Fostering gender equality and reproductive and sexual health among adolescents: results from a quasi-experimental study in Northern Uganda

Abstract

ObjectiveTo assess the impact of the Gender Roles, Equality and Transformations (GREAT) intervention: a narrative-based, resource-light, life-stage tailored intervention package designed to promote gender-equitable attitudes and behaviours, and improve sexual and reproductive health (SRH) and gender-based violence (GBV) outcomes among adolescents and their communities.DesignRepeated cross-sectional evaluation study, using propensity score matching combined with difference-in-difference estimation.SettingTwo postconflict communities in Lira and Amuru districts in Northern Uganda.ParticipantsMale and female unmarried adolescents (10–14 years, 15–19 years), married adolescents (15–19 years) and adults (over the age of 19 years) were selected using a stratified, two-stage cluster sample of primary and secondary schools and households (baseline: n=2464, endline: n=2449).Primary outcome measuresInequitable gender attitudes and behaviours; GBV; and SRH knowledge and behaviours.ResultsStatistically significant intervention effects were seen across all three outcomes—gender equity, GBV and SRH—among older and newly married adolescents and adults. Among older adolescents, intervention effects include shifts on: inequitable gender attitudes scale score: −4.2 points ((95% CI −7.1 to –1.4), p<0.05); Inequitable household roles scale score: −11.8 ((95% CI −15.6to –7.9), p<0.05); Inequitable attitudes towards GBV scale: −1.9 ((95% CI −5.0 to –0.2), p<0.05); per cent of boys who sexually assaulted a girl in past 3 months: −7.7 ((95% CI −13.1 to –2.3), p<0.05); inequitable SRH attitudes scale: −10.1 ((95% CI −12.9 to –7.3), p<0.05). Among married adolescents, intervention effects include shifts on: Inequitable household roles scale score: −6.5 ((95% CI −10.8 to –2.2), p<0.05); inequitable attitudes towards GBV scale: −4.7 ((95% CI −9.8 to –0.3), p<0.05); per cent who reacted violently to their partner: −15.7 ((95% CI −27.1 to –4.4), p<0.05); inequitable SRH attitudes scale: −12.9 ((95% CI −17.3 to –8.5), p<0.05).ConclusionThe GREAT intervention model demonstrates the promise of a resource-light, life-stage tailored programme that employs culturally appropriate, participatory and narrative-based techniques to advance gender equity and adolescent health. This type of programming contributes towards reductions in GBV and improved adolescent SRH outcomes.

Early Educational Interventions to Prevent Gender-Based Violence: A Systematic Review

“…Moreover, schools were supported by experts from Senior Education Advisors. Dagadu et al's program [34], known as GREAT (Gender Roles, Equality and Transformations), includes male and female unmarried adolescents (10-14 years, 15-19 years), married adolescents (15-19 years) and adults (over the age of 19 years), using a stratified, two-stage cluster sample of primary and secondary schools and households.…”

“…Along this line, Chung and Huang [25] aimed to determine whether exposure to counter-stereotypical information could break gender stereotypes in kindergarten children. Dagadu et al [34] proposed a community-based program to promote gender-equitable attitudes and behaviors among children, adolescents and communities to reduce gender-based violence and improve reproductive health (SRH). This intervention was based primarily on the premise that gender identities established early in life shape the future path of boys and girls and that recognizing gender norms influences health-related behaviors, especially during adolescence when gender norms and identities begin to converge.…”

“…Many of the programs are based on active learning, using techniques such as storytelling [24,34], role playing [23,24,31], radio drama and activity cards to each life stage [34], keeping a journal [23] and drawing on the experience of the community [23,34]. In the same vein, Smothers and Smothers [32] reported an intervention which is developed through role modelling and active behavioral skills training.…”

“…Sarnquist et al's sessions [31] facilitated discussions, as well as verbal and physical skills practice. GREAT program [34] includes a toolkit of participatory activities in order to induce reflection, dialogue and action around gender inequitable attitudes, behaviors, SRH and GBV. In addition, health teams in each village were trained to improve access and quality of youth-friendly services Finally, it is worth mentioning that of the 13 articles analyzed, 3 of them include the IMpower intervention as their main program.…”

Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation

“…One group set up a group savings account. home visits by outreach workers to young women and their husbands, providing information on sex, communication, respect, joint decision making, and RH topics including family planning community activities, e.g., health fairs opportunistic interactions with mothers-in-law and senior female family members about sexual health, contraception, antenatal, delivery and postpartum care, husbands’ roles in this period training health service providers on needs of young married women training traditional birth attendants, provision of safe delivery kits, counselling in clinics provision of condoms and pills through peers and clinics strengthened antenatal services through outreach, financial assistance when needed for antenatal care, provided postpartum home visits Control arm : no intervention Arms: Vadodara Diamond Harbour Married young women plus their husbands, families, and community India 17 Gender Roles, Equality, and Transformations Project (GREAT) [ 35 ] Linked references: [ 109 , 110 , 111 , 112 ] Aim : To reduce gender-based violence and improve sexual and reproductive health outcomes Intervention arm: community action cycle—community action groups radio drama aimed at creating discussion around gender equality, GBV, and SRH Village health team member training toolkit for use in existing groups, tailored to married/parenting 15–19 yo; unmarried, nulliparous 15–19 yo; or 10–14 yo in school Control arm: no intervention Arms: NM/NP (newly married/newly parenting 15–19 yo) OAs (older adolescents—unmarried, nulliparous 15–19 yo) VYA(very young adolescents—10–14 yo in school) (not included in this analysis as not asked about contraceptive use) Boys and girls, 10–19 yo plus community Uganda 1 FP = family planning; GBV = gender based violence; SRH = sexual and reproductive health; SRHR = sexual and reproductive health & rights; RH = reproductive health; STI = sexually transmitted infection; yo = year olds. …”