Journal Article

The Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls: results from a cluster-randomised control trial in India

Prakash, Ravi, Watts, Charlotte, Thalinja, Raghavendra, Ramanaik, Satyanarayana, Beattie, Tara S, Bhattacharjee, Parinita, Murthy, Srikanta, Gafos, Mitzy, Davey, Calum, Blanchard, James, Heise, Lori, Moses, Stephen, Isac, Shajy, Collumbien, Martine, Javalkar, Prakash

2019

Overview

Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ST) adolescent girls in rural settings of southern India. 80 of 121 villages in Vijayapura and Bagalkote districts, Karnataka State, were randomly selected (control = 40; intervention = 40). All 12-13 year-old SC/ST girls in final year of primary school (standard 7 ) were enrolled and followed for 3 years (2014-2017) until the end of secondary school (standard 10 ). Primary trial outcomes were proportion of girls who completed secondary school and were married, by trial end-line (15-16 years). Analyses were intention-to-treat and used individual-level girl data. 92.6% (2275/2457) girls at baseline and 72.8% (1788/2457) at end-line were interviewed. At end-line, one-fourth had not completed secondary school (control = 24.9%; intervention = 25.4%), and one in ten reported being married (control = 9.6%; intervention = 10.1%). These were lower than expected based on district-level data available before the trial, with no difference between these, or other schooling or sexual and reproductive outcomes, by trial arm. There was a small but significant increase in secondary school entry (adjusted odds ratio AOR = 3.58, 95% confidence interval CI = 1.36-9.44) and completion (AOR=1.54, 95%CI = 1.02-2.34) in Vijayapura district. The sensitivity and attrition analyses did not impact the overall result indicating that attrition of girls at end-line was random without much bearing on overall result. Samata intervention had no overall impact, however, it added value in one of the two implementation districts- increasing secondary school entry and completion. Lower than expected school drop-out and child marriage rates at end-line reflect strong secular changes, likely due to large-scale government initiatives to keep girls in school and delay marriage. Although government programmes may be sufficient to reach most girls in these settings, a substantial proportion of SC/ST girls remain at-risk of early marriage and school drop-out, and require targeted programming. Addressing multiple forms of clustered disadvantage among hardest to reach will be key to ensuring India \"leaves no-one behind\" and achieves its gender, health and education Sustainable Development Goal aspirations. ClinicalTrials.gov registration number NCT01996241.

• Publisher: Edinburgh University Global Health Society
• Subject: Adolescent / Adolescents / Authorship / Child / Child marriage / Children / Costs / Design / Education / Educational Status / Families & family life / Female / Girls / Global health / HIV / Human immunodeficiency virus / Humans / India / Intervention / Marriage / Marriage - statistics & numerical data / Norms / Population / Poverty / Program Evaluation / Public health / Schools / Secondary education / Secondary schools / Student Dropouts - statistics & numerical data / Sustainable development / Teenagers