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Female Genital Mutilation and Child Marriage: Impact Data with Action Implications

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The strategic, investment and action implications of recent randomized controlled trial (RCT) and systematic review impact data

CHILD PROTECTION

Child protection is a vitally important strategic priority for UNICEF and its partner organizations: "Every child has the right to live free from violence, exploitation and abuse." Within the field of child protection, there is a specific focus on harmful practices, such as female genital mutilation (FGM) and child marriage.


IMPACT DATA - SOCIAL CHANGE AND BEHAVIOUR CHANGE

The Communication Initiative (The CI) is working with, and with support from, the Social and Behaviour Change (SBC) section in UNICEF in New York, with additional support from the Child Protection section, to identify recent high-quality, direct impact data of SBC strategies on overall UNICEF priorities, including FGM and child marriage. Of course, broader issues related to unequal gender norms underpin all the serious concerns and dynamics around FGM and child marriage.

The high level criteria for the identification of that direct impact data were:
  • Positive change or trend in a priority development issue;
  • Social change or behaviour change strategy or process;
  • Randomized controlled trial (RCT) or systematic review methodology;
  • Published since 2010 in a high-quality peer-reviewed journal; and
  • Featuring a numeric impact data point.


STRATEGIC AND INVESTMENT IMPLICATIONS

Naturally, questions flow from the identification of this impact data, which can be seen at this link (and will grow over the next few months):
  • What are the strategic implications from that impact data – which strategies should we prioritize?
  • What are the investment case implications from that impact data – which arguments arise for policy and funding attention and investment in SBC strategies and actions to increase the effectiveness of development action?


CHILD MARRIAGE AND FEMALE GENITAL MUTILATION

The same questions apply to specific UNICEF priorities. In this case, what are the strategic and investment implications for child marriage and FGM?

Specific data on these issues can be seen at these links (some images still to come for the recently added impact data):
What are the child marriage and FGM strategic and investment case implications from the impact data identified as meeting the criteria identified above? Please note that the implications identified below are our initial assessment, as this process is ongoing. We would encourage everyone to please review the data at the links that follow and to draw and discuss their own strategic and investment implications. The title of each impact example below will take you to a relevant impact card, which in most cases includes a link to the full study.


1.Create more safe spaces.

Safe spaces in the context of child marriage and FGM are places where girls/young women can come together to relax, play, have conversations, or receive support in a setting free from judgment or discrimination. This support can include, for example, life-skills training or some form of vocational training. Having a safe space also gives girls an opportunity to connect to others who may be facing similar challenges. This connection can make them feel less isolated and help them develop more effective coping mechanisms. Therefore, safe spaces can be powerful platforms for healing, empowerment, and resilience. (Adapted from Creating Safe Spaces for Adolescent Girls and Young Women)

In relation to child marriage and FGM, the impact data identified included the direct impact of SBC strategies that focus on the creation of safe spaces for girls. For example:

Safe spaces impact example 1: Lower odds of being married at endline due to safe spaces

This study on a life skills and safe spaces programme that sought to reduce adolescent girls' experiences of interpersonal violence in a refugee setting showed:

A decrease in reported child marriage among girls who were married at baseline: Among those married or living with someone as if married at baseline, girls in the treatment arm had lower odds (odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34-0.95), p=0.032) of being married at endline as compared with those in the control arm.

How was this impact achieved?

Major programing elements of the work researched that produced these results include:
  • Weekly adolescent girl life skills sessions in safe spaces that are accessible to women and girls only (consisting of 45-60 min of facilitated content, 30 min of unstructured time, and 30 in-person group sessions);
  • Life skills sessions focused on topics related to improving key skills such as communication, friendship building, and awareness of gender-based violence (GBV) and sexual and reproductive health;
  • Session delivery by trained female refugee mentors aged 18-30 years who spoke the same languages as participants; and
  • Monthly discussion groups for enrolled girls' caregivers, which covered topics such as strengthening communication skills, supporting adolescent girls, and understanding violence and abuse.

Safe spaces impact example 2: Greater odds of believing in delaying marriage until age 18 due to life skills mentoring in safe spaces

In this systematic review of safe spaces programmes:

Safe space participants in one study exhibited greater odds of believing in delaying marriage and child-rearing until after the age of 18 (adjusted odds ratio [aORs] of 1.88 and 2.04, respectively).

