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, ENDLINE

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 were often negatively impacted by early childbearing. A vast majority of adolescent girls who got pregnant dropped out of school, which resulted in widening gender inequalities in schooling and economic participation. Our gender transformative research aimed to generate rigorous evidence that would provide insights on how policy makers and program implementers could support parenting adolescents. We estimated 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 also examined the effect of the intervention on sexual and reproductive health outcomes and mental health. The three interventions we assessed were: a cash transfer conditioned on (re)enrolment into school or vocational training; subsidized childcare; and life skills training that covered nurturing childcare, sexual and reproductive health, and financial literacy.

Study Design: A randomized trial was used to compare the effectiveness of the three interventions. We evaluated 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 were randomized into one of three study arms. Arm one received life skills training through adolescent mothers' clubs. The adolescent mothers' clubs were facilitated by community health workers (CHWs). Given their role as a bridge between the community and the health sector, working with CHWs was also critical in facilitating access to SRH and child health services for adolescent mothers and their children. The second arm received the life skills training and subsidized childcare. The third arm incorporated all three interventions. Comparing the first (mothers' clubs only) and second (mothers' clubs + subsidized childcare) allowed us to test the additional benefit of the childcare subsidy. Comparing the second and third arms (mothers' clubs + subsidized childcare + cash transfer) also allowed us to test the additional benefit of the cash transfer. Comparing the first and third arms allowed us to test the combined benefit of the subsidized childcare and cash transfers. At the endline, we assessed 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 conducted a qualitative process evaluation which adopted 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 helped 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.

与撒哈拉以南非洲诸多国家一样，布基纳法索与马拉维的少女及女性健康、社会与经济福祉，常因早育遭受负面影响。绝大多数怀孕的青春期少女会辍学，进而加剧了教育与经济参与层面的性别不平等。本项性别转型研究旨在生成严谨的实证证据，为政策制定者与项目执行者提供支持为人父母的青春期少女的路径参考。我们在布基纳法索瓦加杜古与马拉维布兰太尔开展研究，评估了三项旨在助力青春期母亲重新（或首次）入学或参与职业培训的干预措施的增量效应，同时还考察了上述干预措施对性与生殖健康结局及心理健康的影响。本次评估的三项干预措施分别为：以重新入学或参与职业培训为条件的现金补贴、托育费用减免，以及涵盖育儿指导、性与生殖健康及金融素养的生活技能培训。
研究设计：本研究采用随机试验比较三项干预措施的有效性。我们通过项目启动前与实施12个月后开展的两轮调查数据对干预措施进行效果评估。基线调查完成后，我们将270名年龄在10至19岁、育有1至3岁子女的青春期母亲随机分配至三个研究组之一。第一组通过青春期母亲俱乐部接受生活技能培训，该俱乐部由社区健康工作者（Community Health Workers, CHWs）牵头运营。鉴于社区健康工作者是联结社区与卫生系统的桥梁，与他们合作也有助于青春期母亲及其子女获取性与生殖健康（SRH）及儿童健康服务。第二组则接受生活技能培训与托育费用减免服务。第三组整合了全部三项干预措施。通过对比第一组（仅母亲俱乐部）与第二组（母亲俱乐部+托育减免），我们可检验托育补贴的额外增益效应；对比第二组与第三组（母亲俱乐部+托育减免+现金补贴），则可评估现金补贴的额外增益效应；对比第一组与第三组，则可检验托育减免与现金补贴的联合增益效应。在终线调查阶段，我们采用意向性治疗（intent-to-treat, ITT）分析方法评估三组的平均干预效应，对比了基线与终线调查时的入学/职业培训报名与留存率、避孕措施使用情况及心理健康水平。为补充量化数据，我们开展了质性过程评估，采用民族志研究方法，结合参与式观察、对青春期母亲的重复深度访谈（In-depth Interviews, IDI），以及对其伴侣、教师、家长与托育中心管理者的关键知情人访谈（Key Informant Interviews, KII）。该方法有助于收集关于青春期母亲的情境化主观认知信息，包括她们与生活中关键角色（如父母、伴侣、教师等）的日常互动，以及对不同刺激的行为反应。