Girl Empower – A gender transformative mentoring and cash transfer intervention to promote adolescent wellbeing: Impact findings from a cluster-randomized controlled trial in Liberia

The study found that the Girl Empower intervention did not reduce sexual violence experienced by the participants, but there were sustained improvements in other domains.

• Girl Empower (GE) and Girl Empower+ (GE+) led to statistically significant improvements in the standardized sexual and reproductive health index.
  • The improvement was seen in four out of the five index components: never married, never had sex, number of sexual partners in the past 12 months, and the safe sex index.
  • The estimated positive impact was 50% higher for GE+ compared to GE.
• Both GE and GE+ led to significant improvements in the gender attitudes index.
  • The improvement was seen in both components of the index: gender equity and attitudes towards interpersonal violence.
  • GE and GE+ had similar impacts.
• Both GE and GE+ led to significant improvements in the life skills index.
  • The improvement was seen in three out of the five index components: knowledge of HIV, financial literacy, and knowledge of condom effectiveness.
  • GE and GE+ had similar impacts.
• The authors conducted additional analyses to ensure that statistical significance of the above effects was not due to random chance.
• The estimated impacts for GE and GE+ in the remaining four domains – sexual violence, schooling, psychosocial wellbeing, and protective factors – were not found to be statistically significant at the 95% confidence level.

The authors hypothesized that GE and GE+ were not successful in decreasing the rate of sexual violence experienced by the participants because the program did not improve protective factors around the participants, such as their social network and the caregivers’ gender attitudes or aspirations for them. Future studies could focus on comparing Girl Empower with cost-equivalent cash transfers, and in modifying or enhancing programs like Girl Empower to reduce the sexual abuse of adolescent girls.

Girl Empower was implemented from February to November 2016 by the International Rescue Committee (IRC) in 84 villages in Nimba, Liberia with at least five eligible girls aged 13 or 14 years old. This age range was chosen based on high rates of sexual debut (57%), school dropout (43%), pregnancy (10%), and marriage (10%) among 15 to 17-year-old females in the region. The North Central region of Liberia, where Nimba county is located, has a slightly higher rate of sexual violence, lower age of marriage, and lower primary school attendance rate for girls compared to the national average.

In the Girl Empower intervention, 1) local female mentors facilitated a life skills curriculum; 2) IRC staff facilitated caregiver discussion groups; 3) participating girls received a start-up fund into their individual savings; and 4) capacity building was provided to local health and psychosocial service providers. In the Girl Empower + variation, IRC added a supplementary cash incentive to the caregivers of the participating girls for their attendance in the program.

Data was collected at baseline in February 2016 and in the 24-month follow-up from August 2017 to February 2018 for seven domains: sexual violence as the primary outcome and schooling, sexual and reproductive health, psychosocial wellbeing, gender attitudes, life skills, and protective factors as secondary outcomes. At baseline, 1,216 eligible girls and 1,132 caregivers were surveyed. At the follow-up, 96.7% of participants and 95.9% of caregivers were successfully interviewed.

The program impact was assessed using an intent-to-treat analysis, where the outcomes for each of the seven domains were compared between participants who were offered the treatment and participants who were not offered the treatment. To ensure robustness, the authors compared the baseline characteristics of participants who were lost from the study to ensure that they were not statistically different from participants who were successfully followed up.