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Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

Yekaterina Chzhen presents “Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents" at Association for Public Policy Analysis and Management Annual Conference, Barcelona July 29-30.

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Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

  1. 1. Impacts of a Cash Plus intervention on gender attitudes among Tanzanian adolescents APPAM International 2019, Barcelona, July 29 2019 Tia Palermo, Yekaterina Chzhen, and Leah Prencipe on behalf of the Tanzania Cash Plus Evaluation Team
  2. 2. “Societal expectations about men’s and women’s roles, rights, and responsibilities.” - Vu et al, 2017 GENDER NORMS
  3. 3. for every child, answers Background Gender norms influence behaviours (including health and violence domains) Research on determinants of gender-norms attitudes in adolescence is mostly from North America and Western Europe (Kågesten et al, 2016) A review of 31 evaluations of small-scale programmes in LMICs documents short-term impacts on adolescents’ attitudes (John et al, 2017)
  4. 4. for every child, answers Cash Plus: The Intervention The Cash: cash transfer to the household - Tanzania’s Productive Social Safety Net (PPSN) The Plus: • 12 weeks of training on livelihoods and life skills (including HIV/SRH and gender equity) • Mentoring (including referrals and productive grant) • Linkages to adolescent-friendly services (e.g. sexual and reproductive health; violence response)
  5. 5. for every child, answers Training Topics Livelihoods • Dreams and goals • Entrepreneurship skills • Business plans and record keeping • Savings HIV/SRH • Coping with puberty • Relationships • HIV knowledge, prevention and protection • Pregnancy and family planning • Violence and gender-based violence • Addressing negative gender attitudes and norms • Alcohol and drugs • Healthy living and nutrition
  6. 6. RESEARCH QUESTION 1: What is the impact of the (cash plus) training on attitudes towards equitable gender norms among 14- 19-year-olds in rural Tanzania in cash transfer recipient households?
  7. 7. RESEARCH QUESTION 2: Whether and how does the impact differ with personal characteristics (e.g. gender, sexual debut)?
  8. 8. Study Design: Cluster Randomized Control Trial 130 villages (clusters) in two districts in Tanzania randomized into: • Treatment: Cash + adolescent- focused services • Control: Cash only for every child, answers
  9. 9. Data Youth questionnaire • Baseline (pre-intervention/pre- randomization) survey • Midline (12-month follow-up) survey
  10. 10. Youth Sample for every child, answers Analytic sample (after excluding DK) GEM scale: 1,279 Violence: 1,907 Reproductive Health: 1,606 Sexual Relationships: 1,505 Domestic chores and daily life: 2,012
  11. 11. for every child, answers Measures Gender norms: Gender Equitable Men (GEM) scale (Pulerwitz et al, 2008) • 24 items validated in a study of adolescents in Uganda (Vu et al, 2017) • Four domains: violence, reproductive health, sexual relationships; domestic chores & daily life • Items recoded, dichotomized and summed into a scale (Cronbach’s alpha 0.87 in our sample). • Higher values denote greater support for equitable gender norms “It is alright for a man to beat his wife if she is unfaithful.” “Only when a woman has a child is she a real woman.” “Men are always ready to have sex.” “A woman should obey her husband in all things.”
