From April 20–30, 2020, during a nationwide lockdown, the Population Council Bangladesh conducted the first round of a rapid phone-based survey on COVID-19 knowledge, attitudes, and practices. The survey randomly selected girls who had provided phone numbers during enrollment in a skills-building program that began before the pandemic. The survey’s objective was to assess the impact of COVID-19 on adolescent lives and to design programs that would contribute to protecting girls and meet social distancing guidelines imposed by the government. Phone interviews were conducted with 479 girls living in the districts of Chapainawabganj, Kushtia, and Sherpur who were participants in a program focused on reducing child marriage by increasing school attendance and grade progression among girls ages 12–15. A follow-up survey was conducted from June 12–22, 2020, prior to the introduction of virtual skills sessions as school closure and social distancing protocols were in effect. The nationwide lockdown had been withdrawn by that time. A third round of remote data collection took place September 5–11, 2020. This brief presents the findings and comparisons from the three rounds of phone surveys.
In this comment, we examine the implications of decolonization on decision making in childcare (Kgatla, 2018). Self-empowerment as a cornerstone of change, long part of community empowerment, has finally achieved recognition within the literature on global health and nurturing care (Charani et al., 2022; Sharm & Sam-Agudu, 2023). Varied perspectives discuss the global benefits of shifting responsibility in decision making, for humanizing of the lives of the global majority and creating more sustainable change (Affun-Adegbulu & Adegbulu., 2020; de Laat et al., 2023; Martin, 2016). There still remains much more to be said, to be clarified and understood, before the imbalances and disconnect in responsibility and accountability still inherent in the current framing of child health and welfare systems are removed. The authors of this comment, both psychologists working in the Global South, have engaged in dialogue for more than a decade, examining our individual and shared experiences of intervention, research and therapy, reflecting on our professional challenges and achievements in the field of global Early Childhood Development (ECD). These discussions have examined the complexity in the process of the decolonization of early childhood frameworks. Within ECD those closest to the child, the parents and guardians, are held, for the most part, accountable for the failure to adequately address children's needs. However, the responsibility, the position of power, for selecting best practices is taken up by those who control the resources, the expert external to family, community and often too, external to the culture. As we observe this relationship play out, we have increasingly understood that sustainable change can only be built on a rebalancing of responsibilities, and in generating a direct connection between responsibility and accountability (Rasheed, 2021). Supporting this tangible shift in decision-making will create a more direct relationship between informed care, the context and its socio-cultural, environmental, and economic demands and the changing needs of the child (Krapels et al., 2020; Muhamedjonova et al., 2021). The evidence in the field is predominantly informed by randomized trials conducted under controlled settings with limited generalizability (owing to the bias of being published in medical journals, as noted by Scheidecker et al., 2023). This is where we believe anthropology has a lot to offer and an excellent multi-disciplinary opportunity for incorporating their methods to understand the complexities of human nature so we avoid making simplistic assumptions of the lives of millions of children in the Global South. In this comment, we continue our process of reflective practice through which our insights have developed, sharing where our dialogue has reached in response to Scheidecker and colleagues' (2023) critique of the field of Global ECD. Over the years, my understanding of decolonization in global health research has evolved. Initially, it seemed complex, but observing colonial behaviors in a collaborator opened my eyes to explore decolonization in the context of global health in Early Childhood Development (ECD), where I work in mostly Western collaborations. As I've delved deeper and contributed to this discourse in global health journals, I've noticed that the momentum behind decolonization in global health is mainly driven by individuals based in the Global North tied to existing systems for survival. They suggest adapting to these structures. However, I believe we should seize this moment to create a new system that values the unique cultures and strengths of the Global South. In academia, the focus on metrics like "publish or perish," prestige, and power has overshadowed community and impact. Decolonization, for me, means leading on our terms. Our systems and aspirations differ significantly, and we shouldn't compromise our identities for Northern resources. Decolonization requires that we expand and embrace our own regional systems that reduce inequities. Ultimately, decolonization, as I understand it, is about reclaiming power in the South (Rasheed, 2023). Our focus should shift towards recognizing, valuing, and applying behaviors that align with our own criteria for validation. In essence, decolonization is the path to a more equitable, inclusive, and self-empowered future in global health and beyond. Adding to this, exclusion, whether unconscious or deliberate, leads to inherently unstable systems. The shift as you describe is therefore not just a right, but a necessity. In the process of decolonization, however, the danger is to merely shift to another dominant perspective. You discuss this in your previous paper (Manjpara, 2022). As with the artist, the scientist who chooses not to be constrained by the dominant perspective will be "starved" professionally, be excluded from discussion, and from access to resources. The non-conformist scientist is marginalized by being labeled as "difficult" or "eccentric." This labeling can be even more destructive; it can include tags such as uneducated or, worse, uneducable. Unfortunately, I have observed this "ghostlining" (Krapel