Promoting Opportunities for Adolescent Girls in the Sahel Region through Evidence-Informed Programming

This A3 Insights describes key elements of the Population Council’s work on the Sahel Women’s Empowerment and Demographic Dividend initiative (SWEDD), which aims to reduce risks and promote opportunities for adolescent girls and young women. The work described in the blog post is executed through UNFPA, the organization tasked with overseeing SWEDD activities and providing technical assistance to SWEDD countries in collaboration with its technical assistance partners (including Population Council). Subsequent posts will cover lessons learned, insights generated, and other related themes from the Council’s SWEDD project. This piece was authored by Miriam Temin (Project Co-Director) primarily, and Anne-Caroline Midy (Project Coordinator).  

Unique challenges facing adolescent girls and young women in the Sahel region

During the dynamic life phase of adolescence, many girls in West Africa’s Sahel region grapple with multiple threats to their health and well-being, undermining their potential to access their rights and thrive as adults. Many of these challenges are complex and multi-factorial, reflecting intersecting, long-standing forces and systemic issues. Indeed, the region includes countries with some of the highest rates of poverty, food insecurity, conflict, and population displacement in the world.

The  adolescent indicators dashboard from the GIRL Center’s Adolescent Atlas for Action (A3) provides data for a closer look at various threats in Sahel countries. Using data from nationally representative surveys in Benin, Burkina Faso, Cameroun, Côte d’Ivoire, Guinea, Mali, Mauritania, and Niger, the adolescent indicators dashboard makes a strong case for urgent action for girls and young women in the Sahel.

For example, the dashboard shows that in Mali, Guinea, and Cote d’Ivoire,  over 20% of adolescent girls have given birth at least once, while in Niger, Mali, and Burkina Faso, that statistic exceeds 30%. 61% of adolescent girls were married or living in union in Niger. In Mali and Guinea, over 60% of adolescent girls consider wife beating justified. Strikingly, the dashboard also highlights that Niger, Guinea, and Mali are among the countries with the highest prevalence of illiteracy in the world, with the vast majority of adolescent girls being unable to read a whole sentence.

Supporting the use of evidence and resources by government and implementing partners

While the Sahel historically has been underserved by overseas development assistance, the current moment provides exciting opportunities as more bi- and multilateral organizations make the Sahel region (and more specifically, French West Africa [FWA]) a priority. Large investments offer the possibility of supporting governments and civil society, growing capacity, and strengthening the evidence base to reduce risks and enhance opportunities for girls.

Starting in early 2020, the Population Council stepped into this landscape as part of the World Bank’s Sahel Women’s Empowerment and Demographic Dividend (SWEDD) Initiative, building on our existing and recent portfolio of FWA research and deep adolescent girl expertise.

Funded by the World Bank to the tune of over US$700 million[1] for the period 2014-24, SWEDD’s overall aim is to “increase women and adolescent girls’ empowerment and their access to quality reproductive, child and maternal health services in selected areas of the participating countries” by reducing child marriage, early pregnancy, and girls’ school leaving, inter alia.

SWEDD is a regional activity, expanding from an original six to the current set of nine countries (Benin, Burkina Faso, Cameroun, Cote d’Ivoire, Guinea, Mali, Mauritania, Niger, and Tchad).[2] The governments of these countries lead the initiative, with participation from multiple ministries and implementing partners. Taken together, the range of SWEDD activities was established to position these countries to reap a demographic dividend, whereby rapid economic growth is possible under the right conditions when the size of the young, dependent population shrinks relative to the size of the population of working adults.

Within SWEDD, the Council uses evidence and our capacity, relationships, and tools and other program resources to support activities that target adolescent girls and young women. We do so by strengthening national and sub-national capacity to make evidence-informed use of SWEDD resources based on our large body of evidence on what works and what doesn’t work to reach marginalized adolescent girls and reduce their risks. We aim to increase the quality of SWEDD programming through process documentation; training for managers and implementers on key skill sets; implementation science; regional capacity strengthening workshops, and other activities that aim to promote the use of evidence for action.

