Menstrual Health in Ethiopia Sponsored by the Bill and Melinda Gates Foundation

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Executive Summary:

Ethiopia has seen strong macroeconomic growth, with experts forecasting this trend to continue in coming years. The average annual GDP growth for the past decade has been nearly 11%, making the Ethiopian economy one of the fastest growing in the world. 1 Income inequality has also decreased significantly during that time. 2 However, women and girls continue to face a broad set of gender inequities and are influenced by discriminatory social norms that negatively affect their health, empowerment, and well-being.

Data suggests that many of these social norms and inequities become more pronounced with the onset of puberty. It is common for parents and family members to try to control her mobility and emerging sexuality. A 2010 study in the Amhara region shows that 52% of girls were married by age 15 and 80% of girls were married by age 18. 3 A 2010 survey shows 74% of rural Ethiopian women have undergone female genital mutilation/cutting (FGM/C). 4 Ethiopia has the second highest prevalence of FGM/C in Africa. 5

Significant barriers to high-quality menstrual hygiene management (MHM) also persist across Ethiopia and remain particularly high in rural and remote areas. Girls do not consistently have access to education on puberty and menstrual health, and 67% of girls across Ethiopia reported receiving no education on menstruation at school. 6 Approximately 80% of women and girls in rural areas use homemade alternatives, and just over a quarter of the population in both rural and urban settings has access to improved sanitation. 7, 8

Although there is evidence in Ethiopia illustrating enablers and barriers to MHM, the evidence linking the impact of poor menstrual health, an encompassing term for menarche and MHM, to life outcomes is limited. Current studies have small sample sizes, and they rely on qualitative, self-reported, or anecdotal data making it difficult to generalize findings across different types of adolescent populations and diverse regions which have different cultural and socio-economic contexts.

There has been limited momentum from donors and NGOs to address problems related to MHM and only recent interest from the national government. 

While immediate opportunities exist to better support menstrual health for women and girls in Ethiopia, including improving access to menstrual health education and MHM products, an MHM approach alone may not be enough. Given finite resources and prevailing issues of gender inequity, experts suggest that there is a need to prioritize research and programming on issues of gender inequality and the role of social norms to improve women and girls’ health, development, and empowerment outcomes.

Methodology

This report seeks to understand: (1) the current state of girls’ experience with menarche and MHM in Ethiopia, (2) the donor, government, and NGO responses to girls’ needs, and (3) opportunities for research, advocacy, and programming to better address these needs. This complements a Global Landscape Analysis and is one of three Country Landscape Analyses focused on India, Kenya, and Ethiopia.

This report is the result of a review of over 50 peer-reviewed articles and grey literature, 30+ interviews with experts and practitioners in Ethiopia, and a review of relevant programming focused on menstruation and MHM. The country research for Ethiopia was also informed by 18 interviews with adolescent girls from Debre-Birhan, a rural area in Ethiopia, in the following categories: (1) early post-menarche 0 to 1 year post-menarche, (2) postmenarche 1 to 3 years post-menarche, and (3) late post-menarche 3+ years post-menarche to 18 years old. Interviews were also conducted with 7 influencers including mothers, sisters, teachers, and a community health care worker. The research location was chosen based on the following criteria: (1) proximity to Addis Ababa, (2) access to girls, and (3) feasible access to moderators.