et al., 2020), the removal of people from a conversation because their voices are less valued, in global health forums on many occasions. This same process of ghostlining is evident in the rationalization given for not including the community voice directly in decision-making. We have both faced pressure from reviewers to supply references from the Global North that substantiate/validate our methods, processes, tools, and reflections. But those narratives do not address the history of the knowledge, wisdom, and experience of the Global South. In my lived experience, scientific activity is actually constrained by a focus on searching for "the" universal truth. The exclusion of other world ideas and experiences culminates in re-centering, while de-centering can create infinite power for change by reflecting on multiple perspectives and referencing across scientific traditions. Which approach did you have in mind when you spoke of validation? I had decentering in mind. To me, decentering is a psychological process where we shift our perspective away from ourselves as the central focus. Instead of solely considering our point of view, we value the perspectives and experiences of others, fostering empathy, understanding, and inclusivity. Even in the Global South, there's a tendency to measure success against Western standards, rooted in our colonial past. This mindset infiltrates our lives, reinforced by a parallel system of resources and power controlled by the North. This reliance on external validation perpetuates mental colonization, where our voices and experiences are primarily validated by the Global North. However, I've realized that my reality and struggles are different from those in the North. I've shifted my focus to peers who share similar experiences, reclaiming our narratives and directing the discourse to what truly matters to us. Seeking Northern validation can be detrimental, overshadowing our voices and experiences. Validation becomes a tool of control, influencing one's sense of self-worth. We have to accept the fact that external resources or from the North are not meant to build us; they are meant to distract us by engaging us in non-meaningful yet comfortable work. It's time to challenge this reliance and define our worth on our terms, independent of external validation. As someone whose family was from the Global North but whose lived experiences are largely in the Global South, what is your conceptualization of decolonization? Colonization refers in general terms to the appropriation of space, and so in terms of science, space is the thinking space. Simply put, then, I conceive decolonization as the creation of an open thinking space where the diversity of thoughts is intentionally included and equitably valued. In The Doors of Perception, Aldous Huxley (2010) wrote: "There are things known, and things unknown, and in between are the doors to perception." In the in-between, paradigms of thought can evolve that are influenced by a much broader range of experience and knowledge than science currently draws on to develop theory and frameworks. The irony is that science, ostensibly about breaking through boundaries of knowledge, is all too often trapped within boundaries of its own making. This is the tyranny that follows the imposition of standard practice, when those standards do not address multiple settings, values and needs. It is what I fear from Artificial Intelligence (AI). Can we trust those who set the algorithms to ensure sufficient diversity of perspectives and goals to reach a new frontier of thinking? AI is likely to continue the colonization of thought unless the algorithm is set for learning to occur freely through the examination of all wants and all values and considers the consequences of all possible choices, intentionally including those whose perspectives have previously been ignored. Without this shift, we'll never solve our problems because we are unlikely to find out what the problem actually is. When I visualize the word framework, I see scaffolding and reflect on the way scaffolding has been used to describe both continuity and flexibility in help and support given directed at children's learning (Verenikina, 2003). Early childhood is the time of the most rapid change, and growth. Any framework that has a predetermined direction perpetuates colonization, constraining that growth. While a decolonized framework recognizes, without fear or prejudice, the responsibility of each to find out what they need to understand, to fix and manage our own needs. Within a decolonized approach, an ECD framework will provide support that is responsive to different perspectives, places, times, objectives, and different sets of resources. In implementation design, for ECD as for many other human systems, there is what amounts to an obsession with uniform systems, controlled centrally. The justification is the need to make comparisons across and between contexts, and as one UN representative described, "We are the ones responsible for the children." Universal frameworks, it seems, are commonly adopted for the convenience of large international organizations, whether implementers or funders, to streamline the management of their portfolios, ignoring the ultimate and unavoidable power of the parent to place the specific needs of the child at the core. If you put this into everyday language, the universal framework tells the parent what others want them to do, in a specified way, with little consideration of personal knowledge of the child or context. What then happens can then be counted up, to report on global data, whose meaning and targets may hold little relevance to the family at the focus of the work. That is not science; it is an appropriation of my responsibilities as a parent and an appropriation of both my physical and mental space. The application of universal standards both builds on and perpetuates a narrow focus of responsibility and accountability. It is colonization at its most extreme. Only when different perspectives are acknowledged and valued will we move towards understanding the full panoply of human potential and be able to select solutions that are valued and work in context, sustainably over time (Kreuter et al., 1999; Shaw & Silva, 2023). Adopting a humanistic and realistic framework to understand the impact of colonial legacies on ECD