For instance, we drew upon effective Council programs to create a second-generation curriculum for mentors in SWEDD’s safe spaces, as well as a bespoke safe spaces minimum standards guide. We developed instructional materials to guide implementers on topics such as non-formal literacy training and operating community-based girl groups during the COVID-19 pandemic. Providing focused technical assistance and strengthening capacity to improve monitoring, evaluation, and learning functions is also a priority area that leverages the Council’s expertise and programmatic resources.

Addressing gendered risks through a multi-sectoral and multi-level approach

SWEDD is uniquely designed to take on the social and structural drivers of gendered risks through a package of programming that is multi-sectoral and works at multiple levels. Its interventions address individuals, communities, local government representatives, and policymakers through the health sector, schools, communities, and demographic researchers. This reflects the importance of socio-ecological approaches to sustainably reduce girls’ risks, based on evidence from the Council and elsewhere.

Recognizing that individuals underlie the summary statistics shared above, the bulk of the Council’s inputs and the largest SWEDD components directly engage community members and adolescent girls and young women (AGYW). Through life skills training in mentor-led safe spaces (espaces surs) groups in communities and schools, mentors aim to equip AGYW with knowledge, skills, and assets to empower them and enable them to navigate risk. In an effort to reap the proven benefits of gender-transformative programming, we support partners to create synergies between safe spaces and SWEDD clubs for husbands and future husbands (clubs des maris et des futurs maris).

Looking ahead: Using early SWEDD lessons to sustain and scale country-owned action

As country-level actors implement the second phase of SWEDD and plans for the third phase take shape, Population Council, along with other technical partners, has a continuing role in promoting evidence, good practice, and learning. Given SWEDD’s large size and ongoing expansion, it will be important to build upon the essential enablers of program success to continue to sustain and scale country-owned action. The multi-sectoral and multi-leveled approach offers countries the opportunity to bring evidence-informed practice together in intentionally selected geographies or ‘hot spots’. Governments in participating countries lead the charge, demonstrating their commitment to SWEDD goals through the involvement of multiple ministries and laying a foundation for sustainability. Furthermore, ownership of SWEDD extends to communities and local opinion leaders including through the active participation of religious leaders in many countries, accounting for the strong influence of community norms in influencing the impact of adolescent girl programming.

At this stage, it is equally vital that lessons from the early days of SWEDD are available and informing expansion, leveraging the regional aspect of the initiative. The Council continues to advance this objective by facilitating cross-learning between country-level stakeholders, documenting and disseminating lessons on ‘safe spaces’ implementation, and using implementation science to identify and expand effective practices that will be feasible and sustainable in SWEDD settings.

To learn more about the Council’s role in the World Bank’s SWEDD Initiative, click here.

This piece is also available in French.

[1] Figure up to date as of 10/20.
[2] SWEDD III is currently being planned for Senegal, Congo-Brazzaville, Togo, Gambia.

Promouvoir les opportunités pour les adolescentes dans la région du Sahel grâce à une programmation fondée sur des données probantes

Cet article tiré de l’Atlas des Adolescents pour l’Action (A3) du GIRL Center décrit les éléments clés du travail du Population Council sur l’initiative SWEDD (Autonomisation des Femmes et Dividende Démographique au Sahel -Sahel Women’s Empowerment and Demographic Dividend), qui vise à réduire les risques et à promouvoir les opportunités pour les adolescentes et les jeunes femmes. Le travail décrit dans cee blog est exécuté à travers UNFPA, l’organisation chargée de superviser les activités du projet SWEDD et de fournir une assistance technique aux pays du projet SWEDD en collaboration avec ses partenaires d’assistance technique (y compris Population Council). Les articles suivants porteront sur les leçons apprises, les idées générées et d’autres thèmes liés au projet SWEDD de Population Council. Cet article a été rédigé par Miriam Temin (Codirectrice du projet), et par Anne-Caroline Midy (Coordinatrice du projet).

Les défis uniques auxquels sont confrontées les adolescentes et les jeunes femmes dans la région du Sahel

Au cours de la phase dynamique de l’adolescence, de nombreuses filles de la région du Sahel en Afrique de l’Ouest sont confrontées à de multiples menaces pour leur santé et leur bien-être, ce qui les empêche d’exercer leurs droits et de s’épanouir en tant qu’adultes. Nombre de ces défis sont complexes et multifactoriels, reflétant des forces concordantes qui existent depuis longtemps et des problèmes systémiques. En effet, la région comprend des pays où les taux de pauvreté, d’insécurité alimentaire, de conflits et de déplacements de population sont parmi les plus élevés au monde.

