Key Social Norms Take-aways This study demonstrates the effectiveness of gender-transformative life-skills programming in the Act With Her–Ethiopia program in shifting stigmatizing social norms around menstruation among very young adolescents in rural Ethiopia. Programming that synchronously engages girls, boys, caregivers, and communities can significantly reduce menstrual stigma and improve knowledge and behavior around menstrual health. However, its success is influenced by existing norms, infrastructure, and educational environments, with greater impact observed in less conservative areas.
Objectives The study aimed to evaluate the impact of the Act With Her–Ethiopia life-skills program on improving menstrual health literacy among very young adolescents (aged 10–14) in two regions of rural Ethiopia—Amhara (South Gondar) and Oromia (East Hararghe)—with a focus on social norms, knowledge, and practices related to menstruation.
Methods A longitudinal mixed-methods design was used, combining a cluster-randomized controlled trial across 97 kebeles (58 treatment, 39 control) with quantitative surveys of 2,492 adolescents and their caregivers, and qualitative interviews with 291 adolescents, caregivers, and 96 key informants. The analysis measured changes in knowledge, behavior, and norms around menstruation and menstrual hygiene management, with a focus on gender and regional differences.
Intervention Details The Act With Her-Ethiopia program included weekly safe space sessions for girls aged 10–12, parallel sessions for boys, and group meetings with parents. The curriculum covered topics such as puberty, health, communication, gender, and rights. One arm also included community-level norm-shifting efforts and system strengthening, while another added an asset transfer package (school and hygiene supplies) to support attendance and engagement. Mentors were trained local youth serving as facilitators.
Results The intervention led to statistically significant improvements in knowledge about menstruation (e.g., frequency, biological function) and behavior (e.g., improved menstrual hygiene practices). In Amhara, large increases were observed in mother–daughter communication and community-level norm shifts. In Oromia, knowledge gains were significant despite more conservative norms, but backlash was noted. Boys also demonstrated increased awareness and support, with some contributing to menstrual health management infrastructure. Application of knowledge was stronger in areas with supportive systems and higher school attendance.
Conclusions Life-skills programming that integrates gender-transformative content can catalyze change in menstrual health literacy and related social norms, even among very young adolescents. However, success depends on context-specific adaptation, community engagement, and reinforcement through education systems and infrastructure. Norm change is possible but must be supported by enabling environments and broader systemic change.