is essential. As you say, it's crucial to involve the people directly impacted in discussions about interventions and it should be more than a superficial act of seeking their feedback on a designed intervention (based on Global North perspectives). Engaging with the beneficiaries should begin before you start designing with an intent to explore their priorities. This approach provides valuable insights into the challenges and potential solutions. However, there's often a disconnect between those addressing the issues and the affected communities largely driven by academic incentives to conduct a randomized trial and getting a publication in a high-impact journal. While we use community members to collect data, their role in decision-making remains limited. Second, we also need to ask how we can truly measure the effectiveness of interventions and prepare individuals for the future. The focus of the current interventions driven by the Global North are those living in abject poverty in the South, this overlooks the needs of middle-class families. Interventions tailored to these families, who have more resources and support, may be more impactful than those for the most disadvantaged. Designing interventions that fit their context and requirements is crucial. Community members understand the complexities and nuances of their challenges in a way that external observers cannot, and decision-makers distant from the situation invariably do not, in the quest for simple solutions, for silver bullets. Given the opportunity to share their intimate knowledge of, for example, political and environmental disruptions that disconnect people from their familiar environments, we have both experienced communities framing potential and acceptable options to address their complex situations. Exclusion from solution design extends to exclusion from data use, with outsiders gathering information, and compiling it in documents, most commonly in English. We are, thus, far from sharing our learning wisely. As you pointed out earlier, the path to achieving distributed leadership, genuine shared decision-making, remains distant. Decolonization is not about continually critiquing the Global North or emphasizing their wrongs and the need for their change, as I've encountered in the discourse, I've been part of. In fact, it reminds me of a valuable lesson you once shared with me when I had to present in front of a committee dominated by the perspective of the Global North. You wisely conveyed that the focus should not be on how "wrong" someone else is but rather how right your approach is. This lesson has profoundly resonated with me. It reinforces the idea that the true change begins with us, within our own systems, our communities, and the reclamation of our power. It's an unshakable responsibility we must shoulder, and there's simply no alternative. Psychologists, and this brings us to our last question, refer to the community as clients, and the core of our approach is empowerment. They, the clients, are the true leaders, shaping the way they want their lives to change. We serve as guides and facilitators, and our primary role involves asking questions that enable others to delve deeper into their challenges. Our fundamental assumption is that the solutions reside within the individuals we work with, our clients. This perspective motivates me to emphasize the need to introduce psychology from this vantage point, to rehumanize global health, to foster empathy, and to accept the inherent uncertainties. It's about placing the community or individual we aim to assist at the heart of our efforts, acknowledging their abundance of solutions. Our role should pivot from what aid agencies have traditionally done and shift towards addressing systemic issues, focusing on system strengthening. Sensitization and dialogue with these systems on how best to support these individuals should supersede simply doing things for them, to generate informative research and favorable outcomes. You raise the importance of systems. An example of this, for me in the global health/ECD space are discussions on maternal depression (Stewart, 2007). All behavioral phenomena, while communicated simply through the use of labels such as depression, manifest themselves not as categorical phenomena, but along a continuum of experience that is inextricably intertwined within current and past experiences and the system which surrounds it. This points to the solution primarily lying, as you say, in creating systemic shifts in the context in which people live (Fearon et al., 2017). As a psychologist with a specialization in assessment, I am keen to shift the role of measurement from the constraints of categorization to define risk that has generated a process of resource allocation (e.g., educational support) based on numeric scores, towards better understanding of behavioral continuums and pathways of resilience (Gaidhane et al., 2020; Holding, Fotso & Elungata, 2018; Holding et al., 2018). The de-colonized approach of using information would generate; empathy through access to multiple perspectives; and distributed leadership through uncovering meaning and sharing this understanding more broadly (Mignolo, 2009; Watkins et al., 2023). Information fosters agency and empowerment, shifting the role of individuals to being accountable to and for themselves. Back to that idea of scaffolding, the ability to change roles as the system changes is something that I have observed simply has not happened with most international organizations. There is a tendency to maintain that exact same type of contribution until the money runs out, and then there's nothing that has been left behind to ensure sustainability. This failure is, as you point out, in part due to the failure of the community to actively build their roles and responsibilities. As a psychologist I hope to make a contribution to creating fluid and dynamic systems by stimulating reflective practice (Gaidhane et al., 2023). I hope that this paper contributes to that process. I hope so too. Frankly, throughout my 15 years of engagement in global health, I often felt like an anomaly, questioning my sense of belonging in this field. However, I've come to recognize that the study of human behavior should be a crucial component of global health and ECD training. It has the potential to rehumanize the field.