Le tableau des indicateurs sur les adolescents de l’Atlas des Adolescents pour l’Action (A3) du GIRL Center fournit des données permettant d’examiner de plus près les diverses menaces qui existent dans les pays du Sahel. S’appuyant sur des données issues d’enquêtes nationales représentatives menées au Bénin, au Burkina Faso, au Cameroun, en Côte d’Ivoire, en Guinée, au Mali, en Mauritanie et au Niger, ce tableau plaide en faveur d’une action urgente pour les filles et les jeunes femmes du Sahel.

Par exemple, ce tableau montre qu’au Mali, en Guinée et en Côte d’Ivoire, plus de 20 % des adolescentes ont accouché au moins une fois, tandis qu’au Niger, au Mali et au Burkina Faso, cette statistique dépasse les 30 %. 61% des adolescentes sont mariées ou vivent en concubinage au Niger. Au Mali et en Guinée, plus de 60 % des adolescentes considèrent que les coups portés par les époux sont justifiés. Il est encore plus frappant de constater que le Niger, la Guinée et le Mali figurent parmi les pays où la prévalence de l’analphabétisme est la plus élevée au monde, et ou  la grande majorité des adolescentes sont incapables de lire une phrase entière.

Soutenir l’utilisation des données et des ressources par le gouvernement et les partenaires de mise en œuvre

Alors que le Sahel a toujours été mal desservi par l’aide au développement, la tendance actuelle présente des opportunités intéressantes puisque davantage d’organisations bilatérales et multilatérales font de la région du Sahel (et plus spécifiquement de l’Afrique de l’Ouest Francophone [AOF]) une priorité. Des investissements importants offrent la possibilité de soutenir les gouvernements et la société civile, d’accroître les capacités et de renforcer la base de données afin de réduire les risques et d’améliorer les opportunités pour les filles.

Début 2020, le Population Council a rejoint ce paysage d’organisations à travers l’initiative SWEDD (Autonomisation des Femmes et Dividende Démographique au Sahel -Sahel Women’s Empowerment and Demographic Dividend) de la Banque Mondiale, en s’appuyant sur son portefeuille consistant et à jour sur la recherche sur l’AOF, et sur sa profonde expertise sur les adolescentes.

Financée par la Banque mondiale à hauteur de plus de 700 millions de dollars américains[1] pour la période de 2014-2024, l’initiative SWEDD a pour objectif global de “renforcer l’autonomisation des femmes et des adolescentes et leur accès à des services de santé reproductive, infantile et maternelle de qualité dans certaines régions des pays participants” en réduisant notamment le mariages des enfants, les grossesses précoces et le décrochage scolaire des filles, entre autres.

Le SWEDD est une activité régionale qui s’est élargie de six à neuf pays (Bénin, Burkina Faso, Cameroun, Côte d’Ivoire, Guinée, Mali, Mauritanie, Niger et Tchad[2]).  Les gouvernements de ces pays dirigent l’initiative, avec la participation de plusieurs Ministères et partenaires de mise en œuvre. L’ensemble des activités de l’initiative SWEDD a été mis en place pour permettre à ces pays de bénéficier du dividende démographique, selon lequel une croissance économique rapide est possible dans de bonnes conditions lorsque la taille de la population jeune et dépendante diminue par rapport à la taille de la population d’adultes actifs.

Dans le cadre de l’initiative SWEDD, le Population Council utilise des données probantes, ses capacités, ses relations, ses outils et d’autres ressources de programme pour soutenir les activités ciblant les adolescentes et les jeunes femmes. Pour ce faire, nous renforçons la capacité nationale et locale à utiliser les ressources du SWEDD de manière informée et soutenue, sur la base de notre vaste champ de données sur ce qui fonctionne et ce qui ne fonctionne pas pour atteindre les adolescentes marginalisées et réduire les risques auxquels elles sont exposées.

