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Innovative Programming to Improve Adolescent Health in Sub-Saharan Africa

Paper Session

Saturday, Jan. 4, 2020 8:00 AM - 10:00 AM (PDT)

Manchester Grand Hyatt, Ocean Beach
Hosted By: International Health Economics Association
  • Chair: Kathleen Beegle, World Bank

Including Males: Improving Sexual and Reproductive Health for Female Adolescents

Manisha Shah
,
University of California-Los Angeles and NBER
Jennifer Muz
,
George Washington University

Abstract

Despite decades of public health interventions and research in sub-Saharan Africa, the prevalence of teenage pregnancy, early marriage, HIV and other sexually transmitted infections (STIs) in this population remain among the highest in the world. Moreover, 30 percent of ever-partnered adolescents aged 15 to 24 report intimate partner violence in the last 12 months (Stockl et al. 2014). Traditional family planning and sexual and reproductive health programs focus on married adults often leaving adolescents out. In addition, many of these programs target females even though males are an integral component of partner dynamics that lead to adverse female sexual and reproductive health outcomes.

We implement a randomized controlled trial (RCT) that targets adolescents in Tanzania to better understand which types of interventions best improve sexual and reproductive health (SRH) and intimate partner violence (IPV) outcomes for adolescent females. We also focus on including males in the intervention. We partner with BRAC, a large NGO in Tanzania, which runs a network of 150 adolescent girl clubs called Empowerment and Livelihoods of Adolescents (ELA). These clubs offer information on sexuality, menstruation, teenage pregnancy, negotiating relationships with the opposite sex, HIV/AIDS, etc. and fundamentally aim to empower adolescents to make better long-term decisions.

The control group will be ELA. We layer two additional treatment arms onto ELA and randomly assign the 150 clubs to each of the three arms.
(1) Demand side, ELA Continue operating business-as-usual which is ELA
(2) Supply side, ELA+MST: Continue ELA programming plus have bi-monthly visits from nurses who provided family planning contraceptives; and
(3) Male demand side, ELA+MST+GRS: Receive all programming previously described in (2) plus invite boys from the social networks of the girls to participate in SRH and life skills intervention that is delivered through weekly soccer clubs.

Increasing the Uptake of Long-Acting Reversible Contraceptives (LARCs) among Adolescent Females and Young Women in Cameroon

Berk Özler
,
World Bank
Susan Athey
,
Stanford University
Julian Jamison
,
University of Exeter

Abstract

In sub-Saharan Africa, 25% of females start childbearing as teenagers (ICF, 2015). While young women describe many of these births as planned and intentional, women under the age of 20 also have the greatest percentage of mistimed/unintended pregnancies compared to all other age groups. For example, in Cameroon, more than 30% of the births to this group were unwanted or wanted later (DHS 2011). Low age at first birth has a significant impact on the spacing of births and timing of future pregnancies. It may also reduce accumulation of human capital for both the mother and the child. Despite the desire to delay childbearing, only a minority of sexually active unmarried women in most low-income countries uses any modern method of contraception (ICF, 2015). The shares of women using reliable short-acting methods of contraception (injectables and pills) are even smaller, with very few unmarried or nulliparous women using long-acting reversible contraceptives or LARCs (IUDs or implants). For example, 41% of sexually active unmarried women in Cameroon report using male condoms, with 6% using SARCs and less than 1% using LARCs (DHS 2011). Given meaningful differences in the typical-use effectiveness of these different methods, it is important to understand why most women don’t use any modern methods of contraceptives, and why, among users, women favor the short-acting (but, less reliable) methods over the long-acting (but almost 100% effective) ones. This paper discusses ongoing work in Cameroon that is attempting to identify the barriers to the uptake of LARCs and testing interventions to overcome them. The paper describes (i) the formative qualitative work used to identify the supply- and demand-side barriers (ii) a tablet-based decision-support tool developed for nurses to counsel young women on modern contraceptive methods, (iii) and describe the design of two randomized-controlled trials that test some of the