  12. 12. for every child, answers Estimation Imperfect compliance with the intervention  intent-to-treat (ITT) impacts Low autocorrelation between outcomes at baseline and midline (ρ=0.13)  Analysis of Covariance (ANCOVA) 𝒀 𝟏𝒊𝒋 = 𝜶 𝟎 + 𝜶 𝟏 𝑻𝒋 + 𝜶 𝟐 𝒀 𝟎𝒊𝒋 + 𝜶 𝟑 𝑿𝒊𝒋 + 𝜺𝒊𝒋 𝑌0𝑖𝑗 - baseline value of the outcome for adolescent i living in village j 𝑌1𝑖𝑗 - midline value of the outcome for adolescent i living in village j Tj – treatment dummy (1-lives in a treatment village; 0 otherwise) Xij – controls (age at baseline, gender, district x village size fixed effects)
  13. 13. No impact on the overall GEM scale. Cash Plus Intervention Impacts on Gender-Norms Attitudes for every child, answers ITT Impact Baseline Mean Midline Cash Only Midline Cash Plus Mean Mean (1) (2) (3) (4) GEM scale (0-24) 0.776 12.475 14.685 15.558 (0.40) N 1,279 1,279 666 613 Violence sub-scale (0-6) 0.120 3.686 3.841 3.976 (0.09) N 1,907 1,907 981 926 Reproductive health sub-scale (0-5) 0.167 2.779 3.171 3.358 (0.09) N 1,606 1,606 840 766 Sexual relationships sub-scale (0-8) 0.144 4.298 5.393 5.564 (0.14) N 1,505 1,505 774 731 Domestic chores sub-scale (0-5) 0.263** 1.719 1.937 2.237 (0.10) N 2,012 2,012 1,034 978 *p<0.05, **p<0.01. Controlling for gender, age & outcome value at baseline, district x village size fixed effects. Standard errors (in parentheses) adjusted for village-level clustering.
  14. 14. The intervention increased support for equitable gender norms only among males (for the overall scale; violence sub-scale and domestic chores sub-scale). Cash Plus Intervention Impacts on Gender-Norms Attitudes (by gender) for every child, answers Females Males ITT Impact ITT Impact Differential impact (1) (2) (3) GEM scale (0-24) -0.051 1.368* -1.412* (0.44) (0.53) (0.60) N 546 733 Violence sub-scale (0-6) -0.064 0.278* -0.350 (0.13) (0.12) (0.18) N 845 1,062 Reproductive health sub-scale (0-5) 0.110 0.206 -0.095 (0.10) (0.12) (0.14) N 699 907 Sexual relationships sub-scale (0-8) -0.145 0.347 -0.505* (0.17) (0.18) (0.23) N 643 862 Domestic chores sub-scale (0-5) -0.006 0.489** -0.508* (0.12) (0.15) (0.20) N 913 1,099 *p<0.05, **p<0.01. Column 3 refers to regressions estimated on the pooled panel sample and augmented by the interaction term (treatment x subgroup). The estimated coefficient on the interaction term is reported.
  15. 15. The intervention increased support for equitable gender norms only among males who had not sexually debuted (at baseline). Cash Plus Intervention Impacts on Gender-Norms Attitudes (males & females, by sexual debut at baseline) for every child, answers Sexually debuted Not sexually debuted Males ITT impact Females ITT impact Differential impact Males ITT impact Females ITT impact Differential impact (1) (2) (3) (4) (5) (6) GEM scale (0-24) 1.25 0.30 -0.95 1.46* -0.06 -1.52* (1.07) (0.81) (1.35) (0.57) (0.50) (0.68) Violence sub-scale (0-6) 0.03 -0.01 -0.04 0.32* -0.08 -0.41* (0.28) (0.25) (0.37) (0.13) (0.14) (0.20) Reproductive health sub-scale (0-5) 0.16 0.28 0.12 0.23 0.08 -0.15 (0.31) (0.19) (0.37) (0.12) (0.12) (0.16) Sexual relationships sub- scale (0-8) 0.45 -0.03 -0.48 0.37 -0.16 -0.53* (0.40) (0.30) (0.52) (0.19) (0.19) (0.25) Domestic chores sub- scale (0-5) 0.60 0.11 -0.49 0.52** -0.04 -0.56* (0.32) (0.20) (0.38) (0.16) (0.13) (0.22) *p<0.05, **p<0.01. Column 3 refers to regressions estimated on the pooled panel sample and augmented by the interaction term (treatment x subgroup). The estimated coefficient on the interaction term is reported.