How was this impact achieved?

The three programmes that showed the most impact had the following components:
  • Mentor-facilitated life skills programming administered in dedicated safe spaces to improve knowledge and attitudes of gender norms, sexual and reproductive health, early marriage, social network-building, and education (implemented over 10 months); and
  • Caregiver sessions consisting of monthly meetings to support the skills developed with their adolescents (around 30 sessions).
Strategic and Investment Implication: Increase the action focus on the creation of safe spaces for girls and increase the funding levels for and policy attention to the creation of safe spaces for girls.


2. Amplify dialogue, debate, conversation, talk, and "chatter" on FGM and child marriage issues, dynamics, and trends.

Increased dialogue, debate, conversation, and overall "chatter" in a family and social context on key issues is a core element for a social change strategy. The centrality of this element has been clear across the full tapestry of development issues: from civil rights and participative governance to family planning, HIV/AIDS, and more. Just one specific example: the importance of friends, family, community, national, and international dialogue, debate, conversation, and sharing of accurate information for effective action on the complex issues underpinning and related to HIV/AIDS.

In relation to child marriage and FGM, the impact data identified included the direct impact of SBC strategies that focus on amplifying dialogue, debate, and conversation. For example:


Dialogue and debate impact example 1: Empowerment around FGM - 69% talked to family vs. 12% in the control group

The three interventions discussed in this paper showed that "organized diffusion" - the sharing of knowledge by programme participants with family and community members - can be a fruitful strategy to increase the reach of community discussions, ultimately helping interventions achieve effective social norms change. In particular, the Community Empowerment Program, which sought to tackle FGM in Mali, showed that:

At baseline, 84% of respondents anticipated positive reactions in their families for cutting their daughters; at midline, this percentage had, on average, decreased to 35%.

At midline, 69% of participants reported having actively talked to their family about FGM vs 12% in the control group.

At endline, after participants' efforts to share knowledge at large in the intervention communities, the study observed further decrease in family approval for FGM (5% participants, 15% adopted members, and 8% other members in intervention communities), with no change in control communities.

How was this impact achieved?

The impact was achieved through the use of organized diffusion for normative change, which involves six phases in the process of diffusion of the knowledge (Mackie and LeJeune, 2009):
  • Phase one includes the discussions happening before the programme, as rumours about the intervention generate curiosity.
  • Phase two involves the creation of the new knowledge with a selected group of participants.
  • In phase three, participants share their knowledge with one "adopted" member in their community: usually a family member with whom they discuss what was interesting to them during project activities that day.
  • In phases four to six, information spreads out from the intervention community to new communities, eventually reaching people across the entire larger group (ethnic group, region, or country).

Dialogue and debate example 2: Economic support, CSE, and community dialogue - lowered unprotected sexual activity

A cluster RCT in rural Zambia on the effects of economic support, comprehensive sexuality education (CSE), and community dialogue on sexual activity and contraceptive use and beliefs among 4,922 adolescent girls found that:

Economic support and the additional CSE and community dialogue were effective in lowering unprotected sexual activity ... The addition of CSE and community dialogue improved contraceptive use among those recently sexually active (risk ratio (RR) 1.26; 95% CI 1.06-1.50) and knowledge regarding contraceptives (RR 1.18; 95% CI 1.01-1.38) compared to economic support alone.

How was this impact achieved?

  • Economic support consisted of unconditional cash transfers to girls and their guardians, as well as payment of school fees for girls continuing to grades eight and nine.
  • CSE and community dialogue meetings focused on practices around girls' fertility, marriage, and education. The interventions lasted two years.
  • Six community and parent meetings were held per year on the benefits of girls' education and postponement of early marriage and childbearing.
  • Youth clubs, which were convened every second week (36 in total), provided CSE for the participants and boys in the same class.
  • The youth clubs also included life skills training with the aim of increasing learners' ability to resist peer pressure, solve conflicts, set goals, and make decisions.
  • A manual with detailed descriptions of class activities for every meeting included interactive discussions and role plays.
  • Two films were produced for the youth clubs and community meetings - facilitators moderated discussions on the films.
  • Most of the dialogue sessions touched on gender dynamics and power relations.

