Throughout the developing world, structural, cultural, and individual factors prevent women from achieving their desired reproductive health and education outcomes. Even despite high aspirations - poor education, financial constraints, early marriage, pregnancy, and a lack of bargaining power can limit girls' opportunities for success.
Teenage pregnancy rates and HIV prevalence in sub-Saharan Africa remain among the highest in the world. In Tanzania, less than 10% of adolescent girls report using modern contraceptive methods, even though 60% of girls have had sex before age 18. While decades of educational and behavioral interventions have been employed to improve sexual and reproductive health (SRH) outcomes, few have documented significant and lasting positive effects. One possible reason for this lack of long-term improvements is that very few interventions have incorporated both supply (e.g., availability of contraceptives) and demand side (e.g., use of contraceptives) components, and when they have, few have targeted adolescents.
In 2008 BRAC started the Empowerment and Livelihood for Adolescents (ELA) program, which provides a safe space and skills trainings for vulnerable girls aged 12-24. Through an intervention in BRAC's ELA clubs, this study aims to identify the impacts factors which influence adolescent SRH behavior in Tanzania. Specifically, the intervention tests the relative importance of two major behavioral factors - present bias and social norms - on SRH decision making among girls participating in the clubs. In addition to providing standard SRH programming and access to contraceptives, the intervention employs two arms to address these behavioral biases. In one arm, girls are provided with the opportunity to participate in incentivized goal setting. Here, girls set RH goals for themselves, such as getting tested for HIV/STIs or delaying pregnancy. If girls meet their pre-set goals at 6 and 12 months, they will receive a small cash transfer. The second behavioral arm addresses the influence of peer boys' behaviors on girls SRH outcomes; from discussions with ELA club members, it is clear boys control much of the power in negotiations over contraceptive use. In this intervention group, researchers provide boys with SRH education during soccer club practices.
Results and Policy Implications
Study ongoing, results forthcoming.