  16. 16. for every child, answers Key findings The Cash Plus intervention had no impact on gender equitable attitudes among 14-19-year-olds. The Cash Plus intervention increased gender equitable attitudes among males (but not females), particularly in the domains of violence and the domestic chores. But the impact was heterogeneous even among males: • The intervention only increased support for equitable gender norms among males who had not reported experiences of sexual debut at baseline • This is not driven by age differences: the intervention affected males (but not females) in both the younger (14 -15) and older (16-19) cohorts, with or without controlling for sexual debut at baseline
  17. 17. for every child, answers Implications Gender-focused interventions need to take place early, before personal experiences have led to the consolidation of attitudes to gender norms. • Experience of sexual intercourse is correlated with less equitable gender norms in adolescents (Uganda; Vu et al, 2017) More efforts need to be made to demonstrate the value of progressive gender norms to female adolescents. Broader social protection policy can affect gender attitudes via impacts on drivers of gender attitudes . • Cash transfer programmes targeting mothers of young children increase women’s empowerment (Zambia; Bonilla et al 2017)
  18. 18. On behalf of the Tanzania Cash Plus evaluation team UNICEF Office of Research: Tia Palermo (co-Principal Investigator), Lusajo Kajula, Jacobus de Hoop, Leah Prencipe, Valeria Groppo, Jennifer Waidler Economic Development Initiatives: Johanna Choumert Nkolo (co-Principal Investigator), Respichius Mitti (co-Principal Investigator), Nathan Sivewright, Koen Leuveld, Bhoke Munanka Tanzania Social Action Fund: Paul Luchemba, Tumpe Lukongo Tanzania Commission for Aids: Aroldia Mulokozi UNICEF Tanzania: Ulrike Gilbert, Paul Quarles van Ufford, Rikke Le Kirkegaard, Frank Eetaama THANK YOU.
  19. 19. ANNEX
  20. 20. Descriptive Statistics Control Treatment Variables Mean N Mean N p-value Age 16.09 1,071 16.05 1,009 0.58 Female (ref: Male) 0.47 1,071 0.43 1,009 0.12 Mufindi PAA (ref: Rungwe) 0.51 1,071 0.51 1,009 0.97 Large village (ref: small) 0.71 1,071 0.67 1,009 0.54 Baseline means of background characteristics in the panel sample, by treatment status Means of outcome variables at baseline in the panel sample, by treatment status Control Treatment Mean N Mean N p-value GEM scale (0-24) 12.62 849 12.32 763 0.55 Violence sub-scale (0-6) 3.73 1,026 3.67 978 0.63 Reproductive health sub-scale (0-5) 2.78 952 2.74 863 0.72 Sexual relationships sub-scale (0-8) 4.34 919 4.27 842 0.70 Domestic chores sub-scale (0-5) 1.76 1,056 1.67 998 0.49 for every child, answers
  21. 21. Attrition & Balance Means of outcome variables at baseline, by attribution status for every child, answers Attrited Panel Difference Difference Cash Only Cash Plus P-value Cash Only Cash Plus P-value Col(1)-Col(4) P-value Col(2)-Col(5) P-value (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) GEM scale (0-24) 13.66 11.63 0.01 12.62 12.32 0.48 1.04 0.06 -0.69 0.08 Violence sub-scale (0-6) 3.99 3.55 0.05 3.73 3.67 0.63 0.26 0.06 -0.12 0.34 Reproductive health sub-scale (0-5) 2.68 2.45 0.21 2.78 2.74 0.68 -0.10 0.37 -0.30 0.02 Sexual relationships sub-scale (0-8) 4.67 4.20 0.09 4.34 4.27 0.68 0.33 0.08 -0.07 0.60 Domestic chores sub-scale (0-5) 1.78 1.49 0.13 1.76 1.67 0.44 0.02 0.88 -0.18 0.05 Notes: Mean values represent unadjusted statistics, while p-values in column 3 are from the coefficient on 'treatment' from a regression predicting each characteristic listed in the table among the group of attritors, while column 6 is the same among the panel sample. All regressions control for district x size fixed effects and standard errors are clustered at the community level. N may differ by indicator.
  22. 22. PSSN Details

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