A “Plus” Model for Safe Transitions to Adulthood: Impacts of an Integrated Intervention Layered onto A National Social Protection Program on Sexual Behavior and Health Seeking among Tanzania's Youth

Abstract

Poverty is a structural driver of risky sexual behaviors. While cash transfers can mitigate some of this risk, complementary interventions have been posited as a way to further reduce multidimensional vulnerability. We examine the impacts of a multicomponent intervention targeted to Tanzanian adolescents on their sexual behaviors and reproductive health. The intervention comprised livelihood and life skills training, mentoring, and health facilities’ strengthening. Data come from a cluster randomized controlled trial, where one study arm received the intervention and the other was randomized to control, but both arms participated in a government cash transfer program. Among 1,933 adolescents interviewed over three rounds, we found increases in contraceptive and HIV knowledge. The program also increased health seeking and HIV testing among boys, but slightly reduced age at sexual debut among girls. There were no impacts on contraceptive use, number of sexual partners, or pregnancy. Findings support the value of an adolescent intervention, and the fact that it was delivered within a social protection platform suggests a potential for scalability. Additional efforts are required to delay sexual debut and reduce the number of sexual partners and pregnancy, possibly through addressing supply‐side barriers and social norms, or through additional linkages to economic opportunities.

Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed‐methods study

“…This may be due to a number of reasons. While this intervention has been previously demonstrated to be protective along several pathway indicators, including gender-equitable attitudes [49], increased knowledge related to contraception and HIV prevention [50], mental health [51] and economic activities [47], it was perhaps not sufficient to overcome all the interrelated social, relational and economic vulnerabilities which lead AGYW to engage in transactional sex. Alternatively, the lack of impacts may be reflective of alternative drivers of engagement in transactional sex, namely choice of partners, addressing low self-esteem or a need to boost one's own power and social status [6,52].…”

Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence

“…The two Kenyan studies conducted both in slum (42) and pastoral (46) settings reported that effect of these multiple component interventions comprising violence prevention, education and health was not significantly different from that of standalone (violence prevention) intervention. Similarly, a Tanzanian study reported there was no significant difference in the rates of teen pregnancy among girls in an arm with multicomponent interventions compared to those girls in the "cash only" arm (arm that received the cash transfer program alone) (48). The multicomponent interventions comprised cash transfer conditioned up on school enrolment or seeking essential health services and unconditional cash transfer plus livelihoods and life skills training, mentoring and an asset transfer, combined with linkages to strengthened government-run HIV and SRH services).…”

“…Among the included studies that reported on child marriage, four of them reported on the effect of three component interventions. These projects were conducted in Ethiopia (44), Kenya (46), Tanzania (48). One study was a multicounty study conducted in Tanzania and Burkina Faso (43).…”

“…Tanzanian study reported that girls in an arm with four component interventions comprising "Cash PLUS" interventions (cash transfer plus livelihoods and life skills training, mentoring and an asset transfer, combined with linkages to strengthened government-run HIV and SRH services), were less likely to enter into marriage compared to the girls in the "Cash ONLY" arm (arm that received the cash transfer program alone) (48). The cash transfer involved both unconditional (to reduce vulnerability and increase income) and conditional (up on school enrolment or seeking essential health services).…”

“…Three studies reported on interventions that addressed three component interventions that addressed any combinations of health, wealth, education, and violence prevention. These projects were conducted Kenya (42,46) and Tanzania (48). The two Kenyan studies conducted both in slum (42) and pastoral (46) settings reported that effect of these multiple component interventions comprising violence prevention, education and health was not significantly different from that of standalone (violence prevention) intervention.…”