DOI: 10.60719/aphrc-2025-053
title: Effectiveness of conditional cash transfers, subsidized child care and life skills training on adolescent mothers’ schooling, sexual and reproductive health, and mental health outcomes in Burkina Faso and Malawi, The PROMOTE, ENDLINE

description: In Burkina Faso and Malawi, as in many countries in sub-Saharan Africa, girls' and women's health as well as social and economic wellbeing were often negatively impacted by early childbearing. A vast majority of adolescent girls who got pregnant dropped out of school, which resulted in widening gender inequalities in schooling and economic participation. Our gender transformative research aimed to generate rigorous evidence that would provide insights on how policy makers and program implementers could support parenting adolescents. We estimated the incremental effect of three interventions aimed at facilitating adolescent mothers' (re)entry into school or vocation training in Ouagadougou (Burkina Faso) and Blantyre (Malawi). We also examined the effect of the intervention on sexual and reproductive health outcomes and mental health. The three interventions we assessed were: a cash transfer conditioned on (re)enrolment into school or vocational training; subsidized childcare; and life skills training that covered nurturing childcare, sexual and reproductive health, and financial literacy.

Study Design: A randomized trial was used to compare the effectiveness of the three interventions. We evaluated the interventions using data from surveys conducted before the start of the program and at the end of 12 months. Following the baseline, adolescent mothers (N=270) aged 10 - 19 years with a child aged 1 - 3 years were randomized into one of three study arms. Arm one received life skills training through adolescent mothers' clubs. The adolescent mothers' clubs were facilitated by community health workers (CHWs). Given their role as a bridge between the community and the health sector, working with CHWs was also critical in facilitating access to SRH and child health services for adolescent mothers and their children. The second arm received the life skills training and subsidized childcare. The third arm incorporated all three interventions. Comparing the first (mothers' clubs only) and second (mothers' clubs + subsidized childcare) allowed us to test the additional benefit of the childcare subsidy. Comparing the second and third arms (mothers' clubs + subsidized childcare + cash transfer) also allowed us to test the additional benefit of the cash transfer. Comparing the first and third arms allowed us to test the combined benefit of the subsidized childcare and cash transfers. At the endline, we assessed the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training enrolment and retention, contraceptive use, and mental health at baseline and endline. To complement the quantitative data, we conducted a qualitative process evaluation which adopted an ethnographic approach combining participant observation and repeat IDIs with adolescent mothers, and key informant interviews (KIIs) with partners, teachers, parents and childcare center managers. This approach helped gather contextual subjective knowledge about adolescent mothers, their daily interactions with key actors in their lives (including their parents, partners, teachers, etc.) and their behavioral responses to different stimuli.