RISE - stärka unga flickor RISE - empowerment of girls The School of Public Health at the University of Zambia have requested financial assistance from Sida to fund an on-going research study (RISE) aiming to find evidence that financial support in combination with sexuality education empowers girls to avoid early pregnancies and drop out of school. Researchers at the University of Zambia (UNZA) School of Public Health, in partnership with researchers from the University of Bergen (UiB), Norway, are currently implementing the Research Initiative to Support the Empowerment of girls (RISE). This is a cluster randomized trial (running since 2016) which is examining whether early childbearing rates can be reduced and grade 9 completion rates increased in a rural Zambian context by:
- provision of economic support to girls and their families, and
- whether combining economic support with comprehensive sexual and reproductive health education and community meetings to address social norms, can have a greater effect.

The trial has three study arms: 1) A control arm, 2) An economic support arm, and 3) A combined arm with economic support, comprehensive sexuality education, CSE, and community meetings. The study units are rural schools in twelve districts in Southern and Central provinces. The eligible participants were 5000 girls enrolled in grade 7 in 2016.
The two universities are partners in a Centre of Excellence in Research funded by the Research Council of Norway and the University of Bergen. The primary objective of the Centre for Intervention Science in Maternal and Child Health (CISMAC) research consortium is to conduct excellent trials in low and middle income countries to generate evidence on how to effectively and equitably deliver health interventions to improve maternal and child health. In addition to generating evidence on the effects of the support packages, the RISE project is also strengthening the research capacity of Masters and PhD students in Public Health at the University of Zambia. Currently 7 master students from the University of Zambia are collecting/using data and being supervised from the RISE project. 

Sida has been requested to provide additional funding to the research project to enable the originally planned follow-up of the girls into 2020. With current funding, the project will have to end in 2018 due to insufficient funds which would not give sufficient evidence to validate the trial results. Svenska ambassaden i Lusaka har approcherats av School of Public Health vid universitetet i Zambia för finansering av en pågående forskningsstudie vars syfte är att hitta evidens att ekonomiskt stöd och SRHR-kunskap minskar andelen tonårsgraviditeter. Forskare vid University of Zambia (UNZA) School of Public Health, i samarbete med forskare från Universitetet i Bergen (UiB), Norge, genomför för närvarande en forskningsstudie för att stärka flickors egenmakt (RISE). Detta är en klusterrandomiserad studie (som pågår sedan 2016), som undersöker huruvida tidiga tonårsgraviditeter minskar och andelen flickor som slutför årskurs 9 ökar genom:

- Tillhandahållande av ekonomiskt stöd till flickorna och deras familjer, och
- En kombination av ekonomiskt stöd tillsammans med utbildning i sexuell och reproduktiv hälsa och diskussionsmöten på lokal nivå om sociala normer kan få större effekt.
Forskningsstudien har tre armar: 1) En kontrollarm, 2) En ekonomisk stödarm och 3) En kombinerad arm med ekonomiskt stöd, sexualitetsutbildning och diskussionsmöten på lokalnivå. Studieenheterna är landsbygdsskolor i tolv distrikt i Södra och Centrala provinserna i Zambia. De stödberättigade deltagarna är 5000 flickor inskrivna i klass 7 år 2016. De två universiteten är partners i ett forskningskonsortium som finansieras av Norges forskningsråd och universitetet i Bergen. Förutom att generera bevis på effekterna av stöd till flickor, stärker RISE-projektet också forskningskapaciteten hos masterstudenter och doktorander i folkhälsa vid University of Zambia. För närvarande deltar 7 masterstudenter från University of Zambia i datainsamling och får handledning från RISE-projektet.

Sida har blivit ombedd att ge ytterligare finansiering till forskningsprojektet för att möjliggöra den ursprungliga planerade uppföljningen av flickorna till 2020. Med nuvarande finansiering måste projektet avslutas i slutet av 2018 vilket inte skulle ge tillräckliga bevis för att validera provresultaten. The overall objective of the trial is to measure the effect of combining economic support with a community intervention to prevent adolescent childbearing in a low income country. There are three 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 effecetiveness of economic support alone and of a combined economic and community intervention on the proportion of girls who sit for the grade 9 exam. 
The secondary objectives are several: to measure the effectiveness of economic support alone and of a combined economic and community intervention on pregnancy and childbearing within 2 years, before the 16th birthday, marriage before the 16th and 18th birthday, socioeconomic inequality of childbearing and marriage before the 18th birthday, enrolment in grade 8 and 10, school attendance and grade 9 exam scores, socioeconomic inequality in participation in the grade 9 exam, knowledge and experiences related to SRH, including modern contraceptives, attitudes and perceived community norms related to the value of educating girls, early marriage, modern contraceptive use and adolescent pregnancy, employment status. 
The cluster randomized control trial has three arms. The clusters are rural schools with surrounding communities. The schools are at least 8 kms apart. The three arms are the following:
- The control arm consisting of girls from 31 schools. They will receive school materials such as pencils, books and pens as an incentive to participate. 
- The economic support arm. Girls from 63 schools participate. In addition to the above mentioned school materials, these girls receive K30 monthly and their guardians an annual cash grant of K350. School fees of about K500/term are paid.
- The economic support arm combined with a community intervention. Girls from 63 schools are receiving the same support as group 2 above but will also be given SRHR education and discuss SRHR at community meetings during the intervention period.
The primary outcome is to study the incidence of births within 8 months of the end of the intervention period, incidence of births before the girls' 18th birthday; and proportion of the girls who sit for the grade 9 exam. The final study interviewers will be unaware of the respondents' intervention arm status. 
The RISE project is also strenghthening the research capacity of Masters and PhD students in Public Health at the UNZA. Currently, 7 Master students are collecting and using date under the supervision of the project. 
The project is deemed sustainable and feasible to scale up, should the Zambian government decide to do so.  The findings will be relevant for programmes focusing on adolescent sexual and reproductive health in Zambia and similar contexts, which is a top priority for Sweden in its development cooperation with Zambia.