Across our world, the rights and dreams of girls are either fortified or threatened in various ways. This year, International Day of the Girl is a rallying ask for change dedicated to championing the rights of girls everywhere. But what rights are we fighting for? 

From securing access to family planning and other crucial sexual and reproductive health (SRH) services to targeting adolescent pregnancy and child marriage, the right to health is a necessity for girls to actualize their potential. At CARE, we believe that positive gender and social norms, alongside access to quality SRH services, have pivotal impacts on adolescent girls‘ lives. Two of CARE’s recent programs, AMAL and IMAGINE, have demonstrated evidence addressing a range of issues affecting adolescent girls with the shared mission of bringing the right to health within reach for every girl.  

The Adolescent Mothers Against All Odds (AMAL) Initiative 

In areas of long-term protracted crises, adolescent girls experience unique vulnerabilities relating to early and forced marriage, adolescent pregnancy, and sexual violence. Despite this increased risk, response efforts often leave adolescent girls behind. The AMAL Initiative is designed to address this gap by meeting sexual and reproductive healthcare needs and building life skills of married adolescent girls in humanitarian settings. AMAL creates spaces for adolescent girls to meaningfully participate in and inform programming, while shifting community perceptions on inequitable gender, power, and social norms.

The AMAL Initiative includes three components:

  • a Young Mothers Club for pregnant girls and first-time mothers,
  • participatory dialogues with health providers, and
  • reflective dialogues with girls’ family and community members. 

Photo Credit: CARE

AMAL was first implemented in 2019 in northwest Syria. Since then, it has scaled-up across Syria, Nigeria, and Somalia. CARE’s AMAL package has been adopted by other organizations for expansion into Jordan and Lebanon. Across these sites, AMAL has generated powerful evidence of the impact of addressing social norms on the well-being and use of family planning (FP) among adolescent girls.

Girls reported experiencing a 43% increase in self-esteem, and 50% increase in confidence seeking health care.

Community support for girls’ use of family planning increased by 23% and health providers increased their comfort providing FP to adolescents by 32%. Facility data found that adolescent uptake of FP doubled, and skilled birth attendance increased by 15%.  

With the face of fragile contexts becoming increasingly young, the AMAL Initiative seeks to inform the global evidence base and dialogue around nexus approaches to adolescent responsive SRH and gender programming.

The Inspiring Married Adolescent Girls to Imagine New Empowered Futures (IMAGINE) program 

Globally, million of girls under the age of 20 are married and give birth soon after. IMAGINE was vital to address contraceptive use and pregnancy choices among adolescents in Niger and Bangladesh.  The project designed and tested interventions that hold promise for delaying the timing of first birth among married adolescents (ages 15-19) and help them pursue alternative paths to early motherhood across both countries.  

Photo Credit: Josh Estey/CARE
IMAGINE end-evaluation findings are promising.

Girls Collectives provided a great safe space for participants to learn a complete set of life skills, including SRH and financial literacy, and Couples Counseling empowered men and woman to plan for their families together. Adolescents have embraced the power of choice, in Niger with 34.1% of the treatment group subscribing to contraceptives (19.1% control group).​ Knowledge bloomed with 99% of the treatment group adolescents knowing where to access FP in Bangladesh (97% control). Helping health care workers to address their bias and improve their knowledge, attitudes, and practices to make SRH services more youth and gender responsive also led to a decline in beliefs in FP myths.    

Other interventions contributed to these results, such as vocational trainings for girls, and activities related to challenging social norms such as Male Allies groups (called FADA) and community dialogues facilitated with CARE’s signature approach on gender transformation, the Social Analysis in Action (SAA) tool.  

A call to action 

Empowering adolescent girls and ensuring their health rights is an ongoing journey. Research shows that for every dollar invested in adolescent-focused programming, there is an estimated ten-fold health, economic and social return. But today, less than two cents of every dollar invested in development initiatives goes to adolescent girls.

CARE’s work demonstrates that supporting girls to realize their full potential and agency requires addressing societal norms, service access, and gender dynamics. While there is no one-size-fits-all solution, effective health programming necessitates ongoing reflection, adaptation, and transformation. As we innovate and adapt, we imagine a world where adolescent girls have autonomy over their lives and bodies, access to quality health services, and agency to actualize their dreams, against all odds.  

The Conversation

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