Shireen Jejeebhoy, AKSHA Center for Equity and Wellbeing - Evidence review on strategies to address girls empowerment outcomes in india

Presentation made at an IFPRI event on "What Lies Beneath: Women’s and Girls’ Wellbeing as a Critical Underpinning of India’s Nutritional Challenge" on December 10, 2018, in New Delhi

1. Shireen J. Jejeebhoy
AKSHA Centre for Equity and Wellbeing
Supporting transitions from adolescence to adulthood:
Evidence informed leads for investment

2. What do we mean by a successful transition from adolescence to adulthood?
Sources: Santhyaet al., 2017; Jejeebhoy, 2017

3. Synthesisingthe global and Indian evidence on what works
(or holds promise)
•Review (2017) of the available evidence on what works to promote each of the key
adolescent transitions, drawing on the global evidence as well as evaluations of pilot
programmesin India
•Various sources of information consulted (Jstor, Pubmed, Popline, Medline,
GoogleScholar) of studies conducted in 1995-2017
•Studies conducted in India, as well as public sector and NGO programme documents
•Cast a wide net, included studies using a variety of designs

4. Some promising and evidence based leads for
investment

5. Entitlements for school going adolescents keep adolescents in school,
reduce discontinuation and enhance learning outcomes
•Supplementarycoachingfordisadvantagedstudents/firsttimelearners,evenby
volunteers,enhanceslearningoutcomesandschoolcontinuation
1
•Scholarshipsandvouchers:affectsenrolmentandlearningoutcomes
2
•Teachercapacitybuilding,incentivisingteachersonperformanceindicators
basedonstudentlearningoutcomes(testscores,mathsandlanguage)
3
•Improvingmobilitytoschools–providingbicyclesorfundstopurchaseone--
reducesdropoutfromprimarytosecondaryschool,andsecondaryschool
completion
4
•Girlswhoreceivedbicycleswere23%morelikelythanotherstocompleteschooland5%morelikelythanothersto
completecollege.
Sources:
1
ASER2017,GlewweandMurlidharan2015,Banerjeeetal.,2007;Lakshminarayanetal.,2013;Banerjeeetal.,2016;Banerjee,2013);
2
GlewweandMuralidharan,2015;
3
MuralidharanandSundararaman,2011;
4
MuralidharanandPrakash,2013;MitraandMoene,2017)
1

6. Conditional cash transfer programmes promote school
completion and have other indirect benefits, e.g. delay marriage
Location(author) Model Outcomes:enrolmentratesandtestscores
Opportunidades,
Mexico(Holmesand
Slater,nd)
Monetaryeducationalgrantsto
participatingfamiliesforeachchild
under22whoisenrolledinschool
betweenthethirdgradeofprimary
andthethirdgradeofhighschool.
Grade7enrolmentrate8.7%higherthan
controls
Largestimpactreportedonchildrenwhoenter
secondaryschool,whereimpactsrepresenta
percentageincreaseofenrollmentover20
percentforgirlsand10percentforboys
Malawi(Bairdetal,
2011,2013;2016)
Forschoolgoinggirlsandoutofschool
girlswhoreturntoschool
No.oftermsenrolledover2yearsincreasedby
0.535;dailyattendanceby8%points;increaseof
0.6yearsinhighestgradecompletedamong
baselinedropouts;declinesinchildmarriage
(11-16%)andearlypregnancy(4-8%)
Pakistan(Chaudhury
andPrajuli,2006)
Girls,class6-8,providedfamilies$3
permonthifdaughterattended
regularly
Increaseinenrolmentof9%
•Payoutisshortterme.g.overtheschoolterm(Fiszbein&Schady,2009;Glewwe&Muralidharan,2015)
2

7. Comprehensive skilling programmes (not just provision of vocational skills)
are associated with a successful transition to work
Effects
LiberiaIncreased by 47% and monthly earnings by about $32 (World Bank, 2016)
Nepal overall employment among exposed girls was 47% higher and nonfarm employment was 14 points
greater than the control group(World Bank, 2016)
India linking rural girls and young women to the outsourcing industry; exposure resulted in greater
employment (5%) than in control group, greater aspirations for a career prior to marriage (12%),
delayed marriage (5%) (Jensen, 2012)
Uganda Combinedwithinformationonsex,reproductionandmarriageraisedthelikelihoodthatgirls
engageinincomegeneratingactivitiesby72%,raisedmonthlyconsumptionby41%,reduced
teenpregnancyandearlycohabitation(Bandieraetal.,2014)
Comprehensiveskillingprogrammesblendvocationaltrainingwithsoftskillsandlifeskills
training,careercounselling,jobsearchsupportandjob-relatedmentoring
3

