Research Initiative to Support the Empowerment of Girls
Condition: Pregnancy in Adolescence
Study type: Interventional

Summary: 
      Background Adolescent pregnancies carry risks to the young mothers and the babies. Keeping
      girls in school can potentially protect girls from getting pregnant. In Zambia, 35% of young
      rural girls have given birth by the age of 18 years, and the pregnancy rates are particularly
      high among girls who are out-of-school. Approximately 50% of girls never enroll in secondary
      school. Widespread myths and negative social norms are barriers to adolescent girls using
      modern contraceptives, thus contributing to high rates of early pregnancy. However, there is
      little robust research from Africa on how sexual and reproductive health programmes can be
      delivered in a way that actually affects early marriage and pregnancy rates.

      Purpose To measure the effect on early childbearing rates and basic school completion in a
      rural Zambian context of (1) economic support to girls and their families, and (2) combining
      economic support with a community intervention to enhance knowledge about sexual and
      reproductive health and supportive community norms

      Design Cluster randomized controlled trial with three arms with clusters being rural basic
      schools (With grades 1-9) with surrounding communities.

      Study population The participant population were girls enrolled in grade 7 in January in 2016
      in rural schools in twelve study districts: Kalomo, Choma, Pemba, Monze, Mazabuka,
      Chikankata, Kapiri Mposhi, Kabwe, Chisamba, Chibombo, Mkushi, and Luano.

      Study size A total of 4922 girls and 157 clusters were recruited, that is 999 girls and 31
      clusters in the control arm and 2004 and 63 clusters in the economic support arm and 1919
      girls and 63 schools in the combined intervention arms. The rationale for having different
      numbers of clusters was that we expected larger differences between each of the intervention
      arms and the control arm than between the two intervention arms themselves.

      Intervention One intervention arm was offered economic support in the form of monthly cash
      transfers to the participating girl and her parents and payment of junior secondary school
      fees in 2017 and 2018. The second intervention arm was offered the same economic support
      combined with a community component comprising community meetings about the value of
      education for adolescent girls and the risks related to early childbearing, and a youth club
      covering comprehensive sexuality education for girls and boys (both in- and out-of-school).
    

Detailed description: 
      Background Adolescent pregnancies carry risks to the young mothers and their babies. Keeping
      girls in school can potentially protect girls from getting pregnant. In Zambia, 35% of young
      rural girls have given birth by the age of 18 years, and the pregnancy rates are particularly
      high among girls who are out-of-school. Approximately 50% of girls never enroll in secondary
      school. A number of studies have found that economic support to girls and/or their families
      can increase school enrolment and attendance, and three trials have found effects on
      postponement of childbearing and marriage. Other studies indicate that widespread myths and
      negative social norms are barriers to adolescent girls using modern contraceptives, thus
      contributing to high rates of early pregnancy. However, there is little robust research from
      Africa on how sexual and reproductive health programmes can be delivered in a way that
      actually affects early marriage and pregnancy rates.

      Purpose To measure the effect on early childbearing rates and basic school completion in a
      rural Zambian context of (1) providing economic support to girls and their families, and (2)
      combining economic support with a community intervention to enhance knowledge about sexual
      and reproductive health and supportive community norms.

      Design Cluster randomized controlled trial with three arms with clusters being rural basic
      schools (With grades 1-9) with surrounding communities.

      Study population The participant population will be girls enrolled in grade 7 in January in
      2016 in rural schools in twelve study districts: Kalomo, Choma, Pemba, Monze, Mazabuka,
      Chikankata, Kapiri Mposhi, Kabwe, Chisamba, Chibombo, Mkushi, and Luano.

      Study size A total of 4922 girls and 157 clusters were recruited, that is 999 girls and 31
      clusters in the control arm and 2004 and 63 clusters in the economic support arm and 1919
      girls and 63 schools in the combined intervention arms. The rationale for having different
      numbers of clusters was that we expected larger differences between each of the intervention
      arms and the control arm than between the two intervention arms themselves.

      Intervention The control group (31 schools) received writing materials. One intervention
      group (63 schools) was offered writing materials and economic support in the form of monthly
      cash transfers to the participating girl and her parents and payment of junior secondary
      school fees in 2017 and 2018. The second intervention group (63 schools) was offered writing
      materials, economic support, and a community component. The community component comprised of
      community meetings about the value of education for adolescent girls and the risks related to
      early childbearing, and a youth club covering comprehensive sexuality education for girls and
      boys (both in- and out-of-school).

      Duration and Follow-up The duration of the trial, from recruitment to the last follow-up
      survey was 4.5 years. A baseline survey was conducted just after recruitment, and a final
      survey was conducted after approximately 4.5 years. In between there were short follow-up
      contacts with all the participants every six months.

      Primary objectives

        1. To measure the effectiveness of a combined economic and community intervention on
           childbearing within 8 months of the end of the intervention period

        2. To measure the effectiveness of economic support alone and of a combined economic and
           community intervention on childbearing before the 18th birthday among girls.

        3. To measure the effectiveness of economic support alone and of a combined economic and
           community intervention on the proportion of girls who sit for the grade 9 exam.
    

Intervention name(s): Material support; Economic; Community dialogue
Intervention type(s): Other; Other; Behavioral
Intervention description(s): Writing materials; Economic support (monthly cash transfer to girls, annual grant to guardians, and payment of school fees in grade 8 and 9); Community dialogue (youth club meetings, community and parent meetings)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention