Program MOE
Number of non-formal education initiative
2.2.7 Program MOE, MOYS
implementing FLE curricula
3. To strengthen multi-sectoral partnerships and create an enabling positive environment at all levels, with line
ministries, research institutions, professional organizations, and partners, including communities and young
people, regarding the reproductive health needs of young adolescents and youth.
Objective 3.1: Increase knowledge and awareness of policy makers towards ARH.
ANNEXES
SECTION VII
Number Entity
3.1.1 Number of policy makers aware of AYRH Program
39
3.1.2 % increase of policies protecting youth RH and rights Program MOJ, MOWA
Number of community-based organizations advocating NGOs,
3.1.3 Program
for YRH religious orgs.
40
Objective 3.2: Decrease risks and vulnerability of adolescents and empower them to make healthy
transitions to adulthood.
Number Entity
Number of policies protecting adolescents

3.2.1 MOJ
against sexual violence and trafficking
3.2.2 Gross enrolment ratio MWS, DHS MOE
3.3.3 Parity Index Measures gender inequities MWS, DHS, CSA
Knowledge and support and prevalence for

3.3.4 DHS CSA
female genital cutting
CSA,HAPCO,
3.3.5 Multi-sexual partner DHS Program
MOH
MOLSA,
3.3.6 Number of RH programs linked to livelihood Program MORAD, MOE,
MOH
MOYS, MOWA,
3.3.7 Number of social networks Program
NGOs
Safe spaces are desegregated by .

3.3.8 Number of safe spaces Program
gender, age, living arrangement
Objective 3.3: Increase coordination and collaboration among all partners
Indicator
Number
MOH, MOYS,
Existence of a functional multi-sectoral
MOWA, MOLSA,
3.3.1 adolescent reproductive health working group MOH position at the federal level Program
MORAD, NGOS,
within the National RH Task Force
FBOs
MOYS, NGOs,
Number of youth programs based on a multi-
3.3.2 Multi-sectoral Survey MOH, MOE,
sectoral approach
MOLSA
MOH, MOYS,
Number of line ministries and partners actively
MOH takes the lead in organizing MOWA, MOE, MOJ,
3.3.3 involved in federal and regional working Survey
working groups MOLSA, MORAD,
groups
NGO, FBO
Number of organizations that deliver Survey; MOE, MOH, MOYS,
3.3.4 consistent gender messages to youth and operational MOWA, MOLSA,
influential adults research NGO, FBO
ANNEXES
SECTION VII
41
4. To design and implement innovative and evidence-based AYRH programs that are segmented and tailored to
42
meet diverse needs of youth by marital status, age, school status, residence, and sex, including younger adolescents
and marginalized and most vulnerable young people in the context of Ethiopian priorities and culture.
Objective 4.1: Conduct program research and evaluation to design, implement, and monitor effective
programs addressing the diversity of the young people in Ethiopia.
Indicator
Number
Number of studies conducted to understand Research institutions

4.1.1 youth behaviors, with a focus on youth at Program and professional
increased risks and marginalized groups organizations
Number of organizations that implement at Need the skills to transfer the research
MOH, MOYS, MOE,
4.1.2 least one best practice, by organization and by findings into effective program Program
NGOs
type designs
SECTION VII 43
ANNEXES
Annex C:
Definition of Terms
1. Access is the extent to which a person can obtain appropriate services at a cost and effort
that is both acceptable to them personally and within the means of a large majority in a
given population.
2. Adolescence is a period of dynamic change representing the transition from childhood

to adulthood and is marked by emotional, physical, and sexual maturation. Habits that
are formed during adolescence had major effects in adulthood.
3. Adolescents: The World Health Organization defines adolescents as young people ages
10-19 years.
4. Early adolescence corresponds to ages 10 to 13 and is characterized by a spurt of

growth and the beginnings of sexual maturation. Young people start to think abstractly.
(WHO)
5. In mid-adolescence (ages 14-15), the main physical changes are completed, while the
individual develops a stronger sense of identity and relates more strongly to his or her
peer group. Families usually remain important.
6. In late adolescence (ages 16-19), the body fills out and takes its adult form, while the
individual now has a distinct identity and more settled ideas and opinions. (WHO)
7. Young people or youth: 15 to 24 years old.
8. Contraception: See next page.

