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

Leah Prencipe, Tia Palermo, and Yekaterina Chzhen and presented “Impacts of a Cash Plus Intervention on Gender Attitudes among Tanzanian Adolescents” as part of European Commission Joint Research Center's Seminar Series. (June 2020)

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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 European Commission Joint Research Centre seminar series, June 26, 2020 Yekaterina Chzhen (Trinity College Dublin), Leah Prencipe (Erasmus MC) and Tia Palermo (State University of New York at Buffalo), on behalf of the Tanzania Cash Plus Evaluation Team
  2. 2. Tanzania Cash Plus Evaluation team University at Buffalo: Tia Palermo (co-Principal Investigator) UNICEF Office of Research: 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
  3. 3. “Societal expectations about men’s and women’s roles, rights, and responsibilities.” - Vu et al, 2017 GENDER NORMS
  4. 4. SOCIAL PROTECTION & GENDER: THE LINKAGES • Poverty, vulnerability and well-being have inherent gender dimensions; thus gender considerations have historically motivated & driven certain design features of SP: • These have mostly been instrumental (motivated by functional & operational features) • More recently, intrinsic value of improving women’s wellbeing & gender equality has gained traction: • Goal 5 of SDGs call for social protection as an avenue for reducing unpaid care (2016) • First gender SPIAC-B working group (formed 2018) • 63rd Commission on the Status of Women with priority theme of social protection systems (2019)
  5. 5. “Comprehensive social protection systems need to be gender-responsive to a) ensure they do not further exacerbate gender inequality and that they b) promote gender equality.” ~Africa Ministerial Pre-Commission on the Status of Women (CSW) 2019
  6. 6. SOCIAL PROTECTION Social services Insurance schemes Labor market policies SOCIAL SAFETY NETS Public works, Subsidies, School feeding, Economic transfers CASH TRANSFERS ~45% global coverage ~2.5 billion in LMICs ~11% coverage in LMICs Sources: World Social Protection Report 2017-2019: Universal social protection to achieve the SDGs, ILO, Geneva, 2017; Ivaschenko et al. 2018. The state of social safety nets 2018 (English). Washington, D.C. : World Bank Group
  7. 7. Source: Beegle K, Coudouel, A & E Monsalve (Eds) (2018). Realizing the Full Potential of Social Safety Nets in Africa. World Bank. • Average country has 15 SSNs • 10% of the population covered • CT represent 41% (growing) share of spending EXPANSION OF SSNs IN SSA A core strategy for addressing poverty and vulnerability
  8. 8. The Transfer Project Who: Community of research, donor and implementing partners – focus on coordination in efforts and uptake of results  UNICEF, FAO, University of North Carolina at Chapel Hill, National Governments, National researchers Mission: Provide rigorous evidence on government-run large-scale (largely unconditional) social cash transfers (SCTs) Motivation:  Income poverty has highly damaging impacts on human development  Cash empowers people living in poverty to make their own decisions on how to improve their lives Where: Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Zambia & Zimbabwe
  9. 9. Enhancing adolescents’ capabilities  Social protection can contribute to a pipeline of investments in childhood & adolescence necessary for enhancing individuals’ capabilities, along multiple dimensions  GAGE defines adolescent capabilities as follows: Graphic source: Coast (2016). Gender and Adolescence: Capabilities, change strategies and contexts for well-being.
  10. 10. for every child, answers Cash Plus: The Intervention The Cash: cash transfer to the household - Tanzania’s Productive Social Safety Net (PSSN) The Plus: • 12 weeks of training on livelihoods and life skills (including gender equity) • Mentoring (including referrals and productive grant) • Linkages to adolescent-friendly services (e.g. sexual and reproductive health; violence response)
  11. 11. for every child, answers Training Topics Livelihoods • Dreams and goals • Entrepreneurship skills • Business plans and record keeping • Savings HIV/Sexual Reproductive Health (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
  12. 12. Study Design: Cluster Randomized Control Trial Cluster RCT design: 130 villages (clusters) in four districts in Tanzania randomized into: • Treatment: Cash + adolescent-focused services (“plus”) • Control: Cash only Youth surveys administered to eligible youth • Aged 14-19 at baseline • Living in a PSSN household Longitudinal design Sample sizes at baseline: • Community (n=130) • Health facility (n=91) • Household (n=1946) • Youth surveys (n=2458) for every child, answers
  13. 13. Data Youth questionnaire • Baseline: April – June 2017 • Midline: May – July 2018 • Endline: May – August 2019 • Follow-up: Planned March – May 2020; postponed due to COVID-19
  14. 14. for every child, answers Estimation Imperfect compliance with the intervention (47% uptake)  intent-to-treat (ITT) impacts Low autocorrelation between outcomes at baseline and midline (ρ=0.13) and baseline and endline (ρ= 0.14)  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 - follow-up 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)
  15. 15. 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?
  16. 16. RESEARCH QUESTION 2: Whether and how does the impact differ with personal characteristics (e.g. gender, sexual debut)?
