Long-term Impacts of a Cash Plus Program on Marriage, Fertility, and Education after Six Years in Pastoralist Kenya: A Cluster Randomized Trial

"This study shows the potential for interventions in early adolescence with an education component to delay marriage and fertility into late adolescence and early adulthood in a marginalized and socially conservative setting with low education and high rates of child marriage."

The Adolescent Girls Initiative-Kenya (AGI-K) was a randomised trial designed to test the short-and longer-term effects of a 2-year multisectoral, cash plus programme designed for girls 11-14 years old. One implementation site was Wajir, a pastoralist rural county where girls face many challenges. Prior studies (at Related Summaries, below) found that the intervention increased school enrollment after 2 years (in 2017) and reduced child marriage and pregnancy after 4 years (in 2019). To understand whether these effects were sustained as the girls aged, this paper assesses the effects in 2021, when the young women were 17-20 years old. The paper estimates effects on the primary outcomes of marriage, pregnancy, and birth, as well as on education-related secondary outcomes.

The prospective 80-cluster randomised trial followed 2,147 girls 11-14 years old starting in 2015, re-interviewing 94.2% of them in 2021. AGI-K interventions included community dialogues, a conditional cash transfer, health and life skills training, and financial literacy. Villages were randomised to 1 of 4 study arms: (i) violence prevention only (V-only); (ii) V + education (VE); (iii) VE + health (VEH); or (iv) VEH + wealth creation (VEHW). For approval by local authorities to carry out the research, all 4 study arms included the community-level violence prevention intervention, ensuring that all participating communities received a direct benefit. In each cluster, a locally formed key stakeholder committee discussed inequitable gender norms and factors contributing to violence against girls in their community, and then formulated and implemented an action plan funded by AGI-K to address them. Per the theory of change, this component promotes an enabling environment supporting the additional interventions layered on top of it in the different study arms, even if this mechanism cannot be directly tested given the study design.

The researchers used analysis of covariance to estimate intent-to-treat impacts of each study arm with an education component, as well as a pooled (weighted average) study arm combining VE, VEH, and VEHW, in reference to V-only, 4 years after the intervention ended. The 3 primary outcomes include binary 0/1 indicators measured in the 2021 follow-up equal to one if the girl had ever: (i) been married; (ii) been pregnant; or (iii) given birth. The researchers also examined 2 secondary outcomes related to education, a key mechanism in the theory of change: a binary 0/1 indicator for current enrollment and the number of grades attained.

Programme fidelity and take-up were high. All clusters completed their community action plans by 2018 at the latest, with most making improvements in village primary schools. Nearly 90% of girls in study arms VE, VEH, or VEHW received at least one cash transfer (and associated school fee payments and school kits), and, on average, girls received 9 of 12 possible payments. On the other hand, no girls in V-only received any cash transfers. Eligible girls attended 33 empowerment meetings on average, with about three-quarters having attended at least 12.

Base specification estimates show reductions in the primary outcomes, though none statistically significant in the full sample. Estimates with extended controls (including baseline school enrollment) are larger, and the pooled study arm had significantly lower marriage and pregnancy. For example, the pooled estimate indicates a weighted average 6.7 percentage point reduction in marriage compared to V-only, 4.5 percentage point reduction in pregnancy, and 3.5 percentage point reduction in birth (marginally significant), an approximate one-quarter reduction relative to V-only for each indicator. Examination of secondary outcomes related to schooling for the full sample reveals that the VE and pooled study arms had higher enrollment in 2021 by 7-10 percentage points (compared to 56.9% enrollment in V-only) and that each study arm (and the pooled study arm) had higher grade attainment by nearly one-half a grade (compared to an average of 7.0 in V-only).

There are considerably larger statistically significant effects for the baseline out-of-school subsample. Pooled estimates indicate 18.2 percentage point lower marriage compared to V-only and 15.1 percentage point lower pregnancy. For the same group, pooled estimates indicate a 27.9 percentage point increase in current enrollment (compared to 7.1% in V-only) and a 1.8 grades increase (compared to 1.2 in V-only).

In conclusion: "With effects concentrated among the most at-risk girls, AGI-K demonstrated that with early intervention it was possible to shift many girls off a path to early marriage and on to one of higher education. Because girls who were not in school when the program started benefited the most, the findings raise the possibility that the cash transfer could be reconfigured and applied differentially to improve cost-effectiveness, provided such changes did not incentivize households with enrolled girls to remove them from school."