The Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls: Results from a clusterrandomised control trial in India

Ravi Prakash, Tara S. Beattie, Prakash Javalkar, Parinita Bhattacharjee, Satyanarayana Ramanaik, Raghavendra Thalinja, Srikanta Murthy, Calum Davey, Mitzy Gafos, James Blanchard, Charlotte Watts, Martine Collumbien, Stephen Moses, Lori Heise, Shajy Isac

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Abstract

Background Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ ST) adolescent girls in rural settings of southern India. Methods 80 of 121 villages in Vijayapura and Bagalkote districts, Karnataka State, were randomly selected (control = 40; intervention = 40). All 12-13 year-old SC/ST girls in final year of primary school (standard 7th) were enrolled and followed for 3 years (2014-2017) until the end of secondary school (standard 10th). Primary trial outcomes were proportion of girls who completed secondary school and were married, by trial end-line (15-16 years). Analyses were intention-to-treat and used individual-level girl data. Results 92.6% (2275/2457) girls at baseline and 72.8% (1788/2457) at end-line were interviewed. At end-line, one-fourth had not completed secondary school (control = 24.9%; intervention = 25.4%), and one in ten reported being married (control = 9.6%; intervention = 10.1%). These were lower than expected based on district-level data available before the trial, with no difference between these, or other schooling or sexual and reproductive outcomes, by trial arm. There was a small but significant increase in secondary school entry (adjusted odds ratio AOR = 3.58, 95% confidence interval CI = 1.36-9.44) and completion (AOR=1.54, 95%CI = 1.02-2.34) in Vijayapura district. The sensitivity and attrition analyses did not impact the overall result indicating that attrition of girls at end-line was random without much bearing on overall result. Conclusions Samata intervention had no overall impact, however, it added value in one of the two implementation districts-increasing secondary school entry and completion. Lower than expected school drop-out and child marriage rates at end-line reflect strong secular changes, likely due to large-scale government initiatives to keep girls in school and delay marriage. Although government programmes may be sufficient to reach most girls in these settings, a substantial proportion of SC/ST girls remain atrisk of early marriage and school drop-out, and require targeted programming. Addressing multiple forms of clustered disadvantage among hardest to reach will be key to ensuring India "leaves no-one behind" and achieves its gender, health and education Sustainable Development Goal aspirations.

Original languageEnglish (US)
Article number010430
JournalJournal of global health
Volume9
Issue number1
DOIs
StatePublished - Jun 1 2019

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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    Prakash, R., Beattie, T. S., Javalkar, P., Bhattacharjee, P., Ramanaik, S., Thalinja, R., Murthy, S., Davey, C., Gafos, M., Blanchard, J., Watts, C., Collumbien, M., Moses, S., Heise, L., & Isac, S. (2019). The Samata intervention to increase secondary school completion and reduce child marriage among adolescent girls: Results from a clusterrandomised control trial in India. Journal of global health, 9(1), [010430]. https://doi.org/10.7189/JOGH.09.010430