Fostering gender equality and reproductive and sexual health among adolescents: results from a quasi-experimental study in Northern Uganda
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Authors
Dagadu, Nana Apenem
Barker, Kathryn M.
Okello, Sam B. T.
Kerner, Brad
Simon, Callie
Nabembezi, Dennis
Lundgren, Rebecka Inga
Issue Date
2022-03-22
Type
Article
Language
en_US
Keywords
Community Child Health , Public Health , Social Medicine
Alternative Title
Abstract
Objective:
To assess the impact of the Gender Roles, Equality and Transformations (GREAT) intervention: a narrative-based, resource-light, life-stage tailored intervention package designed to promote gender-equitable attitudes and behaviours, and improve sexual and reproductive health (SRH) and gender-based violence (GBV) outcomes among adolescents and their communities.
Design:
Repeated cross-sectional evaluation study, using propensity score matching combined with difference-in-difference estimation.
Setting:
Two postconflict communities in Lira and Amuru districts in Northern Uganda.
Participants:
Male and female unmarried adolescents (10–14 years, 15–19 years), married adolescents (15–19 years) and adults (over the age of 19 years) were selected using a stratified, two-stage cluster sample of primary and secondary schools and households (baseline: n=2464, endline: n=2449).
Primary outcome measures:
Inequitable gender attitudes and behaviours; GBV; and SRH knowledge and behaviours.
Results:
Statistically significant intervention effects were seen across all three outcomes—gender equity, GBV and SRH—among older and newly married adolescents and adults. Among older adolescents, intervention effects include shifts on: inequitable gender attitudes scale score: −4.2 points ((95% CI −7.1 to –1.4), p<0.05); Inequitable household roles scale score: −11.8 ((95% CI −15.6to –7.9), p<0.05); Inequitable attitudes towards GBV scale: −1.9 ((95% CI −5.0 to –0.2), p<0.05); per cent of boys who sexually assaulted a girl in past 3 months: −7.7 ((95% CI −13.1 to –2.3), p<0.05); inequitable SRH attitudes scale: −10.1 ((95% CI −12.9 to –7.3), p<0.05). Among married adolescents, intervention effects include shifts on: Inequitable household roles scale score: −6.5 ((95% CI −10.8 to –2.2), p<0.05); inequitable attitudes towards GBV scale: −4.7 ((95% CI −9.8 to –0.3), p<0.05); per cent who reacted violently to their partner: −15.7 ((95% CI −27.1 to –4.4), p<0.05); inequitable SRH attitudes scale: −12.9 ((95% CI −17.3 to –8.5), p<0.05).
Conclusion:
The GREAT intervention model demonstrates the promise of a resource-light, life-stage tailored programme that employs culturally appropriate, participatory and narrative-based techniques to advance gender equity and adolescent health. This type of programming contributes towards reductions in GBV and improved adolescent SRH outcomes.
Description
Citation
Dagadu, N. A., Barker, K. M., Okello, S. B. T., Kerner, B., Simon, C., Nabembezi, D., & Lundgren, R. I. (2022). Fostering gender equality and reproductive and sexual health among adolescents: results from a quasi-experimental study in Northern Uganda. BMJ open, 12(3), e053203. https://doi.org/10.1136/bmjopen-2021-053203
Publisher
BMJ Open