Peer-reviewed article
Impact of the CARE Tipping Point Program in Nepal on adolescent girls’ agency and risk of child, early, or forced marriage: Results from a cluster-randomized controlled trial
Kathryn M. Yount, Robert L. Durr, Irina Bergenfeld, Sudhindra Sharma, Cari J. Clark et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluated CARE's Tipping Point Initiative, a program designed to reduce child, early, and forced marriage in Nepal by building girls' agency and shifting gender norms. The research followed over 1,100 unmarried girls aged 12-16 across 54 communities using a randomized controlled trial comparing a standard program, an enhanced social-norms focused program, and a control group. Although marriage rates remained low (<6%) and 10 secondary outcomes related to girls' agency improved overall, the program showed no significant effects on girls' agency or marriage risk compared to control areas.
Key points
- Marriage rates at follow-up were very low (<6%) across all study arms, limiting the ability to detect program effects
- The program had minimal impact on 15 agency-related secondary outcomes, with only sexual/reproductive health knowledge and group membership showing modest improvements in the enhanced program arm
- Results did not vary by community characteristics including gender norms, household poverty, or women's schooling
- Cox proportional hazard models showed no program effect on time-to-marriage
- Null findings may be attributed to low baseline CEFM rates, poor socio-economic conditions, COVID-19 disruptions, and concurrent programming in control communities
Limitations
The study's null findings may reflect the already-low CEFM rates in the study population at baseline, making it difficult to detect program effects. The analysis cannot disentangle the impact of COVID-19 disruptions and concurrent programming in control areas from true program ineffectiveness.
Abstract
Background: Girl child, early, and forced marriage (CEFM) persists in South Asia, with long-term effects on well-being. CARE's Tipping Point Initiative (TPI) sought to address the gender norms and inequalities underlying CEFM by engaging participant groups on programmatic topics and supporting community dialogue to build girls' agency, shift power relations, and change norms. We assessed impacts of the CARE TPI on girls' multifaceted agency and risk of CEFM in Nepal. Methods: The quantitative evaluation was a three-arm, cluster-randomized controlled trial (control; Tipping Point Program [TPP]; Tipping Point Plus Program [TPP+] with emphasized social-norms change). Fifty-four clusters of ∼200 households each were selected from two districts (27:27) with probability proportional to size and randomized evenly to study arms. A pre-baseline census identified unmarried girls 12-16 years (1,242) and adults 25 years or older (540). Questionnaires covered marriage; agency; social networks/norms; and discrimination/violence. Baseline participation was 1,140 girls and 540 adults. Retention was 1,124 girls and 531 adults. Regression-based difference-in-difference models assessed program effects on 15 agency-related secondary outcomes. Cox-proportional hazard models assessed program effects on time to marriage. Sensitivity analyses assessed the robustness of findings. Results: At follow-up, marriage was rare for girls (<6.05%), and 10 secondary outcomes had increased. Except for sexual/reproductive health knowledge (coef.=.71, p=.036) and group membership (coef.=.48, p=.026) for TPP + versus control, adjusted difference-in-difference models showed no program effects on secondary outcomes. Results were mostly unmoderated by community mean: gender norms, household poverty, or women's schooling attainment. Cox proportional hazard models showed no program effect on time-to-marriage. Findings were robust. Discussion: Null findings of the Nepal TPI may be attributable to low CEFM rates at follow-up, poor socio-economic conditions, COVID-19-related disruptions, and concurrent programming in control areas. As COVID-19 abates, impacts of TPP/TPP + on girls' agency and marriage, alone and with complementary programming, should be assessed. Trial registration number: NCT04015856.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- CARE Tipping Point Initiative: community engagement on gender norms and programmatic topics through participant groups and community dialogue to build girls' agency and shift power relations; TPP+ version emphasized social-norms change
- Population
- Unmarried girls aged 12-16 years (n=1,140 baseline, 1,124 retained) and adults 25+ years (n=540 baseline, 531 retained) across 54 clusters in two districts of Nepal
Key finding
Marriage rates at follow-up were <6% across all arms, with no significant program effect on time-to-marriage