Left out? Coverage of adolescent reproductive health programmes in Ethiopia’s capital

In sub-Saharan Africa, most adolescent reproductive health (RH) programmes are at the pilot stage and scaling these up remains a challenge. But are they reaching the intended people? A study conducted by the Population Council and the Ethiopia Ministry of Youth and Sports, looks at the coverage of youth programmes in two slum areas of Addis Ababa, Ethiopia.

Manystudies have shown an impact of youth programmes on reproductive health (RH)knowledge and attitudes, but fewer have demonstrated behaviour change. Weaknessesof current youth programmes include the narrow focus on fertility, familyplanning and HIV without regard for adolescent boys' and girls' diversity andthe range of local contexts in which they grow up.

Thisstudy looked at the coverage of different sub-groups of young people of the eightpeer education programmes and six youth centres operating in low income andslum areas of Addis Ababa. Most of the programmes are run by local andinternational non-governmental organisations. They offer some recreational equipment,along with RH education activities such as videos or group discussions. Allhave some HIV-related content and some include family planning information andcondom distribution.

Apopulation-based survey was conducted of more than 1,000 adolescents aged 10 to19 living in the programmes' catchment areas.Adolescents were asked if they had had contact with a peer educator in the lastyear or had visited a youth centre. In analysing who the programmes had reachedthe results showed that:

• Boyswere roughly twice as likely to have been reached by youth programmes comparedto girls: in the last year, 20 percent of boys and seven percent of girls hadvisited a youth centre, while 27 percent of boys and 15 percent of girls hadhad contact with a peer educator.
• Olderadolescents, especially older boys, are most likely to be reached by youthprogrammes.
• Girlswho work long hours and who are isolated, such as domestic workers, are leastlikely to be reached by programmes and benefit from them.

Thisresearch shows that programmes may not be reaching the most vulnerable groupsof young people. Patterns of work, mobility and social networks are genderedand may affect whether a young person takes part in a programme. To ensure thatyouth programmes achieve the greatest impact as they scale up, the researchersrecommend:

• targetingsub-groups of adolescents in the design and content of RH programmes
• payingattention to the specific circumstances of young people in the local setting,particularly vulnerable, hard-to-reach sub-groups, including girls
• monitoringwho the programmes do and do not reach
• using other strategies to reach girls moreeffectively, such as outreach at the household level or single-genderprogrammes, or other models such as livelihoods programmes or non-formaleducation.