Contraception methods for young people:
No medical reasons currently exist for denying any contraceptive method based on
young age alone.
Contraception options include:

• Abstinence. No sexual intercourse but other forms of sexual expression were possible.
• Barrier methods. Male and female condoms, spermicides, diaphragm, and cervical cap.
Consistent and correct use is key to effectiveness. Success of this method depends on
partner participation and on negotiating skills. Male condoms are the most effective
method in terms of protecting against all types of STIs, including HIV.
• Oral contraceptives are safe for young women and very effective but do not protect
against STIs
• Injectables and implants are safe for young women and a very effective means of
contraception if used correctly. No STI protection.
• Sterilization is generally not appropriate for young adults because it is permanent.
• IUD offers long term protection, quick return to fertility, safe for young women at low
risk of STIs. No protection against STIs including HIV.
• Lactation Amenorrhea Method (LAM) is an effective method for women who are
amenorrheic and breast feeding up to six months post partum.
• Emergency contraception prevents pregnancy after unprotected intercourse but is not
meant to be a regular method and provides no STI protection.
9. Dual protection: For many sexually active young people, this means using a condom to
prevent against STIs and HIV infection and another form of contraception (hormonal) to
protect against unintended pregnancy.
10. Counseling: To discuss reproductive health issues and choices, guiding the client to make
informed decisions regarding his or her reproductive life while respecting confidentiality
and privacy.
11. Malnutrition: Adolescent boys and girls have a need for extra nutrition as they grow
rapidly and develop. An inadequate diet can delay or impair healthy development.
Stunting can occur in childhood or during adolescence. In girls, poor nutrition can delay
puberty and lead to the development of a small pelvis. Malnourished adolescent mothers
are more likely to experience negative obstetric outcomes (obstructed labor and fistulae).
Malnourished adolescent girls are at increased risk of being anemic and are more likely
to give birth to low birth weight babies and are at increased risk of maternal mortality
(WHO).
12. Menarche: A girl’s first menstruation.

SECTION VII 45
ANNEXES
13. Puberty: A period of rapid change that occurs primarily in early adolescence, involving
hormonal and body changes.
14. Outreach services refer to extending health services beyond facilities to youth centers,
youth clubs, markets booths, bus stations booths, and pharmacies through community
outreach workers − health extension workers, community-based RH agents, teachers,
community members, peer educators, peer counselors, and others.
15. Peer: Children or adolescents who are of about the same age or maturity.
16. Reproductive health is a state of physical, mental and, social well being, not merely
the absence of diseases or infirmity, in all matters related to the reproductive system
and its functions and process. It also includes sexual health, the purpose of which is the
enhancement of life and personal relations, and not merely counseling and care related
to reproduction and sexually transmitted diseases. (ICPD, Program of Action, para 7.2)
17. Rights: Something that an individual or a population deserves, which they can legally
and justly claim.
18. Rights on sexual and reproductive health. These are rights specific to personal decision
making and behavior on reproduction including access to RH information, privacy,
guidance from trained personnel, obtaining RH services free from discrimination, and
no coercion or violence in one’s sexual life.
19. Rape is forcible sexual intercourse with a person who does not consent to it.
20. Sexual coercion: Forced sex. Studies have linked sexual coercion during childhood
to increased consensual unsafe sexual activity during adolescence and also increased
likelihood of multiple partners, and increased risks of unintended pregnancy, STIs,
abortions, and mental health problems.
21. A service provider is a skilled health worker who can offer services according to the
health needs of young people. Non health workers within settings and outlets that provide
health services to youth need to be oriented on AYRH issues.
22. Sexually Transmitted Diseases (STDs). These are diseases that are transmitted
primarily through sexual contact. The contact is not limited to vaginal intercourse but
includes oral-genital contact as well.
23. Youth friendly services: Making services youth friendly is not primarily about setting
up separate dedicated services, although the style of some facilities may change. The
greatest benefit comes from improving generic health services in local communities
and by improving the competencies of health care providers to deal effectively with
adolescents. Key criteria for developing youth friendly services:
Characteristics of adolescent friendly health services