Despite widespread recognition of social norms' influence on child marriage (CM), little is known about how to measure the most influential norms in parental CM decisions. Because of their pivotal role in marriage decision-making, measuring social norms among parents is a critical step to address CM through effective intervention. Guided by social norm theory and contextual attitude scale, this study examines the role of parental norms in CM decisions, aiming to inform policies and programs to address CM in Bangladesh. Data came from a cross-sectional matched study in Khulna Division, Bangladesh, with parents of unmarried (n = 127) and married (n = 127) adolescent girls. We developed several indices reflecting social norms, prudential reasons, combined norms and prudential reasons, and attitudes, based on social norm theory. We performed chi-square tests and logistic regression analyses to identify the role of social norms influencing CM decisions. Chi-square tests revealed that parents of married girls were more likely to agree with items across all measures. Adjusted logistic regression showed the strongest association with CM for the combined norms and prudential reasons index (aOR = 3.15; 95% CI: 1.84–5.37), followed by attitudes (aOR = 2.78; 95% CI: 1.85–4.18), and prudential reasons (aOR = 2.62; 95% CI: 1.75–3.91). The association was not significant with the social norms index. Item-wise regression models showed that parents of married adolescent girls were more likely to agree on two prudential reasons items and several attitude items related to sexuality, agency, violence, and religious beliefs. CM decisions are shaped by a complex interplay of social norms, prudential reasons, and attitudes. Effective interventions must address these interlinked drivers to disrupt the cycle of CM. • Child marriage (under 18 years) remains a persistent issue in Bangladesh. • Social norms, expectations, beliefs, and attitudes drive child marriage of girls. • Parents believed early marriage provides security, and help prevent sexual violence. • Parents thought marrying after 18 years might increase the required amount of dowry.
Md Abul Kalam, Chowdhury Abdullah Al Asif, Md Mehedi Hasan et al.
Child marriages and early age pregnancy are an alarming issue among adolescent girls and young females in South Asian region. This research was carried out to understand the knowledge, attitude, and practices towards child marriages and early age pregnancies. For this purpose an exploratory research design was employed and data was gathered through using qualitative and quantitative research techniques. The research found that the respondents were lacking authentic knowledge about sexual and reproductive health rights. Most of the respondents were having access to public and private health service providers and this channel can be a source for the quality information about sexual and reproduce health and rights. An integrated approach through combing all the channels and stakeholders of the society can be vital for the desired social change to counter child marriages and early age pregnancies.
Syed Imran Haider, Arshad Khan Bangash, Muhammad Ali
Background Marriage is a significant life milestone, shaping family formation and psychological well-being. This study investigates the associations between marriage, marital timing – including child marriage – and mental distress among adolescent girls and young women (AGYW) in four southern African countries.Methods We analyzed data from 13–24-year-old AGYW collected in nationally representative Violence Against Children Surveys (VACS): Lesotho (2018), Mozambique (2019), Namibia (2019), and Zimbabwe (2017). Past-month mental distress was measured using the Kessler Psychological Distress Scale-6 (K6), operationalized as moderate-to-severe (K6 ≥ 5) and severe mental distress (K6 ≥ 13). Marriage was computed as a binary variable of ever-married among 13–17-year-olds. Marital timing among 18–24-year-olds was categorised as: never married, married before age 18 (child marriage), or married at age 18 or older. Multivariable logistic regression models estimated the odds of mental distress associated with (i) having ever married among 13–17-year-old AGYW and (ii) marital timing among 18–24-year-old AGYW, accounting for covariates: school enrollment, household poverty, urban residence, age, and country. We investigated whether past-year IPV moderated the association between marriage/marital timing and mental distress.Results Among 13–17-year-old AGYW, marriage was associated with severe mental distress (adjusted odds ratio [aOR] = 8.85, 95% CI: 2.86–27.39; p < 0.001) but not with moderate-to-severe mental distress. Among 18–24-year-old AGYW, child marriage was associated with severe mental distress (aOR = 3.30, 95% CI: 1.11–9.82; p = 0.032) but not with moderate-to-severe mental distress. Past-year IPV was associated with moderate-to-severe mental distress in both age groups and severe mental distress among 18–24-year-olds. Among AGYW aged 13–17 years, IPV moderated the relationship between marriage and severe mental distress (p < 0.001). Among 18–24-year-olds, AGYW who experienced both IPV and child marriage had the highest probability of severe mental distress (20%).Conclusion Mental health support for AGYW should include IPV prevention and post-violence care to address the unique stressors faced by both married and unmarried AGYW.
