Effectiveness of a girls’ empowerment programme on early childbearing, marriage and school dropout among adolescent girls in rural Zambia: study protocol for a cluster randomized trial

Abstract

BackgroundAdolescent pregnancies pose a risk to the young mothers and their babies. In Zambia, 35% of young girls in rural areas have given birth by the age of 18 years. Pregnancy rates are particularly high among out-of-school girls. Poverty, low enrolment in secondary school, myths and community norms all contribute to early childbearing. This protocol describes a trial aiming to measure the effect on early childbearing rates in a rural Zambian context of (1) economic support to girls and their families, and (2) combining economic support with a community intervention to enhance knowledge about sexual and reproductive health and supportive community norms.Methods/designThis cluster randomized controlled trial (CRCT) will have three arms. The clusters are rural schools with surrounding communities. Approximately 4900 girls in grade 7 in 2016 will be recruited from 157 schools in 12 districts. In one intervention arm, participating girls and their guardians will be offered cash transfers and payment of school fees. In the second intervention arm, there will be both economic support and a community intervention. The interventions will be implemented for approximately 2 years. The final survey will be 4.5 years after recruitment. The primary outcomes will be “incidence of births within 8 months of the end of the intervention period”, “incidence of births before girls’ 18th birthday” and “proportion of girls who sit for the grade 9 exam”. Final survey interviewers will be unaware of the intervention status of respondents. Analysis will be by intention-to-treat and adjusted for cluster design and confounders. Qualitative process evaluation will be conducted.DiscussionThis is the first CRCT to measure the effect of combining economic support with a community intervention to prevent adolescent childbearing in a low- or middle-income country. We have designed a programme that will be sustainable and feasible to scale up. The findings will be relevant for programmes for adolescent reproductive health in Zambia and similar contexts.Trial registrationISRCTN registry: ISRCTN12727868, (4 March 2016).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1682-9) contains supplementary material, which is available to authorized users.

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

“…We used a retroduction approach to develop the mechanisms that are theorized to lead to the outcomes within the specific actors. According to Easton [34], and applied by Mukumbang et al, [26,30] 'retroduction is a mode of analysis in which events are explained by identifying mechanisms which are capable of producing them' [27]. In this study, we brought together codes that related to different mechanisms and different actors to develop the themes.…”

“…The main aim of the RISE project was to test interventions for enhancing opportunities for communities to support adolescent girls to continue going to school, and for increasing girls' possibilities to postpone pregnancy and marriage. Details of the RISE project have been reported elsewhere [25,26]. Briefly, RISE is a three-arm cluster randomized controlled trial involving 157 schools and targeting approximately 4900 girls.…”

“…In 2016, the trial enrolled girls who were in grade 7 (average age approximately 14 years). The interventions were provided for two years from Septemebr, 2016 to Novermber, 2018 [25,26].…”

“…The intervention brought together CBHWs and teachers to coordinate: 1) community and parental meetings promoting supportive social norms around the postponement of early marriage and early childbearing, as well as promoting education for girls. The community meetings were held twice per term in each school; 2) the establishment of new adolescents' clubs in order to increase life skills and knowledge of SRHR, including modern contraceptives and promoting a change in behaviour and beliefs relating to contraceptive use among both school-going and non-schoolgoing adolescent girls and boys; 3) providing limited school material support (books and pens); and 4) providing economic support of paying school fees, limited monthly financial support to girls, and annual financial support to families [26]. Through these activities and a multi-sectorial approach of engaging all the stakeholders (adolescents, parents, teachers, CBHWs), the combined intervention arm of RISE aimed to improve girls' SRHR and decrease unwanted pregnancies.…”

Factors Associated with Agreeing to Early Childbearing Among School Girls of Selected Rural Districts in Zambia

“…The clusters are rural schools with surrounding communities and approximately 5000 girls who were in grade 7 in 2016 were recruited from 157 schools in 12 rural districts. The study is on-going until 2020 [2].…”