This post is part of a blog series on evidence generated through the Population Council’s RISING program. RISING uses implementation science, evidence review, and organizational grants to build knowledge about what works in adolescent girls programming. The views expressed here are those of the authors and do not necessarily represent the views of the Population Council. Please direct any questions to Jeffrey Edmeades.
Recent studies have shown that girl-focused programs can be very effective in expanding girls’ ability to make strategic life choices by providing them with access to critical resources. Understanding what type of programs or program components work best in addressing the unique needs and challenges adolescent girls face is the focus of the RISING program. Making girl-centered programming more effective through rigorous examination of which programs have the greatest impact in improving the lives of girls worldwide will provide critically important guidance for programmers going forward.
To do this, ICRW evaluated a program called “Economic Empowerment and Sexual and Reproductive Health Outcomes for Adolescent Girls,” or TESFA (“hope” in Amharic). The program was implemented by CARE International in the Amhara region of Ethiopia, an area with historically very high rates of child marriage and very low levels of female empowerment. It focused specifically on girls aged 14–19 who had already been married—including those who were widowed or divorced—using a group-based, peer-education approach to improve their sexual and reproductive health and empower them economically.
TESFA started with community engagement activities to bring community leaders on board, help identify married girls and formerly married girls to participate in the program, and nominate two community facilitators to be trained to support the girls’ groups. Participating girls were organized into groups of 15–20 girls that met twice per month for one year. Peer facilitators, identified from among the participating girls, were trained in the curriculum and received ongoing support from their community facilitators in leading the girls' groups.
TESFA reached over 5,000 girls in total, split into four program arms: one that received only training on sexual and reproductive health; one that received only economic empowerment training; one that received a tailored combination of both; and a group receiving a delayed version of the program. This approach allows us to directly compare the effectiveness of different types of programming, both against each other (e.g., sexual and reproductive health vs. combined) and against the status quo (e.g., combined vs. delayed intervention). The lessons learned from this process will be directly relevant to programmers thinking of how to best meet both the health and economic needs of girls, particularly in terms of the value of combining different content areas.
In the analyses done for the RISING project, we focus on the sexual and reproductive health and combined arms, comparing them against each other and against the delayed arm across a range of outcomes, including use of modern contraceptive methods, use of sexual and reproductive health services, HIV testing, intention to invest savings, and feelings of economic self-sufficiency.
The results of these analyses show that girls participating in the TESFA program, regardless of which arm they were in, saw far greater improvements in both the sexual and reproductive health and economic outcomes than those who were not participating. However, the results also clearly show that improvements in sexual and reproductive health were greater for the group that received only training on sexual and reproductive health than for the group that got the combined training. Similarly, improvements in economic outcomes were greater for the group that received only economic training than for the group that got the combined training.
The program results, which we’ll visit in greater detail in an upcoming post, show that it is possible to achieve significant improvements in girls' lives over a relatively short time by targeting programming. Digging a little deeper, we are going to explore whether the program was able to improve health and economic outcomes for the most vulnerable participants—those who were divorced or widowed, and those who were married at the youngest ages. The emerging results also seem to reinforce the notion that data about girls' needs—be they reproductive health information or economic assistance—should guide program content. If these are related to sexual and reproductive health, specific programming seems to work best, while combined programming may result in greater overall improvements in the lives of girls. These are the questions we will be exploring in more detail over the next couple of months. Stay tuned!
Other posts in this series:
- Invest in Girls, Change the World, by Martha Brady and Nicole Haberland
- If Young Girls Had Access to Small Savings Accounts Would They Be More Likely to Stay in School? by Shelley Clark
- Engaging Adolescents, Parents, and the Community to Change Inequitable Gender Norms in Rural Nepal, by Brad Kerner