Adolescent friendly procedures to facilitate
• easy and confidential registration of patients, retrieval and storage of records, short
waiting times, and (where necessary) swift referral
• consultation with or without an appointment
Adolescent friendly health care providers who

• are technically competent in adolescent specific areas and offer health promotion,
prevention, treatment, and care relevant to each client’s maturation and social
circumstances
• have interpersonal and communication skills, are motivated and supported, are non-
judgmental and considerate, easy to relate to, and trustworthy
• devote adequate time to clients or patients, act in the best interests of their clients, .
treat all clients with equal care and respect
• provide information and support to enable each adolescent to make the right free
choices for his or her unique needs.
Adolescent friendly support staff who are

• understanding and considerate, treating each adolescent client with equal care and
respect
• competent, motivated, and well supported.
Adolescent friendly health facilities that

• provide a safe environment at a convenient location with an appealing ambience
• have convenient working hours
• offer privacy and avoid stigma
• provide information and education material.
Adolescent involvement, so that they are

• well informed about services and their rights
• encouraged to respect the rights of others
• involved in service assessment and provision.
Community involvement and dialogue to

• promote the value of health services
• encourage parental and community support.
Community based, outreach and peer-to-peer

• services to increase coverage and accessibility
• appropriate and comprehensive services that address each .
adolescent’s physical, social and psychological health and development needs
SECTION VII 47
ANNEXES
Characteristics (Continued).
• provide a comprehensive package of health care and referral to other relevant services
• do not carry out unnecessary procedures
Effective health services for adolescents

• that are guided by evidence-based protocols and guidelines
• having equipment, supplies and basic services necessary to deliver the essential care
package
• having a process of quality improvement to create and maintain a culture of staff
support.
Efficient services which have

• a management information system including information on the cost of resources
• a system to make use of this information
Source: WHO Global Consultation 2001 and 2002 WHO expert advisory group meeting
24. Vulnerable groups: These include young people who are hard to reach, for example:.
• are denied the opportunity to complete their education

• have no stable home or support, living rough in towns and cities, exposed to risks of
malnutrition, abuse, violence and disease
• are vulnerable to sexual abuse or violence, or are sexually exploited by people who
are older and more powerful
• work long hours for little pay
• live in areas torn by conflicts
• are displaced into camps where traditional values and community structures are
impossible to maintain
• live as young adolescent wives in families who have limited understanding of the
increased risks of negative reproductive health outcomes associated with early
marriage. .
Annex D:
National Adolescent and Youth Reproductive
Health Strategy Development Committee
Name of Organization Name of Focal Person Position
Federal Ministry of Health Dr. Tesfanesh Belay Lead Member
Federal Ministry of Health Dr. Michael Tekie Member
Federal Ministry of Health/WHO Dr. Ayele Debebe Member
Federal Ministry of Education Takele Alemu Member
Ministry of Rural Development Abaynesh W/Giorgis Member
Ministry of Youth and Sport Seleshi Tadesse Member
UNFPA Nibretie Gobezie Chairperson
UNFPA Dr. Kidane G/Kidane Member
UNFPA /CST Anne Domatob Member
UNFPA/Country Representative Dr. Monique Rakotomalala Member
Former National Committee on
Abebe Kebede Member
Traditional Practices (EGLDAM)
FGAE Adinew Husien Member
Ipas Ethiopia Dr. Solomon Tesfaye Member
Pathfinder International Worknesh Kereta Member
Pathfinder International Gwyn Hainsworth Advisor/Distant
CORHA Ms. Jerusalem Member
Ethiopian Youth Network Atkilt Bekele Member
Ethiopian Youth Network Efrem Tesfai Member
FHI Konjit Kifetew Member
DSW Mekdes Alemu Member
USAID Dr. Kidest Lulu Member
UNICEF Dr. Alemach T/Haimanot Member
WHO Dr. Abonesh Hailemariam Member
Packard Foundation Yemisrach Belayneh Member
Population Council Tekle-Ab Mekbib Member
Population Council Judith Bruce Advisor/Distant
Health Communication Partnership Konjit Worede Member
FMOH/UNFPA Daniel Meshesha Consultant
FMO/FHI YouthNet Marie Eve Hammink Consultant
Packard/FHI YouthNet Fetlework Ketsela Consultant
Photo credits: FHI, Packard Foundation, UNFPA and photographer Tiina Tuppurainen
SECTION VII 49
ANNEXES
ANNEX E:
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Youth Conversation on HIV prevention and care over coffee ceremony
Ministry of Health
P.O. Box 1234
Tel. 251-11-5517011