Nous visons à améliorer la qualité des programmes SWEDD par le biais de la documentation des processus, de la formation des gestionnaires et des responsables de la mise en œuvre sur un paquet de compétences clés, de la science de l’application (« implementation science »), des ateliers de renforcement des capacités régionales et d’autres activités visant à promouvoir l’utilisation de données probantes pour l’action.

Par exemple, nous nous sommes inspirés des programmes efficaces du Council pour créer un Curriculum de seconde génération pour les mentores des espaces surs du SWEDD, ainsi qu’un Guide de normes minimales sur mesure pour les espaces surs. Nous avons élaboré du matériel pédagogique pour guider les responsables de la mise en œuvre sur des sujets tels que l’alphabétisation non formelle et l’organisation des groupes communautaires de filles pendant la pandémie de COVID-19. La fourniture d’une assistance technique ciblée et le renforcement des capacités pour améliorer les techniques de suivi, l’évaluation et l’apprentissage sont également des domaines prioritaires qui tirent parti de l’expertise et des ressources programmatiques du Council.

Aborder les risques liés au genre par une approche multisectorielle et à plusieurs niveaux

Le SWEDD est conçu de manière unique pour s’attaquer aux facteurs sociaux et structurels des risques liés au genre par le biais d’un ensemble de programmes multisectoriels et à plusieurs niveaux. Ses interventions s’adressent aux individus, aux communautés, aux représentants des autorités locales et aux décideurs politiques par l’intermédiaire du secteur de la santé, des écoles, des communautés et des chercheurs en démographie. Cela reflète l’importance des approches socio-écologiques pour réduire durablement les risques encourus par les filles, sur la base d’éléments probants provenant du Council et d’ailleurs.

Reconnaissant que les individus soient à la base du résumé de statistiques présentées ci-dessus, la majeure partie des contributions du Council ainsi que les plus grandes composantes de SWEDD impliquent directement les membres de la communauté et les adolescentes et les jeunes femmes (AJF). Grâce à une formation sur les compétences de vie dans les groupes d’espaces surs dirigés par des mentores au sein des communautés et des écoles, les mentores visent à doter les AJF de connaissances, de compétences et d’atouts pour les rendre autonomes et leur permettre de faire face aux risques. Afin de récolter les bénéfices avérés d’un programme transformateur en matière de genre, nous aidons nos partenaires à créer des synergies entre les espaces surs et les clubs des maris et futurs maris du SWEDD

Un regard vers l’avenir : Utiliser les premiers enseignements du SWEDD pour soutenir et développer l’action nationale

Alors que les acteurs nationaux mettent en œuvre la deuxième phase de SWEDD et que les plans pour la troisième phase prennent forme, Population Council, ainsi que d’autres partenaires techniques, garde un rôle continu à jouer dans la promotion des preuves, des bonnes pratiques et de l’apprentissage. Compte tenu de la taille importante du SWEDD et de son expansion continue, il sera important de s’appuyer sur les facteurs essentiels de la réussite du programme pour continuer à soutenir et à étendre les actions menées par les pays. L’approche multisectorielle et a plusieurs niveaux offre aux pays la possibilité de rassembler des pratiques fondées sur des données probantes dans des zones géographiques sélectionnées à dessein ou dans des « points chauds ». Les gouvernements des pays participants mènent la charge, démontrant leur engagement envers les objectifs de l’initiative SWEDD par l’implication de plusieurs Ministères et posant les bases de la durabilité du programme. En outre, l’appropriation du SWEDD s’étend aux communautés et aux leaders d’opinion locaux, notamment grâce à la participation active des chefs religieux dans de nombreux pays, ce qui explique la forte influence des normes communautaires sur l’impact des programmes destinés aux adolescentes.

À ce stade, il est également essentiel que les enseignements tirés des premiers jours de l’initiative SWEDD soient disponibles et qu’ils servent de base à l’expansion, en tirant parti de son aspect régional. Le Council continue à promouvoir cet objectif en facilitant l’apprentissage croisé entre les parties prenantes au niveau national, en documentant et en diffusant les leçons sur la mise en œuvre des « espaces sûrs », et en utilisant la science de la mise en œuvre pour identifier et étendre les pratiques efficaces qui seront réalisables et durables dans le cadre de l’initiative SWEDD.