8. School-based comprehensive sexuality education (knowledge + human rights,
skills to make informed decisions, critical thinking and sense of self efficacy) is
imperative for healthy development
Awareness
of SRH
Gender
role
attitudes
Skills to
make
informed
decisions
SRH
Condom
use
Multiple
partner
relations
Age at
first sex
STI/HIV
prevalence
Unintended
pregnancy
Global
evidence
reviews
+ + + + + + + (if
combined
with
contra
provision)
+ (if
combined
with contra
provision)
Sources: Patton et al., 2016; Haberland and Rogow, 2015; Haberland 2015; Oringanjeet al., 2016; WHO, 2011, Sani et al., 2016
4

9. Nonformalgroup-based gender transformative life skills education develops
agency, awareness and new notions of masculinity and femininity
Globalevidence: While many
programmes have been implemented,
relatively few have been evaluated
Awareness of
SRH
Gender
role
attitudes
Agency Schooling
outcomes
literacy
Child
marriage
Health
services
Decision
making,
self-
efficacy,
mobility
Financial
literacy
access to
resources
Peer
networks
Global evidence
1
+ + +
Ethiopia, Kenya, Egypt, Zambia
2
+ + + + +
Indiarural
3
+ + + + + +
Bangladesh,Uganda, Sierra
Leone, other
4
+ +
Bangladesh
5
+ + * + + +
Nepal
6
+ +~
Sources:
1
Pattonetal.,2016;Malhotraetal.,2011;
2
Ashrafetal.,2013;GPYE,2013;Bradyetal.,2007;
3
Acharyaetal.,2009,UP;Mehraetal.,2016,UP,MP);
4
Bandieraetal.,
2012;2014;Kashfietal.,2012;ShahnazandKarim2008;
5
Aminetal.,2016;
6
Cadenaetal.,2015)
5

10. Focused programmes for married girls build their agency and
improves reproductive health outcomes
Intervention Agency, social
support, freedom
from violence,
communication
skills
SRH
knowledge
Contraception
including
delaying first
pregnancy
Delivery
preparedness,
antenatal and
PPcheck ups
Evidence review,
(India, Nepal,
Malawi)
1
Counselling, home visits by FLW, HW
capacity building
+ + +
Ethiopia
2
Group based, information and
services on SRH, economic
empowerment, other skills
+ +
India:
3. 4
Group based,focus on empowering
newly married girls and improving
RH
3
Information andcounselling,
orientation of HCP
4
+ + + +
Sources:
1
Sarkaretal.,2015;
2
EdmeadesandHeaves,2014;
3
Santhyaetal.,2008(FirstTimeParentsprogramme,GujaratandWBengal);
4
Jejeebhoyetal.,2016,PRACHARproject,
Bihar)
6

11. Programmes to engage parents improve adolescent outcomes --agency,
school performance and safe sex
Intervention Social
competenc
e
agency
Improved
school
performance
Protective
practices/SRH
communication
HIC
1
family-oriented programmes that strengthen
parent-child relationships, and parental
monitoring and engagement
+ + +
LMIC --Dominican
Republic, Senegal,
Madagascar, Kenya
2
focus on sensitising parents about children’s
education and changing perceived returns to
secondary school
+
Kenya
3
6-session course, parents of 9-12 year olds,
communication, support for children, SRH/HIV
areas and violence prevention
+
India
4
intensive campaign to improve parental
participation in SMCs in 14-27% improvement in
reading, 15% in writing, 27% in Maths
+
Sources:
1
Banati,2016;Fishetal.,2014;Jacksonetal.,2012)
2
Nguyenetal.,2008);Kenya(Vandenhoultetal.,2010)andSenegal(DiopandDiagne,2007);
3
Milleretal(CDC),nd;
4
GoyalandSundaraman,
2009)
7

12. GlobalEvidence IndiaEvidence WayForward
Number of
evaluations
ImpactNumber of
evaluations
Impact
Adolescent friendly
health clinics and
services
Some positiveNone NA RKSK calls for AFHCs with wide
outreach, demonstration projects to
assess outcomes
Peer education
programmes
Multiple None None NA RKSK advocates peer educator
programmes, demonstrationprojects
to assess feasibility despite lack of
global evidence
Adapting and testing programmesadvocated in the RashtriyaKishor
SwasthyaKaryakram(RKSK): Promotion of adolescent friendly health
services and implementation of a strong peer education programme
INDIA:InvestmentisneededtosupporttheRKSK-implementingadolescent-friendly
healthclinics(AFHCs)andstrengtheningpeereducatorprogrammesindifferentsettings.
8

13. Thank You!
Support from the Bill and Melinda Gates Foundation to conduct
this review is gratefully acknowledged
For any specific questions you may contact Shireen Jejeebhoy at [email protected]