Doris Bartel, CARE USA - DFID Girl Summit 2014

""Married girls are often forgotten in work on child marriage and I would like to encourage us to think about the voices, the needs and the rights of married girls as we think about the post-2015 MDG goals..." - Doris Bartel

Panel Discussion: Spotlight on Progress A6 - Supporting and Empowering Those Affected by FGM and Child, Early and Forced Marriage

Context
This is one of the 14 "Spotlights on Progress" video-recorded sessions that took place at the Girl Summit 2014 in London on 22nd July. The sessions were organised to spark conversations and share best practice between practitioners from around the world, between grassroots activists and ministers, and across all the issues of female genital mutilation (FGM) and child, early, and forced marriage (CEFM). Girl Summit is a project of the Department for International Development (DFID), UK.

A featured panelist of this Spotlight session was Doris Bartel, Senior Director of Gender and Empowerment, CARE USA to talk about the TESFA (Towards Improved Economic and Sexual & Reproductive Health Outcomes for Adolescent Girls) programme in Ethiopia.

Profile of Speaker

Doris Bartel is the Senior Director of the Gender and Empowerment Unit at CARE USA. She is an international development specialist and expert in gender integration, with over 24 years of programming, clinical health services and research and management experience. Doris is a certified Women’s Health Nurse Practitioner with a background in community development, conflict mitigation, and reproductive health and rights.

Project strategy and key points made in the presentation:

Doris Bartel outlines the work CARE was doing to support adolescents and girls who are already married to access their needs and rights, and make choices about their lives. The TESFA project (Towards Improved Economic and Sexual & Reproductive Health Outcomes for Adolescent Girls) was implemented in the Amhara region of Ethiopia, and involved over 5000 married, divorced or widowed adolescent girls over a 3 year period (2010-2013).

She explains that marriage is not legal in Ethiopia before the age of 18 but that cultural tradition still prevails. 41% of married women in Ethiopia say they were married before the age of 18, and in the Amhara region the rate is as high as 74%.

CARE found that providing a holistic package worked well. This package included sexual and reproductive health education and services, peer group support, and economic empowerment skills. As outlined in the evaluation report (mentioned below), the strategies involved the following:

• "Empower girls with information, skills and a support network. Bringing girls together to, for instance, learn how to communicate and negotiate with others, stay healthy during their reproductive years, and earn and manage money, increases their knowledge and self-confidence. Meanwhile, helping married adolescents develop support networks alleviates the social and economic isolation many of them experience.
• Provide essential health information and services. Married and unmarried adolescent girls often have limited access to the information they need to protect and promote their health, and the information they do receive may be inaccurate or stigmatizing. When girls have access to high quality, accurate health information and services – especially related to their sexual and reproductive health – they are more likely to experience reduced rates of
  early pregnancy, maternal morbidity and mortality, obstetric fistula, HIV infection and more.
• Educate and rally parents and community members. Families and community elders are traditionally responsible for deciding when and whom a girl marries. Therefore, having community leaders critically reflect and realize how early and forced marriage impacts girls’ and their families’ health and futures often sparks change that is both powerful and sustainable.
• Provide financial and livelihoods training. Equipping married girls with basic financial skills and providing income-generating activities help them better support themselves and their families. Importantly, such opportunities also can be deeply empowering and aid in increasing girls’ negotiating capacity within the household."

Doris Bartel outlines the following key lessons learned: (a) facilitating the peer education group worked really well, (b) mobility issues were a challenge but the programme worked because the community supported the programme, (c) the sexual and reproductive health education, life skills training, and negotiation skills training were very positively received, (d) social isolation work was very important to the girls involved, and (e) engaging other adult members for outreach and support was key as it helped to work with influential gatekeepers, and in creating public discussions to change the norms that negatively affect girls.

She explains that this holistic wrap-around approach resulted in the girls and their community working together to prevent 180 further child marriages during the lifespan of the project. She goes on to share some of the evaluation results from an evaluation conducted by the International Center for Research on Women (ICRW). Findings showed that reproductive health increased. There was a 27% increase in contraceptive use among adolescent girls, as well as an improvement of financial skills and personal savings, which increased by 72%. Girls reported improvement in couple communication and increased participation in household economic decisions. They also reported greater confidence and decreased domestic violence.

Doris Bartel ends off by reiterating that married girls are often forgotten in the work on child marriage, and that we need to think of their voices, needs, and rights as we discuss the post 2015 Sustainable Development Goals, and make sure that they are included in that. She also makes the point that we need scalable models and sees this project as offering some valuable strategies and lessons on how it could be done.

Overview of the "Supporting and Empowering Those Affected by FGM and Child, Early and Forced Marriage" session:

As outlined in the programme summary document handed out at the summit:
"This spotlight discusses the different types of services that we must ensure people affected by FGM and child, early and forced marriage have access to, highlighting the importance of providing a holistic package of support. The spotlight will showcase initiatives which provide medical, counselling and advocacy support, and programmes dedicated to supporting the needs of married girls. This spotlight will hear others’ experiences and discuss what we can learn from them."

As summarised by the panel organisers following the panel discussion:
"The panel of speakers shared their experiences of frontline service provision or programming to support those affected by FGM and CEFM. In discussions on FGM and CEFM, the need to break the cycle of shame were emphasised, and the need to listen to those affected. There was a lot of positive reflection that after many years of campaigning on these issues, people were finally getting a platform to share the reality of girls’ and women’s experiences. However it was agreed that much more needed to be done. There was consensus that a holistic response was needed, that services and programmes needed to consider women and girls whether pregnant or not, and married or not, and that although there were workable models out there to eliminate both practices, these needed to be scaled up."

The session was opened by Leyla Hussein, activist and founder of Daughters of Eve and Dahlia Project.

The speakers, in order of appearance, are:
Isobel Shirlaw Head of Justice Initiatives, Refuge
Dr Venkatraman Chandra-Mouli Department for Reproductive Health and Research, World Health Organisation
Jasvinder Sanghera CBE Chief Executive and Founder, Karma Nirvana
Dr Edna Adan Ismail Founder and CEO, Edna Adan Maternity Hospital and Chancellor, Edna Adan University
Juliet Albert Specialist FGM Midwife, Queen Charlotte’s and Chelsea Hospital (Imperial College Healthcare NHS Trust), London
Doris Bartel Senior Director of Gender and Empowerment, CARE USA

The session is moderated by Susan Bookbinder, journalist, broadcaster, columnist and media consultant with a particular focus on FGM.

Footage of this (available below) and other "Spotlight Sessions" are available on DFID’s YouTube channel.