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Effects of economic support, comprehensive sexuality education and community dialogue on sexual behaviour: Findings from a cluster-RCT among adolescent girls in rural Zambia

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  • Hegdahl, Hanne Keyser
  • Musonda, Patrick
  • Svanemyr, Joar
  • Zulu, Joseph Mumba
  • Grønvik, Taran
  • Jacobs, Choolwe
  • Sandøy, Ingvild Fossgard

Abstract

Adolescent girls in Sub-Saharan Africa are at high risk of poor sexual and reproductive health outcomes. We present findings from a cluster-randomised trial in rural Zambia on the effects of economic support, comprehensive sexuality education (CSE) and community dialogue on sexual activity, contraceptive use and beliefs among adolescent girls. We recruited 157 schools in 2016, and all girls in grade 7 were invited to participate. Schools were randomised to either economic support, combined economic support, CSE and community dialogue, or control. Economic support consisted of unconditional cash transfers to girls and their guardians, and payment of school fees for girls continuing to grades eight and nine. CSE and community dialogue meetings focused on practices around girls’ fertility, marriage and education. The interventions lasted two years from 2016 to 2018, with follow-up for another two years. The effects on outcomes were measured in 2018 and 2019 and compared using generalised estimating equations. We found that economic support lowered sexual activity (risk ratio (RR) 0.70; 95% C.I. 0.54 to 0.91), with a small added benefit of CSE and community dialogue. Economic support and the additional CSE and community dialogue were effective in lowering unprotected sexual activity (RR 0.53 for combined support vs. control; 95% C.I. 0.37 to 0.75). There was no evidence of intervention effects on contraceptive use among those ever sexually active, but the addition of CSE and community dialogue improved contraceptive use among those recently sexually active (RR 1.26; 95% C.I. 1.06 to 1.50) and knowledge regarding contraceptives (RR 1.18; 95% C.I. 1.01 to 1.38) compared to economic support alone. Perceived community support regarding contraceptives was lower in both intervention arms compared to the control. These findings indicate that economic support in combination with CSE and community dialogue can improve the sexual and reproductive health of adolescent girls.

Suggested Citation

  • Hegdahl, Hanne Keyser & Musonda, Patrick & Svanemyr, Joar & Zulu, Joseph Mumba & Grønvik, Taran & Jacobs, Choolwe & Sandøy, Ingvild Fossgard, 2022. "Effects of economic support, comprehensive sexuality education and community dialogue on sexual behaviour: Findings from a cluster-RCT among adolescent girls in rural Zambia," Social Science & Medicine, Elsevier, vol. 306(C).
    • Handle: RePEc:eee:socmed:v:306:y:2022:i:c:s0277953622004312
    DOI: 10.1016/j.socscimed.2022.115125
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    References listed on IDEAS

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    1. Sarah Baird & Craig McIntosh & Berk Özler, 2011. "Cash or Condition? Evidence from a Cash Transfer Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(4), pages 1709-1753.
    2. Esther Duflo & Pascaline Dupas & Michael Kremer, 2015. "Education, HIV, and Early Fertility: Experimental Evidence from Kenya," American Economic Review, American Economic Association, vol. 105(9), pages 2757-2797, September.
    3. Sudhanshu Handa & Carolyn Tucker Halpern & Audrey Pettifor & Harsha Thirumurthy, 2014. "The Government of Kenya's Cash Transfer Program Reduces the Risk of Sexual Debut among Young People Age 15-25," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-9, January.
    4. Ajzen, Icek, 1991. "The theory of planned behavior," Organizational Behavior and Human Decision Processes, Elsevier, vol. 50(2), pages 179-211, December.
    5. Handa, Sudhanshu & Peterman, Amber & Huang, Carolyn & Halpern, Carolyn & Pettifor, Audrey & Thirumurthy, Harsha, 2015. "Impact of the Kenya Cash Transfer for Orphans and Vulnerable Children on early pregnancy and marriage of adolescent girls," Social Science & Medicine, Elsevier, vol. 141(C), pages 36-45.
    6. Carolyn J. Heinrich & John Hoddinott & Michael Samson, 2017. "Reducing Adolescent Risky Behaviors in a High-Risk Context: The Effects of Unconditional Cash Transfers in South Africa," Economic Development and Cultural Change, University of Chicago Press, vol. 65(4), pages 619-652.
    7. Pascaline Dupas, 2011. "Do Teenagers Respond to HIV Risk Information? Evidence from a Field Experiment in Kenya," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 1-34, January.
    8. Kirsten Majgaard & Alain Mingat, 2012. "Education in Sub-Saharan Africa : A Comparative Analysis," World Bank Publications - Books, The World Bank Group, number 13143.
    9. Adriaan M Verspoor, 2008. "At the Crossroads Choice for Secondary Education in Sub-Saharan Africa," World Bank Publications - Books, The World Bank Group, number 6537.
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