Supporting adolescent girls to stay in school, reduce child marriage and reduce entry into sex work as HIV risk prevention in north Karnataka, India

Themes:
Beattie, T; Bhattacharjee, P; Isac, S; Davey. C; Javalkar, P; Nair, S; Thalinja, R; Sudhakar, G; Collumbien, M; Blanchard, J; Watts, C; Moses, S; Heise, L BMC Public Health, 2015; www.biomedcentral.com/1471-2458/15/292

Low-caste adolescent girls in rural northern Karnataka face increased risk of school drop-out, child marriage and entry into sex-work. This enhances their vulnerability to HIV and early pregnancy as well as adverse maternal and child health outcomes.

This protocol describes the evaluation of Samata, a comprehensive, multi-level intervention designed to address these structural drivers of HIV risk and vulnerability. An innovative trial of a comprehensive intervention, it aims to improve the quality of life of low-caste marginalised girls.

The findings will be of interest to programme implementers, policy makers and evaluation researchers working in the development, education, and sexual and reproductive health fields.

Study protocol

The cluster-randomized controlled trial aims to assess the impact of Samata programme on:

  • high school entry
  • high school retention
  • age at marriage
  • age at sexual debut 

A cluster-randomized design was chosen because the programme intervenes at a cluster level. Many components will not be delivered to specific individuals, but to the schools and communities where the girls study and reside.

A survival analysis explores how the intervention affects responses by school and community response to premature school drop-out. It studies the processes and causal pathways that achieve secondary outcomes including:

  • social norms and attitudes related to girls' education, gender roles, early marriage and sexual harassment
  • girls' sense of self-esteem and self-confidence
  • expansion of girls' networks
  • girls' experience of harassment in the past six months
  • girls' entry into sex work

The Samata project links low-caste families to government schemes that provide scholarships, bicycles and other incentives to support girls’ retention in school. The intervention is being implemented in 119 intervention villages in Bijapur and Bagalkot Districts in northern Karnataka, and runs for three years (2015–2018).

Ethical considerations

  • Informed and independent consent of the girls will be sought.
  • If the girls are unmarried, they will be consulted along with a parent or legal guardian.
  • To limit embarrassment and encourage disclosure, sensitive questions will be asked through an anonymous pen and paper questionnaire, administered at the end of the face to face interview.
  • Anonymity will be maintained throughout the process.

Research methods

The trial has four main components:

  1. A quantitative assessment involving two sequential cohort studies, one initiated in Year 1 and another initiated in Year 2, with low-caste girls, their families, high-school staff and school development and management committee members. Questionnaires administered at baseline and endline.
  2. A qualitative assessment documenting the process of implementation including longitudinal case studies and participatory life-line methods conducted annually. In-depth interviews conducted at baseline and endline with adolescent boys to examine how the intervention has affected attitudes and norms around gender, education, marriage and violence.
  3. A monitoring and evaluation system to monitor intervention activities at school and community levels. An individual tracking system to track inputs, outputs and certain outcome-level indicators by school. Support to schools to monitor school achievement of marginalised girls and ensure efficient identification of drop-out and effective follow up. Monitoring of community-level project activities, such as linkages to government schemes, school-to-community contact programmes, support for tutorials/remedial classes with adolescent girls and their families.
  4. An economic analysis to measure costs, benefits and cost-effectiveness of the project.

Resources

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