Worth the effort? Combining sexual and reproductive health and economic empowerment programming for married adolescent girls in Amhara, Ethiopia

Child marriage is an important driver of poor health outcomes at the global level, particularly for those related to sexual and reproductive health (SRH). Relatively few programs focus specifically on married adolescents, however, and most focus narrowly on SRH rather than broader well-being. Programming that combines SRH with economic empowerment (EE) may lead to greater well-being while enhancing the effectiveness of both programmatic components, but few evaluations have directly addressed this. This study explores the relative effectiveness of combined versus single-focus programming using data collected as a part of the evaluation of the Towards Economic and Sexual Reproductive Health Outcomes for Adolescent girls (TESFA) program in Amhara, Ethiopia. Between 2011 and 2013, linked baseline and endline data were collected from 2,272 ever-married adolescent girls aged 14–19 from three arms: the first including training on SRH only, the second integrating EE, and the third serving as a comparison group. The effect of participation in the different program arms is assessed against five SRH and three EE outcomes using difference-in-difference models. Participation in either intervention arm significantly improved four of the five SRH outcomes, with the largest gains in the single-focus arm. In contrast, those girls in the combined arm experienced improvements in two of the economic outcomes compared with one in the single-focus arm. These results provide strong support for broad program impact, but little evidence of a synergistic and mutually reinforcing relationship between the two program elements. Overall, the findings suggest that programmers may face a choice between a program model that delivers somewhat greater impact in terms of SRH outcomes and one that delivers somewhat smaller effects across a broader range of outcomes.