Girl Empower

Girl Empower (GE) encourages adolescent girls living in rural areas of Nimba County, Liberia to partake in weekly mentored community-based workshops on life skills, self-care, and financial literacy. Participants’ parents and caregivers can also attend monthly discussion groups. In addition to working directly with girls to prevent sexual and gender-based violence, GE program leaders also train local health and psychosocial care providers to expand and improve services for survivors in the area. The Population Council, IPA and World Bank are evaluating the GE program’s efficacy in preventing gender-based violence via a randomized control trial featuring a control group, a standard GE group, and a GE+ group, where girls and their families will receive the standard GE intervention, but are will be given small cash incentives to encourage regular attendance at the 32 mentoring sessions over the course of one year of programming.

Girl Empower Liberia
Girl Empower is a mentorship program designed by the International Rescue Committee (IRC) and supported by the NoVo Foundation. The program centers on weekly meetings between girls and trained local female mentors during which the girls learn about life skills and financial literacy. It aims to equip girls with the skills and experiences necessary to make healthy, strategic life choices and to stay safe from sexual exploitation and abuse.

In Liberia, Girl Empower was implemented from February to November 2016 in 56 communities in Nimba County. A total of 772 adolescent girls aged 13-14 year old participated, and 130 adult female mentors were trained to lead them through the Girl Empower curriculum.
The 56 implementation communities in Nimba County were randomized into two Girl Empower variations: 1) GE treatment group (28 villages, 376 girls) and 2) GE+ treatment group (28 villages, 396 girls) while an additional 28 villages served as control. After randomization, the IRC created 59 Girl Empower groups of 6 to 20 girls each. Each girl group was led by two adult female mentors.

Both the GE and GE+ treatment groups received: 1) the Girl Empower life skills curriculum, facilitated by local mentors; 2) caregiver discussion group, facilitated by IRC staff; and 3) savings account start-up. The GE+ group participants also received a small cash incentive given caregivers to encourage regular attendance by girls at Girl Empower mentorship meetings.

1) Girl Empower Life Skills curriculum (GE and GE+)
Mentors delivered the Girl Empower curriculum during weekly meetings of the 59 Girl Empower groups in both GE and GE+ communities. These groups met over a period of 40 weeks in an identified community ‘safe space’ for girls. The life skills curriculum covered:
• Sense of self
• Feelings and emotions
• Social networks
• Protection and safety
• Financial literacy
• Reproductive Health
• Leadership and Empowerment
• Setting life goals

The girls also received an accompanying image book with activities and handouts.

2) Caregiver discussions (GE and GE+)

In all 56 communities, IRC staff facilitators led monthly parent/caregiver discussion group that will complement the learning and asset building of the girls. The caregiver curriculum covered:
• Overview of the Girl Empower life skills curriculum
• Life stages for adolescent girls
• Skills and capacities to keep girls safe
• Parenting techniques
• Health and well-being of adolescent girls
• Safety and protection of adolescent girls
• Financial literacy and savings for adolescent girls
• Early marriage, female genital cutting, and sexual violence
• Gender equality

3) Savings account (GE and GE+)
As part of the financial literacy objectives of the Girl Empower curriculum, each participating girl (GE and GE+) received a total of USD $16 as an initial deposit for a savings account (calculated as USD $0.50 per session, or $49.00LD, for 32 sessions). This was an unconditional cash transfer. All girls also received a cash box for their savings.

4) Cash incentives for participation (GE + only)
In the 28 GE+ communities, GE+ group participants also received a conditional cash incentive given caregivers to encourage regular attendance by girls at mentorship meetings. The caregivers received $1.25 for each of 32 sessions* attended by the girl participants, for a total of up to $40 per girl participant.

* 32 sessions out of 40, because the payments did not start until the 5th session and excluded the final four sessions of the GE, which were focused on planned a community event.

2016-02-01

2016-11-30

The primary outcome of interest is an index of sexual violence at the individual level. The index is composed of four questions in our endline survey instrument. The construction of the index, and a detailed description of its components is described in the pre-analysis plan (PAP) document uploaded under the "Analysis Plan" in this registration.

Please see the PAP document uploaded under the "Analysis Plan" in this registration.

Secondary outcomes are six indices of schooling, mental health, gender norms, life skills, sexual and reproductive history, and protective factors. The construction of each index, along with a detailed description of its components, is described in the PAP document uploaded under the "Analysis Plan" in this registration.

Please see the PAP document uploaded under the "Analysis Plan" in this registration.

After baseline data collection was completed, the research team randomly assigned the 84 study villages to the control group or one of the two treatment groups (GE and GE+). Before carrying out the randomization, the team first blocked (stratified) the villages based on the number of girls surveyed and the average level of school enrollment. The randomization process resulted in 28 villages being assigned to the GE treatment arm, 28 to the GE+ treatment arm and the remaining 28 to the control arm. During the randomization, two of the principal investigators traveled to Liberia to oversee and explain the randomization process to IRC staff. The results are shown in Figure 1 in the Baseline Report linked in this registration. More details on the study design can also be found there.

