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

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.