Conditional cash transfers and the reduction in partner violence for young women: an investigation of causal pathways using evidence from a randomized experiment in South Africa (HPTN 068)

Abstract

IntroductionEvidence has shown that the experience of violence by a partner has important influences on women's risk of HIV acquisition. Using a randomized experiment in northeast South Africa, we found that a conditional cash transfer (CCT) targeted to poor girls in high school reduced the risk of physical intimate partner violence (IPV) in the past 12 months by 34%. The purpose of this analysis is to understand the pathways through which the CCT affects IPV.MethodsHPTN 068 was a phase 3, randomized controlled trial in rural Mpumalanga province, South Africa. Eligible young women (aged 13–20) and their parents or guardians were randomly assigned (1:1) to either receive a monthly cash transfer conditional on monthly high school attendance or no cash transfer. Between 2011 and 2015, participants (N = 2,448) were interviewed at baseline, then at annual follow‐up visits at 12, 24 and 36 months. The total effect of the CCT on IPV was estimated using a GEE log‐binomial regression model. We then estimated controlled direct effects to examine mediation of direct effects through intermediate pathways. Mediators include sexual partnership measures, the sexual relationship power scale, and household consumption measures.ResultsWe found evidence that the CCT works in part through delaying sexual debut or reducing the number of sexual partners. The intervention interacts with these mediators leading to larger reductions in IPV risk compared to the total effect of the CCT on any physical IPV [RR 0.66, CI(95%):0.59–0.74]. The largest reductions are seen when we estimate the controlled direct effect under no sexual debut [RR 0.57, CI(95%):0.48–0.65] or under no sexual partner in the last 12 months [RR 0.53, CI(95%):0.46–0.60].ConclusionsResults indicate that a CCT for high school girls has protective effects on their experience of IPV and that the effect is due in part to girls choosing not to engage in sexual partnerships, thereby reducing the opportunity for IPV. As a lower exposure to IPV and safer sexual behaviours also protect against HIV acquisition, this study adds to the growing body of evidence on how cash transfers may reduce young women's HIV risk.

Towards gender equality: A review of evidence on social safety nets in Africa

“…a. Gender-based targeting: One of the most prevalent gender-aware design features is the targeting of transfers or benefits to women, rather than to men or to households. Some programs specifically target women (girls) as primary caregivers of young children, or do so to meet program objectives related to maternity benefits (Grépin, Habyarimana, and Jack 2019;Cohen et al 2017), or widow pension programs, or those aimed at specifically benefiting adolescent girls (Baird, De Hoop, and Özler 2013;Kilburn, Pettifor, et al 2018). While putting benefits in the hands of women (girls) may enhance pre-conditions for favorable impacts, simply reaching women (girls) does not equal benefiting women (girls) for transformative outcomes.…”

Interventions to reduce gender-based violence among young people living with or affected by HIV/AIDS in low-income and middle-income countries

“…Only three studies measured both primary and secondary outcomes [30,38,43]. Primary outcome measures included unwanted sexual touching [35], forced sex [30,32,33,36,37,41,[44][45][46] and rape perpetration [30, 34,36], sexual assault (forced sex and/or touching) [47], any physical or sexual IPV exposure [30,34,37,42] and perpetration [30,32,34,37,38], physical IPV exposure [32,33] and perpetration [32], and emotional IPV exposure and perpetration [32]. Secondary outcome measures included gender-equitable attitudes [30,38,40,43,48], attitudes towards coerced sex [39] and acceptance of IPV [40].…”

Men’s perspectives on the impact of female-directed cash transfers on gender relations: Findings from the HPTN 068 qualitative study

“…Evidence has also shown that CT programmes can reduce violence by alleviating day-to-day stress and conflict among couples, enhancing the psychosocial well-being of household members and the confidence and decision-making abilities of the women in those households [ 14 ]. A sub-study conducted recently among AGYW participating in HPTN 068, showed that conditional cash transfers (CCT) delayed coital debut and reducing the recipients’ number of sexual partners thereby giving them greater agency over partner choice [ 15 ].…”