Strategic and Investment Implication: Increase the focus - in all contexts, be they local, national, international, policy, or governance related - on expanding the facilitation of informed dialogue and debate on the specific issues of child marriage and FGM, as well as the social drivers that create the space for child marriage and FGM to take place. Participants need to be supported with the knowledge and skills to engage others in their network in transformative conversations.


3. Strengthen empowerment and skills-building.

Skills-building and empowerment initiatives in the context of FGM and child marriage are key to increasing the capacity of individuals and communities to make decisions that support gender equality and the general health and wellbeing of girls. These initiatives often involve ensuring better access to education for girls, empowerment and skills building workshops to improve sexual and reproductive health, and training in life skills and vocational skills.

In relation to child marriage and FGM, the impact data identified included the direct impact of SBC strategies that focus on skills building, training, and empowerment. For example:


Empowerment and skills impact example 1: The impact of skill-building on the delay of child marriage

This multi-arm study on a community-based skills-building programme to delay child marriage among adolescent girls showed the following results:How was this impact achieved?

The impact was achieved through a programme that:
  • offered educational support,
  • promoted gender rights awareness,
  • facilitated income generation and livelihoods training, and
  • provided adolescent girls with 144 hours of skills training in village centres over 18 months.

Empowerment and skills impact example 2: Impact of training and information on income generation, child bearing, and marriage

This study on an adolescent women's empowerment project in Uganda showed that participating girls were:How was this impact achieved?

Impact was achieved through a multifaceted programme that provides adolescent girls with an opportunity to simultaneously accumulate two types of human capital:
  • vocational skills to enable them to start small-scale income generating activities, and
  • life skills to help to make informed choices about sex, reproduction, and marriage.

Strategic and Investment Implication: To make further progress towards eliminating child marriage and FGM, increase the investment in educational support, gender rights awareness training, income generation opportunities, and livelihoods training.


4. Add value to cash transfer programmes.

Cash transfers may not be immediately recognized as part of the tapestry of SBC strategies. Considering that economic pressures may push parents to accelerate their daughter's marriage, and given that FGM is performed in part to increase a girl's marriageability, directly supporting economically struggling families with cash can indeed foster social change. SBC strategies can also enhance the impact of cash transfers. Two impact examples follow to highlight this connection.


Add value to cash transfers impact example 1: Impact of in-kind transfers on child marriage

This systematic review on what works to prevent child marriage looks at interventions that support girls' school attendance and progress through cash or in-kind transfers.How was this impact achieved?

As this is an extensive systematic review, there are a significant range of strategies assessed. In general, impact was achieved through single component and multicomponent programmes that included some form of cash transfer or in-kind transfers that were either
  • conditional (on school attendance, or marriage status) or
  • unconditional and were introduced at different age or schooling (primary or high school) levels.
Related to cash transfers, specific SBC intervention examples within the systematic review include:
  • Community sensitization: discussions of and information on harms of marriage at village meetings and events
  • Community dialogue: weekly discussion groups on harms of child marriage
  • Livelihoods training in computers, servicing, first aid, photography
  • School-based female "helper" for girls entering Grade 6
  • Interventions that are developed and implemented with community consultation
  • Clubs as safe spaces
  • Building of "hard" vocational skills for small-scale income generation (tailoring, poultry computing), sometimes with a financial literacy component
  • Building of "soft" life skills on sexual and reproductive health, menstruation, negotiation, conflict, leadership

Add value to cash transfers impact example 2: Impact of gender-transformative mentoring and cash transfer on child marriage and safer sex practices

The Girl Empower intervention in this study led to:How was this impact achieved?
  • Facilitated life skills sessions
  • Caregiver discussion groups
  • Savings start-up and monthly cash payments for girls
  • Community action events
  • Capacity strengthening for local health and psychosocial service providers
  • Incentive payment to caregivers tied to girls' participation in weekly sessions
  • Monthly savings payments provided directly to the participating girls (not caregivers) as cash in envelopes that were not tied to attendance (girls who were absent on payment day accumulated their payments and received them on the next payment day they attended)

Strategic and Investment Implication: There is evidence that cash transfers can have a direct impact on child marriage and provide a firm foundation for SBC strategies that can build from that base - for example, strategies related to school attendance, mentoring, action for safer sexual practices, and recognition by girls of their own capacities.


