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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 Project randomized controlled

BURKINA FASO, MALAWI, 2024
Health and Well-Being (HaW)
Caroline Kabiru
Last modified October 14, 2024 Page views 704 Documentation in PDF Metadata DDI/XML JSON

Identification

IDNO
DDI-BFA-MWI-APHRC-PROMOTE-2022-V1.0
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 Project randomized controlled
Subtitle
The PROMOTE Project randomized controlled trial
Country
Name Country code
BURKINA FASO BFA
MALAWI MWI
Abstract
ABSTRACT
Introduction: 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 are often negatively impacted by early childbearing. A vast majority of adolescent girls who get pregnant drop out of school, which results in widening gender inequalities in schooling and economic participation. Our gender transformative research aims to generate rigorous evidence that provide insights on how policy makers and program implementers can support parenting adolescents. We will estimate 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 will also examine the effect of the intervention on sexual and reproductive health outcomes and mental health. The three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training; subsidized childcare; and life skills training that will cover nurturing childcare, sexual and reproductive health, and financial literacy.
Study Design: A randomized trial will be used to compare the effectiveness of the three interventions. We will evaluate 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 will be randomized into one of three study arms. Arm one will receive life skills training through adolescent mothers' clubs. The adolescent mothers' clubs will be facilitated by community health workers (CHWs). Given their role as a bridge between the community and the health sector, working with CHWs will also be critical in facilitating access to SRH and child health services for adolescent mothers and their children. The second arm will receive the life skills training and subsidized childcare. The third arm will incorporate all three interventions. Comparing the first (mothers' clubs only) and second (mothers' clubs + subsidized childcare) will allow us to test the additional benefit of the childcare subsidy. Comparing the second and third arms (mothers' clubs + subsidized childcare + cash transfer) will also allow us to test the additional benefit of the cash transfer. Comparing the first and third arms will allow us to test the combined benefit of the subsidized childcare and cash transfers. At the endline, we will assess 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 will conduct a qualitative process evaluation which will adopt 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 will help 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.
Dissemination: We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings using a variety of knowledge products, including online news articles, peer-review journal publications, policy briefs, and conference abstracts, tailored to diverse groups of end-users.

Trial registration number: AEARCTR-0009115

Budget: USD 782,746 over three years

Version

Version Date
2024-07-01
Version Notes
N/A

Coverage

Geographic Coverage
Ougadugau city in BURKINA FASO and Blantyre city in MALAWI
Unit of Analysis
Randomized sampled household with adolescent mothers aged 10-19 years with children aged 1-3 years in Ougadauo in Burkina Faso and Blantyre in Malawi
Universe
The survey covered the randomized households of pregnant and parenting adolescent mothers aged 10-19 years with children aged 1-3 years.

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Caroline Kabiru African Population and Health Research Centre
Producers
Name Affiliation Role
Anthony Idowu Ajayi African Population and Research Center Co- Investigator
Ramatou Ouedraogo African Population and Research Center Co- Investigator
Beatrice Maina African Population and Research Center Co- Investigator and Project Manager
Anne Khisa African Population and Research Center Co- Investigator
Catherine Asego African Population and Research Center Co- Investigator
Grace Kimemia African Population and Research Center Co- Investigator
Michelle Mbuthia African Population and Research Center Co- Investigator
Jane Mangwana African Population and Research Center Co- Investigator
Jane Mangwana African Population and Research Center Co- Investigator
Alister Munthali Centre for Social Research (CSR), University of Malawi Co-Principal Investigator
Chrissie Kantukule Centre for Social Research (CSR), University of Malawi Co-Investigator
Nathalie Sawadogo Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo Co-Principal Investigator
Alexandra Tapsoba ISSP, Université Joseph Ki-Zerbo Co-investigator
Abdoul Tarnagda ISSP, Université Joseph Ki-Zerbo Co-investigator
Abdoul Kader Ilboudo ISSP, Université Joseph Ki-Zerbo Co-investigator
Carole Compaoré ISSP, Université Joseph Ki-Zerbo Co-investigator
Damaris Adoyo African Population and Research Center Data Documentation specialist
Bonface Iingumba African Population and Research Center Data Governance Officer
Funding Agency/Sponsor
Name Abbreviation Role
International Development Research Center IDRC Funder

