The Impact of the Adolescent Girls Empowerment Program (AGEP) on Short and Long Term Social, Economic, Education and Fertility Outcomes: A Cluster Randomized Controlled Trial in Zambia

"These findings suggest that when addressing long-term educational and fertility outcomes among very vulnerable adolescent girls, interventions that only target the girl herself may not be sufficient."

Adolescent girls in Zambia face risks and vulnerabilities that challenge their healthy development into young women: early marriage and childbearing, sexual and gender-based violence, unintended pregnancy and HIV. The Adolescent Girls Empowerment Program (AGEP) was designed to address these challenges by building girls' social, health, and economic assets in the short term and improving sexual behaviour, early marriage, pregnancy, and education in the longer term. This paper evaluates AGEP's theory of change by assessing the impact of the programme on adolescent girls' mid- and longer-term indicators using data collected at the end of the 2-year intervention, and 2 years after the end of the intervention.

The AGEP evaluation was based on a multi-arm randomised cluster design implemented in 10 sites, half urban and half rural, in 4 provinces in Zambia. (Those living in AGEP intervention clusters were invited to participate in the programme, while girls living in control clusters were not issued an invitation.) As described at Related Summaries, below, weekly girls groups, known as "safe spaces", were considered the core component of the 2-year intervention. The weekly girls' group meetings on health, life skills, and financial education were facilitated by a trained female mentor from the community. Additional intervention components included a health voucher redeemable for general wellness and reproductive health services and an adolescent-friendly savings account.

Up to 17 girls aged 10-14 and up to 23 girls aged 15-19 within each cluster, stratified by these 2 age groups, were randomly selected for participation in the research. Baseline data were collected between July 2013 and February 2014 from never-married adolescent girls in 120 intervention clusters (3,515 girls) and 40 control clusters (1,146 girls) and again 2 and 4 years later. An intent-to-treat (ITT) analysis assessed the impact of AGEP on girls' social, health, and economic assets, sexual behaviours, education, and fertility outcomes. Notably, the ITT parameter of impact was defined as whether a girl was invited to participate in AGEP, regardless of her actual participation in the programme. A treatment-on-the-treated analysis using 2-stage instrumental variables regression was also conducted to assess programme impact on those who actually participated.

The intervention had modest, positive impacts on sexual and reproductive health knowledge after 2 and 4 years, financial literacy after 2 years, savings behaviour after 2 and 4 years, self-efficacy after 4 years, and transactional sex after 2 and 4 years. For example, in the domain of social assets, at baseline, respondents showed middling levels of self-efficacy, with an average score of 6 to 6.1, within a potential range of 0 to 10. A high percentage of girls (58-62%) did not have access to a safe place in the community to meet with friends at baseline, which contributed to their social isolation. The percentage of respondents who reported no access to a safe space decreased over time from 45-48% of respondents in the intervention arms and 48% of respondents in the control arm at Round 5. Self-efficacy levels increased over time, as respondents in the intervention arms scored 7.4-7.7 out of 10 and respondents in the control arm scored 7.3 at Round 5.

There was no effect of AGEP on the primary education or fertility outcomes, nor on norms regarding gender equity, acceptability of intimate partner violence (IPV), and HIV knowledge.

Thus, although the intervention led to sustained change in a small number of individual outcomes, overall, the intervention did not lead to girls acquiring a comprehensive set of social, health, and economic assets, or change their educational and fertility outcomes. Per the researchers, it is helpful to consider several factors in understanding why the intervention did not result in the hypothesised changes, which include:

• Low participation: Only 30% of the sample participated in half or more of the programme sessions, and 25% did not participate at all. Potentially, girls from the most disadvantaged households need additional interventions that address the household economic status, which may prevent girls from participating in the first place. It is also possible that without addressing the economic constraints at the household level, even participation in a girls' empowerment program alone is not enough to impact longer-term outcomes such as educational attainment or timing of pregnancy.
• Social and cultural context: With 60% of girls agreeing that IPV is acceptable, two-thirds having experienced physical violence, and half having experienced sexual violence (defined as being forced into sexual intercourse or other sexual acts), it is likely that an intervention targeting only asset building for girls is not sufficient to change attitudes around gender roles or acceptability of violence. Taking a socio-ecological approach in the future may lead to different results. For instance, future programmes in this context may need to address norms at the household and community level, in addition to direct interventions with girls.

In conclusion: "It is important to explore additional interventions that may be needed for the most vulnerable girls, particularly those that address household economic conditions. Additional attention should be given to the social and economic environment in which girls are living."