Pour en savoir plus sur le rôle du Population Council dans l’initiative SWEDD de la Banque mondiale, cliquez ici.

[1] Chiffre mis à jour en octobre 2020
[2] SWEDD III est actuellement en cours de planification pour le Sénégal, le Congo-Brazzaville, le Togo et la Gambie.

The Menstrual (C)uptake Challenge: Global Benefits with Inequitable Efforts

This A3 Insights is published under our ‘Youth Perspectives’ series, where Population Council colleagues, fellows, and interns under the age of 30 write a data-driven thought piece focused on their own research interests. This piece is authored by Yeeva Cheng, GIRL Center Intern, while completing her master’s project designing an online menstrual health education course.   

Re-Emergence of Menstrual Cups 

A recent GIRL Center-led systematic review and webinar examined menstrual health management (MHM) interventions’ impact on girls’ and women’s education and learning outcomes. While further evidence is needed to determine a causal relationship, there is evidence that interventions targeting both menstruators’i access to MHM materials and reproductive health education improve reproductive health knowledge, increase confidence to manage menstrual health at home and at school, and reduce shame about periods.  

In recent years, the menstrual cup has gained momentum as both product and intervention. While earlier prototypes of the menstrual cup were patented as early as the 1870’s, menstrual products requiring insertion, such as tampons and menstrual cups, did not become widely commercialized until the 1950’s, particularly with WWII labor demands shifting menstruators toward public-facing work.  

Recent menstrual cup re-emergence and advertising target a specific population of menstruators. In the last decade, cups have been mostly promoted in low- and middle-income countries (LMICs). Like the road to uptake in the United States, lifestyle demands such as increased mobility, have driven cup usage, though not without concerns. A second major driver that affects menstruators in LMICs that did not affect 1950’s American menstruators was the looming threat of climate change.  

Menstrual Cups Save—Money and the Environment 

Menstrual cups today increasingly advertise being environment-friendly and alleviating “period poverty.” Ranging between 10 to 40 USD with a reusability span of up to 10 years, menstrual cups offer the cost-effective potential to respond to menstruators’ challenges. Since then, over 70 menstrual cup companies have flourished, some with buy-one-give-one plans targeting menstruators in high-income countries (HICs) while distributing or funding a cup in a LMIC context. Such designs are critical in that menstrual cups, while potentially saving between 1700 and 4700 USD of tampons or pads per year, render up-front costs less feasible to menstruators in LMICs. In many cases, menstrual cups are not commonly sold in brick-and-mortar stores and still require online purchasing, creating yet another barrier. 

Menstrual cups can save a menstruator between 5,000 and 15,000 pads in a lifetime, an appealing statistic to environmentalists. The plastic in disposable pads can require between 500 and 700 years to dispose, and methods such as crude burning are air-polluting. In the U.S. alone, 9 billion single-use period products are consumed each year, with about 80% of these expected to end up in landfills. Even assuming a smaller menstrual product waste footprint in LMIC contexts where disposable materials are used sparingly due to costs, the per capita amount of waste accumulated globally makes the menstrual cup an appealing alternative. Though there have been concerns around menstrual cups and water shortages, a systematic review and meta-analysis on menstrual cup safety, leakage, and acceptability revealed that menstrual cups often result in less use of water when accounting for the water that cloth, cotton, or less structured materials and their leakages might require.  

How Educational Policy and Programming Can Reduce Global Period Waste 

Menstrual cups minimize both climate and economic costs long-term, but product uptake also requires an enabling environment aided by policy. In building the Adolescent Atlas for Action (A3) Policy Checklist, we checked for the presence of 56 adolescent-relevant national policies in 113 LMICs. These include policies that 1) support MHM education nationally and 2) support MHM education in schools.

Of the 113 countries in the A3 tracker, 22 had MHM policies, and 23 had policy commitments specifically to support MHM in schools. In 10 of these countries, we can observe situations where there are national commitments but not at the school-level, or school-level commitments but no national policies.