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Youth Conversation on HIV prevention and care over coffee ceremony

Federal Democratic Republic of Ethiopia

Dr. Tesfanesh Belay CNM, MD, MPH

The vision of the National AYRH Strategy is:

Tedros Adhanom Ghebreyesus (PhD)

ANC Antenatal Care

MDG Millennium Development Goal

The strategy is fundamentally grounded in major principles that recognize the

Vision of the National AYRH Strategy:

3. To strengthen multi-sectoral partnerships and create an enabling positive environment

5 Mensch B et al. 1998

Programs must be based on development-oriented and rights-affirming principles:

Address the needs of youth through a holistic approach:

The recognition that gender differences are fundamental in framing AYRH:

Promote youth involvement, youth leadership, and youth-adult partnerships:

Design and plan for scale-up and replication:

7 MOFED. 2005; PASDEP:4

Status of Adolescent Girls and Young Women

Female Genital Mutilation/Cutting (FGM/FGC) is widespread in Ethiopia, with more than

Early Sexual Debut

Age at First Marriage

Early Child Bearing

Figure 1: Teenage Pregnancy and Motherhood 35

Source: EDHS 2005

Unwanted pregnancy is one of the major RH challenges faced by adolescents in Ethiopia. As

35 EDHS. 2005:56. Percentage of women ages 15-19, who have .

Figure 2: Percentage of Planned Births

Source: CSA Analysis 2002

Knowledge and Use of Family Planning Methods

Figure 3: Percentage of Pregnancies Terminated, by Age

Source: CSA Analysis 2002

HIV/AIDS and STIs

40 CSA and ORC Macro. 2005

Existing Services and

Family Life and Sexuality Education

Strategies for the

3. To strengthen multi-sectoral partnerships and create an enabling positive environment

Goal 1: To meet the immediate and long-term RH

Objective 1.1: To improve access to quality reproductive health and

Box 1: Example of Tailored Approaches

Young adolescent girls (10-14) Highly vulnerable groups in urban areas

Develop and revise national guidelines and standards

Develop outreach programs

Box 2: Examples of Outreach Programs

Health care providers can go to where adolescents are, such as

Enlist participation of boys/men, gatekeepers such as mothers-in-law or other family

Goal 2: To increase awareness and knowledge about

Objective 2.1: To influence community norms and attitudes to

Engage parents, family members to enhance family dialogue on reproductive health

Establish channels of communication between adolescents and adults

Objective 2.2: To increase knowledge and information about

Box 3: Segmented Approach to Behavior Change Communication

Young Adolescents Sexually Active Youth

• Emphasize delay of sexual debut • Emphasize messages to reduce HIV

Harmonize and strengthen peer promoters and educators programs

Strengthen the role of media and edu-tainment for youth

Goal 3: To strengthen multi-sectoral partnerships

Objective 3.2: Decrease risks and vulnerability of adolescents and

Box 4: Cross Cutting Strategies

Education level is strongly associated with positive RH