Do Community-Based Livelihood Interventions Affect Sexual and Reproductive Health and Rights of Young People in Slum Areas of Uganda: A Difference-in-Difference with Kernel Propensity Score Matching Analysis
Outcomes: Gender‑Based Violence, Human Immunodeficiency Virus, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways While the intervention did not explicitly use social norms theory, it provides clear evidence of injunctive norms—what individuals believe others expect—related to gender, sexual behavior, and sexual and reproductive health and rights (SRHR). Survey items captured expectations around sexual agency, gender-based violence, and contraceptive responsibility. The intervention led to a decline in the number of youth who endorsed harmful social expectations—such as the belief that it is common or acceptable for girls to be coerced into sex—and increased support for women’s right to refuse sex. However, some problematic norms became more entrenched, including the belief that women should bear sole responsibility for contraception and stigma toward girls who request condom use. These mixed results underscore the need for livelihood programs to integrate explicit, gender-transformative strategies to avoid reinforcing existing biases.
Objectives To evaluate the impact of the Urban Program on Livelihoods and Income Fortification and Socio-civic Transformation (UPLIFT) on the sexual and reproductive health and rights (SRHR) of young people in the slum areas of Kampala, Uganda.
Methods The study used a repeated cross-sectional design with surveys conducted in 2014 and 2017 among youth aged 13–25 in intervention and comparison areas. Difference-in-differences analysis with kernel propensity score matching assessed the program’s effects on SRHR outcomes, adjusting for demographic and social factors.
Intervention Details UPLIFT was a 4-year multi-sectoral program implemented by World Vision and partners. It combined vocational training, peer education on SRHR, youth-friendly services, civic engagement, financial literacy, and community dialogues. Activities also involved outreach to religious leaders and support for youth affected by disability.
Results The intervention improved access to and knowledge of SRHR services, reduced sexual activity in the past year, and shifted attitudes toward gender-based violence. More youth recognized women’s rights in relationships and knew where to access family planning and HIV services. However, the intervention did not improve condom use, reduce sexual coercion, or dispel certain HIV misconceptions. Some gendered norms, such as the idea that women are solely responsible for preventing pregnancy, worsened over time.
Conclusions Community-based livelihood interventions can influence social expectations and improve SRHR access for youth. To achieve sustained change, future interventions must explicitly address gender and social norms through targeted, transformative strategies.
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