Since 2013, UNICEF’s WASH division has focused on countries primarily in South Asia and Sub-Saharan Africa, varying interventions from translating and sharing MHM guides to distributing reusable sanitary pads. However, much of the motivation for promoting reusable and/or natural materials comes down to cost and lack of locally sourced production of materials. While promoting or teaching homemade pad production has been widely popular in LMICs, it is worth noting that these are the contexts that have already been using ecologically safer methods for MHM.  

Moreover, LMICs have led innovative approaches to MHM products, curriculum, and integrative policies. Kenya has dedicated research on access to menstrual products in rural and urban areas, contributing to policy written into the Kenyan Constitution’s guarantees toward basic education. Specifically, the Basic Education Amendment Act No. 17 (2017) stipulates a commitment to providing free sanitary towels to all girls enrolled in public education, as well as safe and sustainable means of disposal. Policy Objective 4 lists eight actions outlining how investment, research, and partnerships will collaborate to prioritize recycling, treatment, and waste management. Nepal released a scoping review and preliminary mapping of MHM in 2017, noting commitment to the provision of sanitary pads and disposal facilities. Some policymakers have pointed out that current disposal methods of such products (providing pits and dustbins) are environmentally harmful. Recognizing that it is unfeasible to completely shift away from disposable pads, pragmatic program actions have included installation of disposable pad incinerators in schools to burn pads in an ecologically safe way. While the Philippines has yet to develop a national MHM policy, smaller-scale initiatives have contributed to sustainability efforts. For example, EmpowHer has re-adapted the disposable pad using locally sourced, biodegradable products (corn cob, rice paper, and water hyacinth) that include destigmatizing messaging on the packaging.   

Of the countries that enacted MHM education policies in the A3 Policy Checklist, we found none that mention within their policy documentation the distribution of menstrual cups or other reusable products. Where there is mention of menstrual products, language and programming typically focuses on distribution of disposable products. As countries continue to draft policies that provide menstrual products, it is critical to urge an enabling environment for eco-friendly products where possible—not only in LMICs but in HICs, where menstruators can generally exercise greater choice and accessibility. For example, an evaluation report was released in 2018 detailing a pilot program in Scotland that delivered menstruators’ products of their choice, for free. Menstrual cups made up only 2% and reusable towels only 3% of the products distributed; in contrast, disposable sanitary towels (pads) made up 54%, tampons 15%, and a combination of the towels and tampons made up 19%. Interviews with menstruators revealed that many did not know that reusable materials existed, showing initial skepticism. Though many expressed interest in trying a reusable product, few participants followed through with using them.  

Cup Concerns 

Two major obstacles to menstrual cup uptake remain in LMIC contexts. A common hesitation for menstruators in LMICs entails concerns around inserting an object inside their bodies and reusing the cup. Menstrual hygiene management educational programs that have sought to promote cups often address these concerns and distribute kits including cups and other materials that help respond to these uncertainties as well as promote comfort with one’s body. For example, kits might include a small hand mirror for menstruators to not only help with inserting a menstrual cup, but to also enable an anatomy-based training that is sensitive to new users. Moreover, programs that promote peer and family support are underlined as critical to menstrual cup uptake. Targeting family support not only sensitively responds to sociocultural concerns around virginity and sexuality, but also the issue of privacy users express around routinely boiling or sterilizing their cups around other family members. 

Emerging MHM Education  

MHM education has yet to emerge as a standard in adolescent-focused policies, but in its early stages, offers opportunity for thoughtful design that integrates climate adaptation. As MHM policies gain uptake, HICs must also make greater efforts and contributions to minimizing climate change. Policymakers might include specific action items including: 

✔ Requirements for programs that distribute menstrual products to offer sustainable options, i.e., menstrual cups or reusable pads 

✔ Inclusion of menstrual product information within MHM education to inform menstruators about environmental impact of products as well as costs and benefits of products available on the market 

✔ Increased partnerships or collaborations between development organizations/agencies and menstrual cup companies to commit to sustainable products 

✔ Promote existing buy-one-give-one menstrual cup programs among HIC menstruators 

✔ Invest in continued research on ecologically safe methods of menstrual product waste disposal and management 

i We use the term “menstruators” here to include any person who menstruates, regardless of their gender identity.  


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