Courtney L. Boudreau, MPH, Pathfinder International; Rachel Rifkin, MPH, Pathfinder International; Sarah Baird, PhD, George Washington University; GAGE Consortium
Children are an investment in the future we wish to create. Research has demonstrated the importance of working with very young adolescents (VYA) — a crucial time when health behaviors and gender norms are formed, which can shape their health and wellbeing for the rest of their lives. In Ethiopia, there are over 13 million VYA between the ages of 10 and 14. COVID-19 is likely to have a substantial effect on Ethiopia and it is vital that we consider the impact on VYA—an impact that is likely to vary substantially by gender.
Since 2018, Pathfinder International, CARE International, and the Government of Ethiopia have partnered to implement Act With Her, a five-year multi-sectoral project designed to lay the health, education, and social foundations that adolescent girls and boys need to thrive. The project was co-designed with, and is being evaluated by, the Gender and Adolescence: Global Evidence (GAGE) Consortium. We take a holistic view of adolescent wellbeing, considering economic empowerment, health, education and more. Act With Her involves regular discussion sessions with adolescents, with some communities implementing parents’ groups, systems strengthening activities, and community-led meetings to discuss harmful norms.
The pandemic will impact all domains of adolescent life, but there is hope that when projects like Act With Her are in place prior to the outbreak, the impact of such shocks may be mitigated. So, what are the areas where VYA may be particularly vulnerable during the outbreak? And how might a program such as Act With Her increase adolescent resilience to the crisis?
The Ebola epidemic in West Africa reaffirmed our understanding that acute health crises have impacts beyond immediate physical health. Much has already been written about the gendered impacts of pandemics, but the pandemic will impact VYA in ways that are both gendered and age-specific. We anticipate several major implications of the crisis for VYA in Ethiopia, each of which is influenced by prevailing gender norms:
- While schools are closed, adolescents may become involved in income-generating activities and may not be able or permitted to return to schools once they reopen. Upon schools reopening, boys’ education is likely to be prioritized over that of girls. The timing of closures is particularly risky for VYA: this is the age that they transition from primary to secondary school, a transition which is already difficult for girls.
- Being out of school places girls at a higher risk for early marriage, while conversely, early marriage often means the end of girls’ education.
- Young married adolescents are particularly vulnerable to violence: early marriage is associated with higher rates of intimate partner violence (IPV), and disasters and emergencies have been found to increase rates of IPV.
- Adolescent girls may engage in transactional sex to meet their basic needs and cope with negative income shocks, as seen during the Ebola outbreak.
- Sexual IPV and transactional sex will lead to unintended pregnancies and adverse sexual and reproductive health (SRH) consequences for VYA.
- The pandemic may increase rates of violence against VYA. In one study, nearly all Ethiopian adolescents surveyed reported physical punishment by their parents. Spending more time at home and economic impacts may increase parental stress, which may increase violence against children.
- There is concern that VYA may be vulnerable to exploitation and abuse by aid workers as response efforts begin.
- The pandemic and associated impacts will lead to worse mental health outcomes for VYA who may have not yet developed coping mechanisms. GAGE mixed-methods research pointed to “a considerable number of adolescents who are stressed and anxious for a variety of reasons, including financial poverty, educational performance, and violence at home and in the community, all of which will be exacerbated by the pandemic.
- Food shortages will impact adolescent food security and nutrition outcomes, and boys’ consumption is likely to be prioritized over that of girls.
The potential impacts described are compounded by the fact that the coronavirus pandemic will tax health systems’ ability to provide key social and health services (violence response, mental health, child protection, and SRH). This is further exacerbated by school closure as schools are potentially a place for VYA to connect with resources or seek help.
The good news is that programs like Act with Her can potentially have a protective effect during crises. During the Ebola crisis, researchers found that girls in empowerment or life skills clubs were less likely to drop out of school, and less likely to spend time with men than girls in control communities. Although direct programming is currently on hold, we hope that Act With Her programming (which has been implemented for 10 months in most project communities) has created the foundation for individual and community resilience that will mitigate the impact of COVID-19. Some possible mechanisms for increased resilience are reflected in stories recently collected from Act With Her participants:
- Backyard gardens: VYA are now growing backyard gardens, which could provide nutrition or generate an income during the pandemic.
- Gender norms: Boys noted they now help sisters and mothers with housework traditionally assigned to women, allowing girls time to study and play. These norm shifts may reduce COVID-19’s disproportionate impact on women and girls.
- Attitudes towards early marriage: Community members reported less support for early marriage, which could prevent families from resorting to this option.
- Negotiation: Girls described improved communication and negotiation skills along with increased confidence, which could aid them in efforts to return to school or avoid early marriage.
- Savings accounts: Adolescents indicated opening savings accounts, which could buffer the pandemic’s economic impacts.
- Water, Sanitation, and Hygiene (WASH): VYA reported improved WASH practices, such as washing their hands before meals and after using the restroom, potentially leading to reduced virus transmission.
- Improved social supports: VYA noted improved relationships with family and friends, which could help mitigate the mental health impacts of the pandemic.
The framework below outlines the potential impacts of the COVID-19 pandemic on VYA, and the potential protective factors associated with empowerment programs.
GAGE’s ongoing longitudinal research and cluster randomized control trial will shed further light on which aspects of Act With Her, if any, were effective in mitigating the impact of the COVID-19 pandemic. In early April, GAGE conducted a rapid assessment that explored older Ethiopian adolescent experiences and priorities in the initial phase of the outbreak. In the meantime, there are a number of recommendations for ways to reduce the gendered impacts of the current crisis as well as apply lessons from behavioral science to ensure we are protecting vulnerable populations, including VYA.