How do adolescent mothers triple their confidence to seek health services in less than 18 months? With programs that girls themselves design, that focus on her needs, and getting the support from the health system.
To address the sexual and reproductive health (SRH) needs of pregnant adolescents and first-time mothers in crisis-hit countries, the Adolescent Mothers Against All Odds (AMAL) initiative was designed to promote access to SRH information and services while also creating conversations around gender, power, and social norms to support a more enabling environment for adolescents to seek care. Launched in March 2020, AMAL was implemented in collaboration with Northwest Syria’s GBV sub-cluster to address adolescent SRH needs with the escalating humanitarian crisis in Syria to provide immediate health needs and tackle gender norms and biases involving adolescents in leadership roles through Adolescent Advisory Committees (AAC).
Through United Nations Sexual and Reproductive Health Agency (UNFPA) funding, AMAL served in Syria from January 2020 – December 2020 with partners in Syria Relief and Development, Shafak and Ihsan. The initiative functions through 3 main components: Young Mother’s Club, engaging healthcare providers, and community engagement. These 3 components have proven successful as a holistic approach to shift norms and improve knowledge and access to SRH services among adolescents in crisis settings. Additionally, AMAL has contributed to global discussions on adolescent responsive SRH and GBV programming. As of 2024, the AMAL initiative is active in Syria, Nigeria (re-started) and most recently, Somalia.
What changed?
Across the first implementation countries, Syria, and Nigeria:
- Young mothers are more confident to make decisions. The Young Mother’s Club in crisis-affected Syria boosted SRH knowledge and confidence across its participants, 73% of this reported high self-esteem, and 89% felt more confident in participation.
- SRH for the win, globally! Key impacts from an evaluation of AMAL in Syria and Nigeria include a 23% increase in support for girls’ use of family planning, 20% increase in support for girls exercising reproductive rights, and a doubling of use in family planning, including contraceptive among adolescents.
- More health visits. Antenatal care visits saw an increase from 14% to 20%, contributing to maternal health.
Currently, the AMAL Initiative is expanding into new countries and continues to explore opportunities across regions to support adolescents in crisis settings. It also continues to expand its approach to localize the program. In Nigeria for instance, CARE is rolling out AMAL for a 2nd time, in collaboration with local partners, the Neem Foundation and EYN.
What’s new?
AMAL, in addition to the 1st global evaluation data on Syria and Nigeria presented above, now has recent data coming from Somalia:
In 2023, Somalia became the newest country to initiate the AMAL program. Early findings show incredible transformations unfolding among adolescent girls in Somalia.
- A remarkable surge in self-esteem, with levels rising by 27%,
- An astounding enhancement in their communication skills within the family, going up 86%.
- An unprecedented boost in their confidence to seek healthcare services--220% increase.
- Community are experiencing a paradigm shift, witnessing a 63% spike in the inclination to challenge gender inequalities
- A 47% surge in backing girls' unrestricted access to SRH services.
- Health providers are increasingly rallying behind adolescent girls' autonomy, with a notable 77% increase in their endorsement of girls' decisions regarding family planning methods.
AMAL + Nutrition integration:
The Somalia AMAL team is ramping up efforts to improve connections to nutrition education, screening, and treatment. Adequate nutrition is crucial for adolescents' growth and development, especially for pregnant girls and breastfeeding mothers. Graduates from the Young Mothers Club who become Adolescent Leaders are aiding their peers by conducting household visits to promote maternal nutrition and feeding practices for children under five. They're also trained to screen for malnutrition and refer those in need for care. To date, Adolescent Leaders have screened nearly 250 children (122 girls, 125 boys) and over 200 pregnant and breastfeeding girls.
How did we get there?
- The initiative started as Young Mother’s club in 2018, and through its adaptive learning based on feedback from the adolescents themselves, AMAL included additional community and health provider components alongside the Young Mother’s Club and Community Advisory Groups. This saw to the initial launch of the AMAL toolkit in Syria in 2020.
- In 2021, CARE worked with local community members and stakeholders to adapt and pilot AMAL in NE Nigeria.
- In 2022, with UNFPA funding, CARE led first ever global evaluation across Syria and Nigeria and by 2024 was implemented across Syria, Nigeria, and Somalia.
What did we learn?
- Adolescent-responsive programming is needed and feasible even in crisis settings.
- Addressing norms to create an enabling environment for adolescents does result in improved uptake of sexual and reproductive health services.
- “With and for” adolescents should be a key programming principle even in fragile contexts.
- Improving linkages with nutrition and other key services can provide wider support for adolescents.
Where do we go next?
We are looking to expand and link with other programs supporting adolescents. Please contact us if interested! Cecilliah Mbaka (cecilliah.mbaka@care.org) and Allison Prather (allison.prather@care.org)
Want to learn more?
Adolescent Mothers Against All Odds (AMAL) – Locally Developed, Globally Scaled
The AMAL Initiative, locally developed and globally scaled, addresses the SRH needs of pregnant adolescents and first-time mothers in different crisis-hit countries. Launched in March 2020, it involves activities like the Young Mothers' Club to bridge the gap in SRH services and challenge gender norms, aiming to contribute to global discussions on adolescent responsive SRH and GBV programming. Read More
AMAL website – here
AMAL Initiative Toolkit - Language facilitator guide, curriculum, and toolkit for program implementers.
AMAL Initiative Flipbook - Visual aids designed to complement the toolkit.
AMAL Learning Report - This report consolidates learnings and recommendations on sexual and reproductive health service provision for adolescents in crisis settings from the first pilot of the AMAL Initiative in northwest Syria.
Falling Forward Podcast - here