Ololade Julius Baruwa, Elona Toska, Boladé Hamed Banougnin et al.
Abstract Child marriage is increasingly recognised as a development priority given its far-reaching life-course and inter-generational consequences. Despite rapid progress, Ethiopia remains in the top five countries globally in terms of absolute numbers of married girls, with significant sub-national variation in the drivers and patterning of child marriage. This article applies a capabilities framing in a novel way to move debates beyond a sole focus on girls and a single modality of marriage. It explores the gendered experiences of child marriage amongst girls and boys in Amhara and Oromia regions, drawing on semi-structured interviews with 190 adolescents, 44 parents and 20 key informants from 2017 to 2020. The findings highlight context-specific economic and gender norms drivers of adolescent-initiated and parent-arranged child marriages, and their differential effects on girls and boys. The article concludes by discussing policy and programming implications in line with the 2030 Sustainable Development Agenda commitment to leave no one behind.
Child, early and forced marriages and unions are defined as a union in which at least one of the parties is under the age of 18. The overwhelming majority of formal and informal child marriages and unions involve girls, although in some cases their male spouses are also under 18. As stated in the Joint general recommendation No. 31 of the Committee on the Elimination of Discrimination against Women/general comment No. 18 of the Committee on the Rights of the Child on harmful practices, and Human Rights Council resolution 29/8 of 2 July 2015, on strengthening efforts to prevent and eliminate child, early and forced marriage, child marriage is considered a form of forced marriage, as it is practiced without the full, free and informed consent of one or both parties (United Nations, 2015b). The definition used to address this violation of the human rights of children and adolescents includes marriages involving a conjugal union recognized by legal, customary or religious norms, as well as informal conjugal unions.
Background: This study aims to identify the contexts, environments, and nurturing care predictors that determine whether a child is developmentally on track in Ceará, Brazil. Methods: We analysed data from a cross-sectional study conducted with caregivers of 6,447 children aged 0-59 months during a vaccination campaign in Ceará in October 2019. The validated Child Development Assessment Questionnaire was used to assess early childhood development (ECD) and children with a z-score ≥ -1 SD were considered developmentally on track. We conducted logistic regression models to understand the effects of contexts, environments, and nurturing care domains on ECD. Findings: Children in the early years (< 36 months) were more likely to meet the ECD milestones if they were not born with low birth weight (AOR: 0·64; 95% CI: 0·42-0·97), were exposed to manufactured toys in their house (2·68; 1·97-3·66), their heads of household were employed (1·61; 1·16-2·23), and their caregivers had read the Child Health Handbook (1·42; 1·13-1·77) and engaged them in stimulating activities (1·71; 1·26-2·32). Children aged 36-59 months were more likely to meet the ECD milestones if they were breastfed (never: ref. / < 3 months: 3·72; 1·91-7·26 / 3-5 months: 3·21; 1·74-5·93 / 6-11 months: 3·73; 1·95-7·16 / ≥ 12 months: 3·89; 2·25-6·72), had books at home (0: ref / 1-3: 1·71; 1·22-2·40 / 4-6: 2·24; 1·27-3·94 / 7+: 2·71; 1·05-7·00), and their caregivers received information about ECD (1·49; 1·11-2·01) and engaged them in stimulating activities (1·80; 1·27-2·56). Children aged 36-59 months were less likely to meet developmental milestones if they watched TV or used tablets/smartphones for more than two hours per day (0·61; 0·44-0·84), played with household objects (0·62; 0·41-0·92), participated in governmental early childhood programmes aimed at vulnerable families (0·62; 0·45-0·86), had families that participated in income transfer programmes (0·68; 0·47-0·99) (families living in poverty or extreme poverty), and their caregivers considered slapping (0·67; 0·48-0·94) a necessary disciplinary method. Interpretation: Having favourable socioeconomic conditions, breastfeeding, the absence of harsh discipline, caregivers who provide responsive care, and the provision of opportunities for early learning are the key factors that increase the likelihood of a child achieving their full developmental potential in Ceará, Brazil. Funding: This study was supported by the Maria Cecília Souto Vidigal Foundation (F0245), Brazil. The funder had no role in the design, analysis, or writing of this article.