Incorporating Mental Health Programming into Adolescent Empowerment Programming: The Role of Group-Based Interpersonal Psychotherapy (IPT-G)

Sarah Baird
,
George Washington University
Berk Özler
,
World Bank

Abstract

Adolescent girls in developing countries face high rates of adversity and are at an elevated risk of depression. Untreated anxiety and depression among adolescents can have negative consequences for a range of outcomes such as schooling and learning, teen pregnancy and child marriage, risky behaviors, and social exclusion, all of which can result in a cycle of poverty for young women and their families. Despite this being a pressing problem, there is little evidence on what types of interventions can help break the vicious cycle of poor mental health and poverty. While interventions like income support can temporarily improve these outcomes, including mental health, they have not been shown to have sustained effects over the longer-run, especially after transition to adulthood (Baird, McIntosh, and Özler 2016). Mental health interventions, such as group-based interpersonal psychotherapy (IPT-G), offer the possibility for, perhaps, more sustained effects on psychological wellbeing, especially if coupled with income support (Baranov et al. 2018; Blattman, Jamison, and Sheridan 2017). Hence, the theory of change that is being tested in this study is that (a) IPT-G can lead to gains in mental health (reductions in anxiety and depression), which can lead to (b) increases in school attainment and learning, as well as reductions in teen pregnancies, early marriages, and risky behaviors, which can then, if sustained (with the help of income support) lead to improved outcomes in the longer-run. The intervention uses the existing infrastructure of BRAC Uganda’s Empowerment and Livelihood for Adolescent (ELA) clubs to deliver the IPT-G model. The IPT-G model, implemented by StrongMinds, is a simple and cost-efficient community-based model to treat depression that has proven to be successful among individuals 18 years and older who were initially screened for moderate to severe depression. We implemented a cluster-Randomized Control Trial (cluster-RCT) in urban and peri-urban

Twenty Year Economic Impacts of Deworming in Kenya

Sarah Baird
,
George Washington University
Joan Hamory Hicks
,
University of Oklahoma
Michael Kremer
,
Harvard University and NBER
Edward Miguel
,
University of California-Berkeley and NBER

Abstract

The role that child health status plays in determining later life outcomes is a major topic of inquiry across research fields. Beyond the direct utility benefits that healthy children (and their families) experience, the belief that investing in child health and nutrition can generate improvements in these individuals’ quality of life when they reach adulthood has been used to justify many public policy initiatives around the world, including in low-income countries, from school feeding programs to subsidized access to health insurance and medical care for children. An area of key interest within this debate is whether such health investments must fall within a critical early period of child development for long-term gains to accrue, or whether investments made in preschool and school-aged children can also have important long-term impacts. Yet, despite the academic and policy interest, there remains a limited body of evidence establishing causal impacts of child health gains on adult living standards, due to the methodological challenges inherent in doing so. Estimating the impact of child health investments on adult living standards faces several major methodological challenges, including the paucity of experimental interventions for which it is feasible to locate participants many years later, as well as difficulties in accurately measuring economic outcomes. This study exploits a randomized health intervention that provided deworming treatment to Kenyan primary school children starting in 1998, the Primary School Deworming Project (PSDP). The PSDP treatment group (50 schools) received up to 3 years of additional deworming treatment, relative to the control group (25 schools). We estimate impacts on their living standards and wellbeing roughly 20 years later, during 2018-2019, using data from the Kenya Life Panel Survey (KLPS). A noteworthy aspect of KLPS is its success at maintaining contact with the original sample: at the 20 year follow-up, the effective respondent
Discussant(s)
Joe Cummins
,
University of California-Riverside
Kelly Jones
,
American University
Pamela Jakiela
,
Center for Global Development
Jennifer Muz
,
George Washington University
JEL Classifications
  • I1 - Health
  • P4 - Other Economic Systems