Randomization was conducted by field staff, supervised by two PIs in the field and checked by another in the US. Stata 13.0 was used for the randomization code. Blocked randomization was used, where blocking variables were number of subjects surveyed at baseline and the mean enrollment rate in the cluster.

The randomization unit, i.e. the level at which the intervention was assigned, was town/village.

Yes

1,216 individuals (females, aged 13-14 at baseline) in 84 clusters in Nimba County, Liberia.

1,216 individuals (females, aged 13-14 at baseline) in 84 clusters in Nimba County, Liberia.

399 individuals (28 towns) in Control
402 individuals (28 towns) in GE
415 individuals (28 towns) in GE+

Calculations were made using Optimal Design (OD) and Stata to allow for clustered design of the study and primary outcomes that are binary indicators. All calculations were made using K=30, N=20, alpha=0.1, and rho=0.05. For binary indicators, estimated minimum and maximum mean values across clusters were utilized in OD. Due to a very small number of listed study participants in a number of towns, the study sample is slightly smaller than envisioned for ex-ante power calculations. "Ever had sex" ---------------- Mean (Range) in Control at 24-month follow-up: 0.57 (0.40-0.80) Minimum detectable mean in GE or GE+: 0.47 Minimum detectable mean between GE and GE+: 0.38 Ever married, ever pregnant, first sexual encounter non-consensual ------------------------------------------------------------------------------ Mean (Range) in Control at 24-month follow-up: 0.10 (0.02-0.18) Minimum detectable mean in GE or GE+: 0.05

Analysis Plan

Abstract
Background
We evaluated Girl Empower – an intervention that aimed to equip adolescent girls with the skills to make healthy, strategic life choices and to stay safe from sexual abuse using a cluster-randomized controlled trial with three arms: control, Girl Empower (GE), and GE+.

Methods
GE delivered a life skills curriculum to girls aged 13–14 in Liberia, facilitated by local female mentors. In the GE + variation, a cash incentive payment was offered to caregivers for girls’ participation in the program. We evaluated the impact of the program on seven pre-specified domains using standardized indices: sexual violence, schooling, sexual and reproductive health (SRH), psychosocial wellbeing, gender attitudes, life skills, and protective factors.

Findings
Participation rates in the program were high in both GE and GE+, with the average participant attending 28 out of 32 sessions. At 24 months, the standardized effects of both GE and GE+, compared to control, on sexual violence, schooling, psychosocial wellbeing, and protective factors were small (β, ≤ 0.11 standard deviations [SD]) and not statistically significant at the 95% level of confidence. However, we found positive standardized effects on Gender Attitudes (GE: β, 0.206 SD, p<0.05; GE+: β, 0.228 SD, p<0.05), Life Skills (GE: β, 0.224 SD, p<0.05; GE+: β, 0.289 SD, p<0.01), and SRH (GE: β, 0.244 SD, p<0.01; GE+: β, 0.372 SD, p<0.01; F-test for GE = GE+: p = 0.075).

Interpretation
Girl Empower led to sustained improvements in several important domains, including SRH, but did not reduce sexual violence among the target population.

Berk Özler, Kelly Hallman, Marie-France Guimond, Elizabeth A. Kelvin, Marian Rogers, Esther Karnley, Girl Empower – A gender transformative mentoring and cash transfer intervention to promote adolescent wellbeing: Impact findings from a cluster-randomized controlled trial in Liberia, SSM - Population Health, Volume 10, 2020, 100527, ISSN 2352-8273, https://doi.org/10.1016/j.ssmph.2019.100527. (https://www.sciencedirect.com/science/article/pii/S2352827319300345) Abstract: Background We evaluated Girl Empower – an intervention that aimed to equip adolescent girls with the skills to make healthy, strategic life choices and to stay safe from sexual abuse using a cluster-randomized controlled trial with three arms: control, Girl Empower (GE), and GE+. Methods GE delivered a life skills curriculum to girls aged 13–14 in Liberia, facilitated by local female mentors. In the GE + variation, a cash incentive payment was offered to caregivers for girls’ participation in the program. We evaluated the impact of the program on seven pre-specified domains using standardized indices: sexual violence, schooling, sexual and reproductive health (SRH), psychosocial wellbeing, gender attitudes, life skills, and protective factors. Findings Participation rates in the program were high in both GE and GE+, with the average participant attending 28 out of 32 sessions. At 24 months, the standardized effects of both GE and GE+, compared to control, on sexual violence, schooling, psychosocial wellbeing, and protective factors were small (β, ≤ 0.11 standard deviations [SD]) and not statistically significant at the 95% level of confidence. However, we found positive standardized effects on Gender Attitudes (GE: β, 0.206 SD, p<0.05; GE+: β, 0.228 SD, p<0.05), Life Skills (GE: β, 0.224 SD, p<0.05; GE+: β, 0.289 SD, p<0.01), and SRH (GE: β, 0.244 SD, p<0.01; GE+: β, 0.372 SD, p<0.01; F-test for GE = GE+: p = 0.075). Interpretation Girl Empower led to sustained improvements in several important domains, including SRH, but did not reduce sexual violence among the target population. Keywords: Sexual violence; Mentoring programs; Cash transfers; Adolescent welfare

https://www.sciencedirect.com/science/article/pii/S2352827319300345