Qualitative Endline Results of the Tipping Point Project to Prevent Child, Early and Forced Marriage in Nepal

"Overall, study findings support the emerging literature on the importance of understanding the influence of participant characteristics and the contexts that influence the effectiveness of CEFM interventions."

Nepal, along with other countries in South Asia and all other regions of the world, will not meet Sustainable Development Goal 5.3 - the elimination of harmful practices, including child, early, and forced marriage (CEFM) by the year 2030. The CARE Tipping Point Program (TPP) is multi-stakeholder, community-based intervention designed to address the root causes of CEFM, promote adolescent rights, challenge social expectations and repressive gender norms, and promote girl-centric and girl-led activism. (A similar process was undertaken in Bangladesh in cooperation with International Centre for Diarrhoeal Disease Research, Bangladesh - icddr,b.) This study presents qualitative results of a mixed-methods evaluation of the TPP in Nepal, investigating the perceived benefits of the programme and exploring contextual features that enhance or detract from programme benefit. 

The quantitative portion of the cluster randomised trial (cRCT) of TPP in Nepal (available at Related Summaries, below) found no impact of the programme on reducing the rate of child marriage and only limited impact on girls' agency. The present paper presents the longitudinal qualitative results of the trial to examine the changes in social norms and girls' agency perceived to be attributable to TPP in a purposive sample of participants in two intervention arms: core and enhanced.

The core TPP approach entailed weekly group sessions for boys and girls and monthly sessions with fathers and mothers of participants. For all four participant groups, these sessions focused on building an understanding of social norms that underpin gender inequities and CEFM, building basic literacy in adolescent sexual and reproductive health and rights, and fostering joint intergenerational dialogues. In addition, girls participated in sessions designed to promote financial literacy and the establishment of savings groups, strengthening leadership, collective action, civic participation skills and capacities, and activists training. A social norms enhanced package also was tested, which contained the core programming along with intensive trainings and follow-up meetings with religious leaders, local government officials, and school personnel, as well as election of girl leaders and girl-led community-based activities designed to shift social norms.

Baseline data included interviews with adolescent girls (N = 20), boys (N = 10), and adult community leaders (N = 8) and focus group discussions (FGDs) with girls (N = 8 groups; 48 individuals), boys (N = 8 groups; 47 individuals), and parents (N = 16 groups; 95 individuals).

Using thematic analysis and structured comparisons by time, gender, district, caste/community, stakeholder type and arm, the researchers found diverse programme participation but widespread improvements in knowledge across several domains. Here are some examples of key findings:
 

• Enhanced knowledge: Participants reported enhanced knowledge on topics such as the health impacts of early childbearing and the importance of education, attributed to TPP.
• Behavioural change: Some participants described putting their new knowledge into action, such as advocating for a more equitable division of labour within households. Behavioural changes concentrated among participants with pre-programme characteristics suggestive of low risk of child marriage. That is, at baseline, they were older, communicated more with their parents, had aspirations for themselves outside of marriage that their parents supported, and reported parental expectations for educational attainment.
• Impact of participation: Greater benefits were noted among those who actively participated in the programme, highlighting the importance of engagement. Adolescents described enduring risk or protection from CEFM, which set the stage for the degree of participation and perceived benefit.
• Minimal social norms change: While some changes in social norms were noted, the overall shift was minimal. Participants reported increased age at marriage and greater consultation with girls in the marriage process, but decision-making largely remained with fathers. Thus, the intervention TPI failed to address the structural barriers and clustering of risk among those most vulnerable to CEFM.

Here is a summary of some of the characteristics of those who benefitted from TPP as compared with those who did not:

• Five of the adolescents interviewed (4 girls and 1 boy) had notably positive changes to their knowledge or behaviours at endline. They tended to be older, with an average age of 17 at endline. They were all attending or enrolled in school at the time of the interviews and aspired to pursue professional careers out of the home. Importantly, all five of them seemed at baseline to have relatively strong relationships with their parents. They communicated with their parents about their desired marriage age, education preferences, and future aspirations. In most cases, they described receiving support and agreement from their parents on these choices and anticipated plans. All participants felt they had learned a lot from TPP.
• In contrast, the girls in the sample who were married or who had their marriages fixed at endline shared several common characteristics. Most were from Kapilvastu, a location with a much greater concentration of Muslim families, characterised by the participants as having very restrictive gender norms. Regardless of location, all the girls lived in families that did not value education for girls. None of the girls were in school despite wishing to be, none had exceeded a primary school education, and all but one came from a family with very little education. Furthermore, none of the girls mentioned career aspirations or plans for the future. Most of the girls had poor social relationships with their parents.
   

The paper outlines a number of implications for research and policy. For example, "[t]he sites for TPP were chosen as being disadvantaged with a large population of at risk girls. However, the differences that emerged during this study across districts and among sub-communities in the same locality suggests that resources were addressing general needs, not the multifaceted needs of those at greatest risk. Highly targeted, community-engaged formative research would be needed to identify the sub-communities and families at greatest risk or marrying their daughter early and to tailor programming to the complex needs of these individuals and sub contexts." In terms of policy, [t]argeted governmental financial support, skill building, and attitudinal and norms change are needed among the sub-population of families whose attitudes and circumstances place girls at highest risk of CEFM."

In conclusion: "Despite a thoughtful step-by-step approach to intervention development in Nepal, the TPP failed to address the structural barriers and clustering of risk among those most vulnerable to CEFM, highlighting the complexity of intervening on CEFM....Study findings support growing calls for better alignment of programming to the needs of those most vulnerable, especially the importance of addressing structural challenges including poverty and poor educational attainment as essential steps toward accelerating the decline in CEFM in Nepal and attainment of SDG 5.3."