Impacts of Multisectoral Cash Plus Programs on Marriage and Fertility After 4 Years in Pastoralist Kenya: A Randomized Trial
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus, Sexual and Reproductive Health, Women’s Economic Empowerment
View SourceKey Social Norms Take-aways The study underscores that addressing individual behaviors is not enough; shifting community norms around gender, sexuality, and the value of girls is essential. Interventions that combine community-level gender norm change with direct support for girls can reshape the social expectations that place them at risk. Successful programs must work across multiple levels — family, school, and community — to challenge restrictive norms and build an environment where girls can exercise greater agency over their futures.
Objectives This study evaluated the long-term impacts of the Adolescent Girls Initiative–Kenya (AGI-K), a multisectoral “cash plus” program aimed at reducing early sexual debut, pregnancy, and improving health, education, and economic outcomes among adolescent girls in Nairobi’s Kibera informal settlements.
Methods Using a randomized controlled trial, researchers followed 2,075 girls aged 11–14 from 2015 to 2019 across four study arms: (1) violence prevention only; (2) violence prevention + education; (3) violence prevention + education + health; and (4) violence prevention + education + health + wealth creation. Data were collected through longitudinal surveys and biological markers (HSV-2 testing), complemented by qualitative interviews with girls, parents, teachers, mentors, and community leaders.
Intervention Details AGI-K combined community dialogues on gender and violence, conditional cash transfers to support girls’ education, health and life skills sessions, and financial literacy and savings activities. The interventions were designed to build girls’ assets in education, health, and economic empowerment while challenging harmful gender norms.
Results Two years after the program’s end, girls who received the education and full-package interventions were significantly less likely to have given birth or become pregnant, especially among older adolescents. The program also improved school attainment, sexual and reproductive health knowledge, and financial literacy. Qualitative findings revealed that while girls had greater knowledge and aspirations, barriers like peer pressure, economic hardship, and limited ability to negotiate safe sex persisted, highlighting the importance of structural supports.
Conclusions Multisectoral cash plus programs can create lasting protective effects for adolescent girls by improving their educational, health, and economic assets. These integrated approaches offer promise for reducing early pregnancy and improving long-term outcomes in marginalized urban settings.
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