Ethiopia has made significant progress in supporting gender equality and girls’ empowerment. Rates of child marriage and teenage pregnancy have decreased substantially, and access to sexual and reproductive health services has increased. In the education sector, school attendance rates at all levels have risen, and the gender gap in enrolment is narrowing.
Despite these positive trends, inequalities and entrenched patriarchal norms remain, especially for adolescent girls and young women in rural areas. Nationally, child‑marriage rates are still among the highest in Africa; 2016 data estimated that 58 % of girls and 9 % of boys were married before age 18. Educational attainment for adolescent girls also lags, with only 15 % of women completing secondary or higher education compared with 23 % of men. As one of the world’s youngest and fastest‑growing populations, Ethiopia’s future depends on achieving gender equality to enable young people to reach their full potential. This will require addressing gender attitudes and norms linked to early marriage, childbearing, and barriers to girls’ education.
The country’s national community health programme aims to increase the availability of basic health services and promote healthy lifestyles through community outreach, including household visits. Policymakers have sought to understand its impact on adolescent health and well‑being to guide further improvements. Our study examined the association between this health‑extension programme and twelve indicators of adolescent health and well‑being. While the programme primarily focuses on disease prevention and health promotion, our findings suggest that household visits by health‑extension workers have measurable effects on multiple interconnected adolescent challenges beyond health alone. These visits appear to reduce rates of child marriage, early pregnancy, and school dropout—outcomes with long‑term consequences. Delaying marriage and pregnancy promotes adolescent girls’ health and aspirations, while higher educational achievement increases their earning potential and empowers autonomy and decision‑making.
The health‑extension programme, introduced in 2003, is delivered by local health‑extension workers—mostly young women recruited from the community based on language proficiency and completion of secondary education. They promote routine medical check‑ups at local health posts and conduct door‑to‑door visits to educate families about health issues, including family planning, youth reproductive health, and child marriage. The programme has become a flagship intervention, yet many Ethiopian families, particularly in rural communities, continue to place high value on marriage and motherhood. Although the legal marriage age is 18, child marriage and early pregnancy remain prevalent nationwide. The government aims to eliminate child marriage by 2025, and our study indicates that the health‑extension programme is likely to play an important role in achieving this goal.
Our research shows that household visits by health‑extension workers are linked to significantly lower risks of child marriage, early pregnancy, and school dropout. Specifically, receiving such visits is associated with a 70 % reduction in the probability of child marriage, a 75 % reduction in the probability of early pregnancy, and a 63 % increase in the probability of being enrolled in education. We also observed improvements in adolescent girls’ literacy and numeracy scores. These effects are likely produced by health‑extension workers discussing the risks of child marriage and early pregnancy and the benefits of girls’ education with families, thereby modifying expectations and encouraging investment in secondary education. Workers can also monitor preparations for marriage and intervene when a bride is younger than the legal age of 18. In doing so, they are not only improving adolescent health but also transforming girls’ opportunities to pursue education, employment, and family aspirations.
Our research highlights areas for further work, particularly regarding adolescent girls’ sexual and reproductive health rights, which remain taboo in some communities where modern contraception is feared to promote promiscuity. We found no evidence that household visits addressed common misconceptions among adolescent girls about fertility and preventing sexually transmitted infections. Social barriers continue to limit girls’ access to information, services, and support, fostering misinformation about modern contraception. One promising initiative is Adolescents 360’s Smart Start intervention, which collaborates with young girls and the health‑extension programme to deliver contraceptive programming.
In the past two years, Ethiopia has faced the COVID‑19 pandemic, conflict in the north, and widespread drought. These crises have disrupted healthcare delivery, closed schools, heightened adolescents’ needs, and may have reinforced discriminatory gender roles. Consequently, health‑extension workers still have work to do to address cultural and attitudinal barriers that hinder adolescent girls’ education. Dessalew Emaway, a public health practitioner, and Silinganisiwe Dzumbunu, a doctoral student at the University of Cape Town’s Centre for Social Science Research, contributed to this article and the original research. William Rudgard, Senior Postdoc, University of Oxford.
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