Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

Abstract

Inequitable attitudes toward men's and women's roles, rights, and responsibilities are associated with poor healtherelated outcomes, particularly for girls and women. Yet, we know relatively little about what interventions work to improve gender-equitable attitudes among adolescents in low-income countries. This study examines the impact of a government-implemented "cash plus" intervention on gender-equitable attitudes among adolescents in Tanzania. The intervention includes discussions and activities related to gender norms, embedded in broader life skills, livelihoods, and health training. Methods: The study utilizes a cluster randomized design, using data from 1,933 males and females aged 14e19 years at baseline who took part in the baseline (2017), midline (2018), and endline (2019) surveys. Gender attitudes were measured using 24 items from the Gender-Equitable Men (GEM) Scale. We estimate intent-to-treat impacts on the GEM scale and four subscales (violence, sexual relationships, reproductive health, and domestic chores). Results: The "cash plus" intervention had a significant impact on the overall GEM scale at midline. The intervention increased gender-equitable attitudes on the domestic chores subscale at both midline and endline. The intervention improved gender-equitable attitudes among males on the overall GEM scale and three subscales at midline and on two subscales at endline, but it had no impacts among females.

A “Plus” Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth

“…Previous findings from this study have also demonstrated differential impacts on hypothesized pathways which may subsequently have led to differential impacts revealed in the current study. For example, the intervention was found to increase gender-equitable attitudes among males, but not females (Chzhen et al 2021).…”

“…For example, the intervention was found to increase gender‐equitable attitudes among males, but not females (Chzhen et al. 2021).…”

Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed‐methods study

“…This may be due to a number of reasons. While this intervention has been previously demonstrated to be protective along several pathway indicators, including gender-equitable attitudes [49], increased knowledge related to contraception and HIV prevention [50], mental health [51] and economic activities [47], it was perhaps not sufficient to overcome all the interrelated social, relational and economic vulnerabilities which lead AGYW to engage in transactional sex. Alternatively, the lack of impacts may be reflective of alternative drivers of engagement in transactional sex, namely choice of partners, addressing low self-esteem or a need to boost one's own power and social status [6,52].…”

Effects of Adolescent-Focused Integrated Social Protection on Depression: A Pragmatic Cluster-Randomized Controlled Trial of Tanzania’s Cash Plus Intervention

“…However, the pathway indicators examined here do not fully explain the effects on mental health. In work published elsewhere, investigators found that the intervention increased equitable gender attitudes ( 35 ) and reduced experiences of sexual violence and the perpetration of physical violence ( 36 ). These results may have contributed to better mental health, as violence perpetration among males is associated with increased substance use, less gender-equitable attitudes, and posttraumatic stress disorder and depression ( 37 ).…”