The Samata Intervention to Increase Secondary School Completion and Reduce Child Marriage Among Adolescent Girls: Results from a Cluster-Randomised Control Trial in India

Abstract

Background: Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a multi-level, structural and norms-based intervention could reduce secondary school drop-out and child marriage among rural, marginalised adolescent girls in southern India. Methods: 80 of 121 village clusters in Vijayapura and Bagalkote districts, Karnataka State, were randomly selected (40 intervention; 40 control). Scheduled-caste/scheduled-tribe girls aged 12-13 years in the final year of primary school were enrolled into the study. The primary trial outcomes were the proportion of girls who (i) completed secondary school and (ii) were married, by trial end-line (15-16 years). Findings: 92.6% (2257/2457) of girls at baseline and 72.8% (1788/2457) at end-line were interviewed. At end-line, a quarter had not completed secondary school (control=24.9%/intervention=25.4%), and 10% were married (control=9.6%/intervention=10.1%). These were lower than expected, with no difference between arms. There was no difference in other schooling or sexual and reproductive outcomes by trial arm. Stratified by district, there were small but significant increases in secondary school completion (control=73%; intervention=77%) among girls in Vijayapura. Interpretation: Low school drop-out and marriage rates reflect large secular changes and government programming during our trial. This makes it difficult to assess the value of the intervention overall or the value of this approach in settings where school dropout and child marriage are persistently high. Further research is needed to explore interventions for the substantial minority of girls who remain at risk of marriage and school drop-out in this setting. Funding Statement: Project Samata was funded by the UK Department for International Development (DFID) as part of STRIVE, a 6-year programme of research and action devoted to tackling the structural drivers of HIV and ViiV Healthcare. Declaration of Interests: The authors confirm no conflicting interests. Ethics Approval Statement: This work complies with the Principles of the Ethical Practice of Public Health code. The study was approved by ethics committees at St John’s Medical College, Bangalore (Ref 111/2013), LSHTM (Ref 7083), and the University of Manitoba (Ref H2014:414).