1. Federal Democratic Republic of Ethiopia Ministry of Health

2. Reproductive Maternal and Newborn Innovative Fund (RIF) Findings of the Assessment to identify barriers to RMNH service uptake among pastoralist communities

3. Objective of the assessment To Identify Barriers of service uptake at individual level Socio cultural barriers that hinder women and young girls seek RMNH services environmental context that affects RMNH service uptake

4. Data collection method FGD guide and key informant interview guides developed, tested and used 10 Data collectors recruited and oriented on the tools Seven days of field work to collect data FGD – 2 FGDs in each zone involving young girls, women and men – Key informant interview with 10 key informants from each region identified and contacted

5. Geographic coverage RegionZoneWoreda Afar01Dubti and Asayta OromiaBorenaMetagefersa and did Yabello GujiWadera and Sebaboru SomaliDegehabur and Jigjiga Kebribeyah and fafen SNNPRSouth OmoBena Tsemay and Hamer

6. Major findings of the assessment Individual level: – Limited knowledge and information – Misconceptions (might not be pregnant for long periods if she gives birth at health institution) – past experience – Fear of stigma among girls – difficulty to accept male service providers at L&D, ANC, – feeling of shame to give birth at health institution with support of outsiders – prefer their own positioning during labor than professional’s advice

7. Social level: – Gender related male dominance, Control over resource women and girls long working hour women don’t have the right to limit the number of children they possibly could have Lack of decision making power among women Women expected to obey decisions of their partners – Lack of male partner support – Cultural and social ceremonies at birth isolating laboring woman to give birth alone

8. – Children are considered as blessing and keepers of the clan strength – Religious values discouraging FP – Lack of open discussion on RH issues among family members – Female genital cutting family honor (respect), cleanliness, a woman’s ability to walk for long distances and women giving birth with ease – Young married couples expected to have their first child soon – common unprotected sex for unmarried girls which results in repeated abortion (girls are not allowed to give birth before marriage)

9. Environmental – Transportation (ambulance one way) – professionals mistreatment

10. Adolescent Health Postnatal care Facility delivery and EmONC services ANC Comprehensive abortion care Family planning Fear of Stigma Women/yout h friendly services Traditional beliefs Partner and family support Gender roles Community participation Women and girls empowerment RMNH information and knowledge Open discussion in family Attitude and past experience Cultural and religious norms and values Access Transportatio n

11. Addressing barriers to increase uptake Increase acceptability of RMNH services among women, girls and the community through – Increased knowledge and awareness – Behavior change – Addressing norms and values – Empowerment of women and girls – Enhancing Male engagement and support – strengthening networking and partnership

12. Improve community attitude to RMNH services – Create Positive attitude to RMNH services and service providers – Creating enabling social environment (enhance role of religious leaders, community leaders etc – Community mobilization

13. Empower women and girls to use RMNH services – Enhance self esteem and self confidence among women and girls – Strengthen multi-sectoral approach – Address gender stereotype and enhance male involvement – Community mobilization to address GBV and other forms of violence – Foster decision making and action through collective processes – Working with relevant stakeholders to ensure equal participation in developmental processes

14. Enhance Responsiveness of health service to communities needs – Working with relevant stakeholders to ensure accountability – Improve IPC of service providers – Promote women and girls participation in facility management boards – Promote women and youth friendly service – Ensure Gender mainstreaming

15. Thank you!