Effects of economic support, comprehensive sexuality education, and community dialogue on sexual behaviour: Findings from a cluster-RCT among adolescent girls in rural Zambia
Outcomes: Child, Early, and Forced Marriage, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study illustrates that combining economic support with community dialogue and comprehensive sexuality education (CSE) can influence adolescent girls’ sexual behavior and perceptions of reproductive health, although not all effects align with intended outcomes. Notably, while these interventions improved knowledge and contraceptive use, they also paradoxically reduced perceived community support for adolescent contraceptive use. This suggests that social norms surrounding adolescent sexuality are deeply entrenched and resistant to change, particularly in contexts where abstinence is strongly emphasized.
Objectives To evaluate the impact of economic support alone and in combination with CSE and community dialogue on recent sexual activity, contraceptive use, and beliefs related to modern contraception among adolescent girls in rural Zambia.
Methods A cluster-randomised controlled trial involving 157 rural schools in Zambia. Girls in grade 7 were randomly assigned to one of three arms: economic support alone, combined economic support with CSE and community dialogue, or control. Outcomes were measured through face-to-face and audio-assisted self-interviews conducted between 2016 and 2020. Analyses used generalized estimating equations accounting for clustering.
Intervention Details
Economic support Monthly unconditional cash transfers to girls and annual transfers to guardians, plus secondary school fee coverage.
Combined intervention All of the above, plus biweekly youth clubs offering CSE and life skills training, and six annual community/parent meetings focusing on delaying early marriage and promoting education.
Control Standard schooling and health services.
Results
Economic support significantly reduced recent sexual activity (RR 0.70), and the combined intervention further reduced unprotected sexual activity (RR 0.53 vs. control). The combined intervention also increased current contraceptive use among sexually active girls (RR 1.26 vs. economic only) and improved contraceptive knowledge (RR 1.18). However, both intervention arms reported lower perceived community acceptance of contraceptive use than the control group. No significant changes were found in overall control beliefs regarding access to contraceptives.
Conclusions Economic support reduced sexual activity, and combining it with CSE and community dialogue increased contraceptive knowledge and use, reducing unprotected sex. However, interventions unintentionally lowered perceived normative support for contraceptive use, highlighting the need for strategies that more effectively engage and shift community-level norms around adolescent sexuality.
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