Sampling

Sampling Procedure
Study sites
In Burkina Faso, the study was conducted in Ouagadougou, the capital city. The city of Ouagadougou is located in the heart of the province of Kadiogo in the Central Region35. The city's population is young with 47.3% of the population being younger than 20 years with a median age of 16.1 years. In a previous study, approximately 82% of pregnant and parenting adolescents in Ouagadougou were out of school, with 23% reporting that they dropped out of school because of pregnancy. Among those out of school in Burkina Faso, 39% wanted to return to school, while 79% wanted to have an income generating activity.
In Malawi, the study was conducted in Blantyre City, the country's commercial capital. In 2018, the total population of the city was estimated at just over 800,000 with 24% of the population aged between 10 and 19 years 36. A previous study on pregnant and parenting adolescents in Blantyre showed that poverty, sexual violence, COVID-19-related school closure, inequitable gender norms and lack of access to accurate contraceptive information and services make girls vulnerable to early and unintended pregnancy13. Most of these girls got pregnant outside of marriage and consequently faced social exclusion from their peers, parents and communities. While most rely on their parents to provide for them and their babies, others depend on their partners. However, all of these girls face dire financial situations, sometimes lacking food and other basic needs. In the same study, approximately 94% of pregnant and parenting adolescents were out of school and about half of them dropped out because of pregnancy. Notably, 76% wanted to return to school if provided with financial and childcare support, while 93% wanted to learn vocational skills.
Study design
A randomized controlled trial (RCT) was designed to estimate the incremental effect of a conditional cash transfer, subsidized child care and adolescent mothers' clubs on adolescent mothers' (re)enrollment into school or vocation training. We also examined the effects of the interventions on SRH outcomes and mental health as secondary outcomes, and to determine the most cost-effective interventions to increase adolescent mothers' (re)enrollment into school or vocational training.Adolescent mothers were randomly assigned to one of three study arms. Adolescent mothers in all arms received life skills training through adolescent mothers' clubs. Adolescent mothers in arm two also received subsidized child care, while those in arm three received all three interventions. Comparing arm one (mothers' clubs only) and arm two (mothers' clubs + subsidized child care) allowed us to test the additional benefit of the childcare subsidy. Comparing arms two and three (mothers' clubs + subsidized child care + cash transfer) also allowed us to test the additional benefit of the cash transfer.Comparing arms one and three allowed us to test the combined benefit of the subsidized child care and cash transfers.
Given the potential for contamination, rather than testing a community wide intervention, we held community dialogues aimed at engaging a variety of community members including community and religious leaders, health workers, social workers, teachers, parents, and adolescent mothers.The goals of these community dialogues was to jointly identify the root causes of adolescent pregnancies, including gender norms; to discuss possible ways to support parenting adolescents; and to develop a sense of ownership in collectively supporting these adolescents. The initial dialogues also served as a forum to discuss the feasibility of the proposed interventions and to adapt them to ensure local relevance and appropriateness.
Deviations from the Sample Design
Deviation from sampling: 276 teenage mothers were surveyed instead of 270.
Response Rate
Response rate: 100%
Weighting
N/A

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date
2024-02-02 2024-06-11
Mode of data collection
Face-to-face [f2f]
Supervision
Ten (10) collection agents were divided into three (03) teams with a supervisor at the head of each team. There were two teams of two (02) investigators each and one team of three (03) investigators.
Roles of supervisors
Throughout the duration of the collection, the three (03) supervisors conducted regular supervision trips to their different zones to ensure that they were well demarcated and that the investigators respected all the directives, namely:
• The introduction of the study among households and adolescent girls,
• Respect for confidentiality and ethical standards.
During the day, the supervisor was required to follow at least two investigators to ensure compliance with all the directives listed, and at the end of the day, a team debriefing was held in order to resolve difficulties and misunderstandings. The questions requiring answers from the research team were then relayed by the supervisors to the central team in order to have the necessary answers and the action to follow.
Frequency of central team supervision: a total of eleven (11) supervisions were carried out by the ISSP team.
Type of Research Instrument
The questionnaires have four major sections which include the introduction, cover letter,household schedule and the CAPI section.
The cover letter gives a brief introduction of the project sections; The questionnaires are designed to explore the lived experiences of adolescent mothers who are sampled to participate in the PROMOTE project. The instrument interrogates the circumstances surrounding their pregnancy, parental and community reactions, impacts of pregnancy on adolescent health and wellbeing, and future aspirations, including school re-entry and enrolment in apprenticeship. The first section includes questions on demographic and background charateristics, including their schooling and desire to return to school. The second section examines family characteristics. The third section comprises questions on social capital and networks. The fourth section includes questions on self-report health - both physical and mental health. The fifth section includes questions on marriage and sexual behavior. The sixth section comprises question on reproductive health knowledge and contraceptive behavior, while the seventh section captures data on adolescent mothers' pregnancies and births. This section also includes questions on their child care experiences. The eighth section comprises questions on HIV/AIDS and other sexually transmitted infections. Section nine has questions on gender-based violence and adverse childhood experiences. The last section captures data on adolescents aspirations, concerns and perceived life chances. The cover letter contains an informed consent to voluntary participation and withdrawal from the study at any particular period of the study.The household schedule the identification of the household, Name of household head, Region/District where the survey is being undertaken,the identification of the respondent and the language being used.In a nutshell it has three major sections that include identification,interviwer visits and the language used.The CAPI section is divided into ten sections as explained on the introduction part.

Data Processing

Cleaning Operations
The enumerators were organised in teams which covered and each team was led by a team leader who coordinated the duties allocation, monitored progress and ensured daily targets were achieved.
The CSR, Malawi and ISSP Burkina Faso ensured data quality control measures in the field before data were synced to the server. Once synced, data quality control measures were conducted by the APHRC team in conjunction with the data managers at CSR and ISSP.
In each country, core research team members visited the field on a regular basis. The APHRC team also visited the field at the beginning of the survey to pilot the survey instruments.
Other Processing
N/A

Data Appraisal

Estimates of Sampling Error
N/A

Data access

Contact
Name Email URI
African Population Health And Research Centre datarequests@aphrc.org/info@aphrc.org aphrc.org
Conditions
APHRC data access condition

All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research.
This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:

1.Data Ownership:
The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.

2.Purpose:
The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.

3.Respondent Identifiers:
The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.

4.Confidentiality pledge:
The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.

5.Reporting of errors or inconsistencies:
The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.

6.Publications resulting from APHRC data:
The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.

7.Security:
The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.

8.Loss of privilege to use data:
In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.

9.Acknowledgement:
Any work/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:
"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City."Additionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.

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The user should submit electronic and paper copies of all publications generated using APHRC data to the Policy Engagement and Communications Department, with copies to the Director of Research.

11.Change of contact details:
The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.
Citation requirement
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download

Metadata production

Document ID
DDI-BFA-MWI-APHRC-PROMOTE-2022-V1.0
Producers
Name Abbreviation Role
African Population and Health Research Centre APHRC Documentation of the DDI
Date of Production
2024-07-01
Document version
Version 1.0 (July 2024)