5. Deepen community engagement.

Effective action across the full spectrum of development action requires engagement from those who are both experiencing day to day the priority issues of concern and have leadership and decision-making roles within communities, be they geographic or identity communities. The impact evidence identified confirms this assertion for effective action on child marriage and FGM issues.


Deepen community engagement impact example 1: Reduction in reports of partner or sexual violence due to enhanced communication

A systematic review on the prevention of violence against women and girls showed that programmes that are participatory, engage multiple stakeholders, foster critical discussion about gender relationships and the acceptability of violence, and support greater communication and shared decision making among family members led to:

55% reduction in reports of physical or sexual partner violence from women after 2 years.

How was this impact achieved?
  • Women-centred approach
  • Advocacy
  • Home-visitation programmes
  • Group training for women and men
  • Community mobilization
  • Combined livelihood and training interventions for women
  • Multisectoral programmes that engage with multiple stakeholders
  • Efforts to challenge the acceptability of violence
  • Work to address the underlying risk factors for violence, including norms for gender dynamics, the acceptability of violence, and women's economic dependence on men
  • Support for the development of new skills, including communication and conflict resolution
  • Participatory projects and community-driven development that engage multiple stakeholders and address gender norms
  • School or community programmes to improve women's agency that can include other components such as safe spaces, mentoring, life skills, or self-defence training
  • School or community workshops to promote changes in norms and behaviour that encourage violence against women and girls and gender inequality
  • Microfinance, vocational training or job placement, cash or asset transfers (e.g., land reform), plus gender equality and violence prevention training

Deepen community engagement impact example 2: Women's experiences of intimate partner violence (IPV) reduced

A community-based intervention that sought to address violence against women and support victims of violence through action teams that are nominated by the community to carry out awareness of violence against women (VAW), change gender norms, and create referral systems for victims had the following impact:

9.3% less sexual IPV in intervention vs. in control communities & 15% reduction in the reported prevalence of men's perpetration of emotional IPV.

How was this impact achieved?
  • Worked with a broad range of stakeholders within the community
  • Increased knowledge on VAW
  • Provided counseling and support to couples affected by IPV and other victims of VAW
  • Assisted victims to seek redress from state institutions
  • Set up a referral system between the community-based response systems and state agencies to encourage a consistent and coordinated response
  • Strengthened appropriate traditional systems of resolution of VAW
  • Chose 6 people per community to form Community Based Action Teams (COMBATs) within the 20 study communities
  • Supported the teams to work together when undertaking community sensitization and awareness-raising
  • Used every opportunity, such as community festivals and meetings, weddings, funerals, parents-teacher association (PTA) meetings, membership meetings of social associations, religious groupings, and other meetings of family and friends
  • Shared information on wives' property rights after bereavement and the importance of wills and talked about how to share work in the home, how to have a non-violent marriage, and how to argue against child neglect
  • Provided counselling for couples referred to them because they were known to be experiencing violence

Strategic and Investment Implication: Increase the levels of genuine support to communities in order to strengthen their capacity to advocate for effective policy and resource use, to understand and analyze priority issues in their communities, to organize to address those issues, and to negotiate strategies, plans, and assessments with the government and other development actors.

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Why the focus on direct impact data?

A common challenge from policy makers, funders, community members, people directly experiencing development issues, and governments is: Demonstrate your Impact. Prove that what you are doing works. The high quality, highly credible data presented on the cards below is designed to help you answer that question for your social change, behaviour change, community engagement, communication and media for development, strategy formulation, policy engagement and funding initiatives. At this link filter the research data to your specific interests and priorities

Why a playing cards design?

There is a physical pack of cards with this data (to get a copy please request through the comment form for any card). The card approach allows for easy identification and selection of relevant direct impact data in any context. For example if talking with a donor and you need to identify proof of impact say "take a look at the 7 of Hearts". Quick access can be provided to high-quality data for many areas of your work – funding, planning, policy, advocacy, community dialogue, training, partner engagement, and more. A card deck is also engaging, easy to use and share, a conversation starter, and a resource - and they are fun and different. So we kept that design for the online images as it can serve similar purposes. 

What are the criteria for inclusion?

The impact data presented meets the following high standard for inclusion criteria:

  • Positive change or trend in a priority development issue;
  • Social change or behaviour change strategy or process;
  • Randomized Control Trial or Systematic Review methodology;
  • High quality peer review journal published;
  • Numeric impact data point
  • Published since 2010.