  17. 17. for every child, answers Background Gender norms influence behaviours (including health and violence domains) Adolescence is a key period when new social roles and power relations manifest 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)
  18. 18. 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 • Females more likely to express support for inequitable norms in 11 of 24 items; males in 1 of 24. • Items recoded, dichotomized and summed into a scale (Cronbach’s alpha 0.87 in our sample). “It is alright for a man to beat his wife if she is unfaithful.” (F 57%; M 42%) “Only when a woman has a child is she a real woman.” (F 63%; M 50%) “Men are always ready to have sex.” (F 48%; M 38%) “A woman should obey her husband in all things.” (F66%: M 54%)
  19. 19. Panel Sample for every child, answers Endline analytic sample (after excluding DK for baseline and endline) GEM scale: 1,229 Violence: 1,760 Reproductive Health: 1,517 Sexual Relationships: 1,393 Domestic chores and daily life: 1,866 2,458 interviewed at baseline 2,104 re- interviewed at midline 2,191 re- interviewed at Wave 3 1,933 interviewed at all three waves
  20. 20. Cash Plus Intervention Impacts on Gender-Norms Attitudes for every child, answers
  21. 21. Cash Plus Intervention Midline Impacts on Gender-Norms Attitudes (by gender) for every child, answers
  22. 22. Cash Plus Intervention Endline Impacts on Gender-Norms Attitudes (by gender) for every child, answers
  23. 23. Cash Plus Intervention Midline Impacts on Gender- Norms Attitudes (males, by sexual debut at baseline) for every child, answers
  24. 24. for every child, answers Key findings The Cash Plus intervention increased gender equitable attitudes among males (but not females), particularly in the domains of violence and the domestic chores. Some impacts disappeared one year after face-to-face trainings; sustained impacts in domestic chores and violence (among males) sub-scales Evidence of heterogeneous impacts even among males: • Impacts were more pronounced 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
  25. 25. 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)
  26. 26. The authors would like to acknowledge the support of the TASAF and TACAIDS, in particular Ladislaus Mwamanga (TASAF), Amadeus Kamagenge (TASAF), and Mishael Fariji (TASAF) for the implementation of this evaluation. In addition, the UNICEF personnel instrumental to the initial planning stages of this pilot and study include: Beatrice Targa, Patricia Lim Ah Ken, Victoria Chuwa, Naomi Neijhoft and Tulanoga Matwimbi. We would also like to acknowledge the hard-working field teams of EDI Group, who conducted the data collection for this study to the highest professional standards. Funding for this research has been provided by Oak Foundation (#OCAY-16-73) and UNICEF Tanzania; as well as the Swedish Development Cooperation (G41102) and the UK Department for International Development (203529-102) through grants to UNICEF Office of Research—Innocenti supporting the Transfer Project. Additional funding for implementation of program activities was provided by Irish Aid THANK YOU.
  27. 27. ANNEX
  28. 28. Levels of inequitable gender norms attitudes at baseline (% agreed) Gender differences significant at p<0.05 are in bold. Standard errors adjusted for clustering by village. Female (N=841) Male (N=1,039) There are times a woman deserves to be beaten. 36 38 A woman should tolerate violence in order to keep her family together. 42 43 If someone insults a man he should defend his reputation with force if he has to. 41 35 It is okay for a man to hit his wife if she will not have sex with him. 29 24 A man using violence against his wife is a private matter that should not be discussed outside the couple. 44 34 It is alright for a man to beat his wife if she is unfaithful. 57 42 It is a woman's responsibility to avoid getting pregnant. 58 51 A man should be angered/shocked if his wife asks him to use a condom. 40 40 Women who carry condoms on them are easy. 38 44 Only when a woman has a child is she a real woman. 63 50 A real man produces a male child. 38 36 It disgusts me when I see a man acting like a woman. 72 72 A woman should not initiate sex. 47 48 You do not talk about sex, you just do it. 36 40 A woman who has sex before she marries does not deserve respect. 51 53 Men need sex more than women do. 39 33 Men are always ready to have sex. 48 38 A man needs other women, even if things with his wife are fine. 38 30 It is the man who decides how he wants to have sex. 48 44 Giving the kids a bath and feeding the kids are the mother's responsibility. 76 60 A woman's most important role is to take care of her home and cook for her family. 80 68 A man should have the final word on decisions in his home. 69 64 The husband should decide what major household items to buy. 61 57 A woman should obey her husband in all things. 66 54 Violence Reproductive Health Sexual relationships Domestic chores and daily life for every child, answers Highest support for inequitable gender norms in domestic chores/daily life; lowest in the violence domain. Females more likely to express support for inequitable norms in 11 of 24 items; males in 1 of 24.
  29. 29. Descriptive Statistics Baseline means of background characteristics in the panel sample, by treatment status for every child, answers Control Treatment Mean N Mean N Background characteristics Age 16.08 987 16.01 932 Female 0.46 987 0.43 932 Sexually debuted 0.17 987 0.15 932 Age of household head 58.65 985 58.34 932 Female-headed household 0.67 987 0.65 932 Household size 4.94 987 5.01 932 Mufindi/Mafinga PAAs 0.50 987 0.51 932 Large village 0.72 987 0.67 932 Gender-norms attitudes GEM scale (0-24) 12.68 780 12.30 699 Violence sub-scale (0-6) 3.75 942 3.66 896 Reproductive health sub-scale (0-5) 2.78 876 2.75 797 Sexual relationships sub-scale (0-8) 4.35 836 4.28 756 Domestic chores sub-scale (0-5) 1.76 969 1.68 916
  30. 30. Attrition for every child, answers Non-interviewed at midline and/or endline (‘attritors’) Re-interviewed at both midline and endline (panel) Difference Difference Control Treatment P-value Control Treatment 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) 13.12 11.94 0.08 12.68 12.30 0.41 0.44 0.40 -0.37 0.21 Violence sub-scale (0-6) 3.85 3.64 0.26 3.75 3.66 0.48 0.10 0.42 -0.01 0.65 Reproductive health sub-scale (0-5) 2.71 2.52 0.27 2.78 2.75 0.72 -0.07 0.44 -0.23 0.07 Sexual relationships sub-scale (0-8) 4.51 4.24 0.28 4.35 4.28 0.65 0.16 0.34 -0.04 0.68 Domestic chores sub- scale (0-5) 1.76 1.54 0.15 1.76 1.68 0.45 -0.00 0.66 -0.13 0.12
  31. 31. PSSN Details