Sônia Isoyama Venâncio, Juliana Araújo Teixeira, Maritsa Carla de Bortoli et al.
The Covid-19 pandemic and mitigation measures had widespread societal impacts. Young children are particularly vulnerable yet the ways the pandemic affected children in informal settlements (slums) are not well described. This study aimed to investigate the impacts of the pandemic on early childhood in three Nairobi informal settlements. Five rounds of cross-sectional computer assisted telephone surveys (with 578-774 respondents in each) in three settlements (Kibera; Mukuru-Viwandani; Kawangware) over 13 months, correlating with different phases Covid-19 restrictions. Impact was assessed through comparing changes in summary statistics on responses to survey questions on each domain of Nurturing Care over time. Survey results found significant disruptions in healthcare services, particularly in early rounds with missed vaccinations (reported by 1 in 5 parents of infants) and therapeutic healthcare seeking (missed by up to 21% of families). Persistent food and nutrition insecurity, with a large majority of families struggling to feed their children (72% in Round 1) due to financial constraints. Economic shocks were near-universal; 99.7% of respondents reporting earning less since the start of the pandemic. Use of paid childcare initially plummeted but showed a resurgence over time (up to 21% by Round 5) as pandemic control measures evolved. Young children were commonly left alone in all rounds, but especially earlier ones; underscoring the enduring challenges in providing nurturing care in these settings. Very few (<2%) of study participants reported direct experience of illness from Covid-19 in their family in any round. In conclusion, despite adaptations over time and the decrease in reported disruptions, prolonged economic shock was associated with multiple adverse effects on Nurturing Care. The study's longitudinal scope provides insights into the dynamic nature of ensuring young children in slums thrive during crises, highlighting the need for interventions and policies that address the compounded vulnerabilities of young children in these communities.
Robert C Hughes, Silas Onyango, Nelson Langat et al.
BACKGROUND: Secondary education and delayed marriage provide long-term socio-economic and health benefits to adolescent girls. We tested whether a structural and norms-based intervention, which worked with adolescent girls, their families, communities, and secondary schools to address poverty, schooling quality and gender norms, could reduce secondary school drop-out and child marriage among scheduled-caste/scheduled-tribe (SC/ST) adolescent girls in rural settings of southern India. METHODS: ). Primary trial outcomes were proportion of girls who completed secondary school and were married, by trial end-line (15-16 years). Analyses were intention-to-treat and used individual-level girl data. RESULTS: 92.6% (2275/2457) girls at baseline and 72.8% (1788/2457) at end-line were interviewed. At end-line, one-fourth had not completed secondary school (control = 24.9%; intervention = 25.4%), and one in ten reported being married (control = 9.6%; intervention = 10.1%). These were lower than expected based on district-level data available before the trial, with no difference between these, or other schooling or sexual and reproductive outcomes, by trial arm. There was a small but significant increase in secondary school entry (adjusted odds ratio AOR = 3.58, 95% confidence interval CI = 1.36-9.44) and completion (AOR=1.54, 95%CI = 1.02-2.34) in Vijayapura district. The sensitivity and attrition analyses did not impact the overall result indicating that attrition of girls at end-line was random without much bearing on overall result. CONCLUSIONS: Samata intervention had no overall impact, however, it added value in one of the two implementation districts- increasing secondary school entry and completion. Lower than expected school drop-out and child marriage rates at end-line reflect strong secular changes, likely due to large-scale government initiatives to keep girls in school and delay marriage. Although government programmes may be sufficient to reach most girls in these settings, a substantial proportion of SC/ST girls remain at-risk of early marriage and school drop-out, and require targeted programming. Addressing multiple forms of clustered disadvantage among hardest to reach will be key to ensuring India "leaves no-one behind" and achieves its gender, health and education Sustainable Development Goal aspirations. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT01996241.
Ravi Prakash, Tara Beattie, Prakash Javalkar et al.
