BACKGROUND: Limited qualitative research examining community factors have been performed in Ethiopia to investigate vulnerabilities in orphans and vulnerable children and negative health and educational outcomes. To address this gap, a comprehensive mixed methods parent evaluation was conducted. For the present study, we will make use of the evaluation’s rich source of qualitative data to examine the vulnerabilities for orphans and vulnerable children (OVCs) in Ethiopia using a socio-ecological approach exploring qualitative views of caregivers, community members, and children, at the individual, household, interpersonal and community levels.
METHODS: In-depth interviews (IDIs) with adult caregivers, focus group discussions (FGDs) with adult community members, and community mappings (CMs) or focus group discussions with children were conducted in four regions of Ethiopia (Amhara, Tigray, Oromia and SNNPR) as one component of the parent evaluation. Questions addressed known vulnerabilities of OVCs. A subset and majority of the above qualitative data (46 IDIs, 26 CMs and 19 FGDs) were analyzed for this present study. Data were analyzed using a thematic socio-ecological approach.
RESULTS: A total of 377 participants (224 children and 153 adults) were included in the study sample. Amhara was the most represented out of the four regions with 50% of the adult FGDs and 43% of the child CMs occurring there. FGDs were representative of both genders, while IDIs of caregivers were conducted with predominantly female respondents (78.3%).
Individual Level Vulnerabilities:
Both child and adult respondents identified the health of children as a fundamental issue affecting all aspects of quality of life. The main issues that participants discussed relating to child health were poor nutrition (51/86, 59.3%), lack of adequate clothing (44/86, 51.2%), poor shelter (40/86, 46.5%), poor physical health (33/86, 38.4%), poor mental health (20/86, 23.3%), and poor hygiene (19/86, 22.1%).
In general, respondents were very aware of the wide-ranging issues that girls in Ethiopian society face making them more vulnerable to abuse. For example, respondents noted families often pressured girls into early or forced marriages (7/86, 8.1%), wealthy families employed girls as maids or nannies, forcing girls to live away from their families (10/86, 11.6%), and families discouraged girls from attending school (4/86, 4.6%). Child respondents spoke more frequently and vocally about these issues than adult respondents.
Children frequently and urgently described work-related risks, such as physical and sexual harm, caused by work-related exposure to certain harmful environments. Respondents talked at length about work-related exposures in 29% (25/86) of all transcripts; participants highlighted children working for subsistence was often at the cost of school attendance.
Household Level Vulnerabilities:
Respondents generally identified caregiver’s age, mental and physical health, and relation to child as vulnerabilities at the household level. Respondents highlighted in comments that households with more elderly caregivers, for example, grandparents or retired parents, are less able physically and financially to support the child. Non-parent households and HIV-affected households were also more vulnerable to negative health and educational outcomes.
Respondents strongly emphasized poor shelter as a vulnerability across all FGDs, CMs and IDIs (40/86, 46.5%). Respondents mentioned poor shelter only second in frequency to poor nutrition (51/86, 59.3) and lack of adequate clothing (51.2%, 44/86). Participants identified the quality of housing as crucial to children learning successfully.
Respondents frequently described home ownership as a vulnerability since renting and rising rent create future uncertainties in caregivers’ ability to provide shelter and other necessities to children. Most feared by respondents was the inability to pay rent and being forced to live out on the street. Worries within the community expressed by respondents were centered around the safety of homeless children.
Interpersonal Level Vulnerabilities:
Respondents identified the following basic needs that were not met by caregivers: provision of food and nutrition, shelter, adequate clothing and material goods for hygiene. Almost all respondents identified the main cause of these inadequacies in caregiving as poverty.
Participants highlighted a range of abuses, including sexual, physical and emotional abuse both within and outside of the home. Child respondents in CMs most frequently discussed forced labor (20/26, 76.9%), sexual abuse (13/26, 50%), and physical abuse (10/26, 38.5%). In general, discussion of abuse was more prominent in child than adult focus groups. Children in CMs (20/26, 76.9%) were many times more likely to discuss issues of forced labor in comparison to adult respondents in FGDs (1/14, 7.1%) and IDIs (2/46, 4.4%); child respondents in half (13/26) of the CMs discussed sexual abuse in contrast to adult respondents in two out of 14 (14.3%) FGDs and only one out of 46 (2.2%) IDIs. There was no major difference between regions in how frequently abuse was discussed. The most common abusers and abuse location were parents at home.
Community Level Vulnerabilities:
Respondents described numerous community-level vulnerabilities, including: lack of safe spaces, educational system infrastructure challenges, lack of job opportunities for child and caregiver, weak health care infrastructure and inability to meet many basic needs of community. Respondents recognized the effects of community level vulnerabilities on child vulnerabilities at all other levels.
CONCLUSIONS: This study contributes to the literature on needs of vulnerable youth in Ethiopia. Collecting children’s perspectives and narratives on their environment and needs provides direct insight to services and programs that are designed for OVCs. Understanding what children within communities most fear but face daily helps target these services.
OVCs are not heterogenous. Within the broader category of OVCs, certain subsets of OVCs, such as AIDS-orphaned children, street children and female OVCs, are more vulnerable to abuse, worse mental health outcomes and lower educational achievement than others, which justifies the targeting of services at children in these particularly vulnerable groups. Our findings are concerning regarding the prevalence of child abuse and gender-related abuses, such as early child marriage, which need to be addressed in future interventions.
The socioecological approach provides a helpful perspective on community level vulnerabilities affecting children’s abilities to navigate the world individually and interpersonally. The interactivity of vulnerabilities between socioecological hierarchies, at the individual, household, interpersonal, and community/society levels, within broad interwoven themes of education, health, shelter, security, gender, and caregiving, make the results from this study particularly useful. Additional research in this area will be crucial to helping understand policy design and interventions that protect the most vulnerable of children. / 2024-02-09T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43860 |
| Date | 10 February 2022 |
| Creators | Liu, Elizabeth |
| Contributors | Sabin, Lora |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial-NoDerivatives 4.0 International, http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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