Preventing Early Child Marriage in Nepal
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|ClinicalTrials.gov Identifier: NCT04015856|
Recruitment Status : Completed
First Posted : July 11, 2019
Last Update Posted : February 17, 2022
|Condition or disease||Intervention/treatment||Phase|
|Child Marriage||Behavioral: Full TP intervention Behavioral: Light TP intervention||Not Applicable|
Each year, child marriage, before age 18 years, affects more than 10 million girls globally. The practice is associated with adverse maternal and child health outcomes and diminished long-term economic empowerment. About half of all child marriages occur in South Asia. A recent study in four high prevalence South Asian countries showed declines in girl-child marriage from 1991-1994 to 2005-2007, however, these declines were concentrated in the youngest ages. Namely, significant relative reductions occurred in the marriage of girls before age 14 years in all countries, however, little or no change was seen in the marriage of 16- to 17-year-old girls for any country except Bangladesh, where the prevalence of such marriages increased.
Tipping Point (TP) is an innovative program developed by Cooperative for Assistance and Relief Everywhere, Inc. (CARE) to change community social norms and build capacity among adolescent girls to become agents of change in their communities, with the ultimate goal of reducing the risk of child marriage.
The quantitative evaluation of the TP package will involve a three arm Cluster Randomized Controlled Trial (CRCT), where the arms are as follows:
- Arm 1: Full TP intervention including emphasized social norms change
- Arm 2: Light TP intervention without emphasized social norms change
- Arm 3: Pure control
The overall evaluation in Nepal will start with the baseline study, followed by eighteen months of interventions. After the intervention phase, there will be a one year 'freeze' period, when no interventions will take place. After that one year, the end-line evaluation study will be conducted in Nepal to assess the impact of the packages.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||2828 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||Wards (the lowest government administrative units in Nepal) will be treated as clusters or the primary sampling units in this study. Each cluster will be randomly assigned to one of the three arms. Adolescents residing in the study wards will be recruited.|
|Masking:||None (Open Label)|
|Official Title:||Impact Evaluation of the Tipping Point Project in Nepal: An Intervention to Prevent Early Child Marriage|
|Actual Study Start Date :||May 2, 2019|
|Actual Primary Completion Date :||January 4, 2022|
|Actual Study Completion Date :||January 4, 2022|
Experimental: Full TP intervention including emphasized social norms change
Participants in this study arm will receive the full TP intervention, including emphasized social norms change, for 18 months.
Behavioral: Full TP intervention
CARE's Tipping Point initiative focuses on addressing the root causes of child, early, and forced marriage (CEFM) and promoting the rights of adolescent girls through community-level programming and evidence generation in Nepal and Bangladesh, as well as multi-level advocacy and cross-learning efforts across the globe. Tipping Point's approach focuses on synchronized engagement with different participant groups-including adolescent girls, adolescent boys, parents/community members, community leaders-around key programmatic pillars, and creates public spaces for all community members to engage in the dialogue. Tipping Point's approach relies on challenging social expectations and repressive gender norms and promoting girl-centric and girl-led activism to enable adolescent girls to identify and move into social spaces where they can challenge inequality.
Active Comparator: Light TP intervention without emphasized social norms change
Participants in this study arm will receive the light TP intervention, without emphasized social norms change, for 18 months
Behavioral: Light TP intervention
The Tipping Point project also has designed a social norms light package, which includes a subset of the social norms and activism components of the full package.
No Intervention: Control
The control group will not have any study interventions.
- Change in proportion of never married adolescents [ Time Frame: Baseline, Month 30 ]The proportion of never-married adolescents (aged under 20) in each study arm will be examined.
- Change in proportion of married adolescents [ Time Frame: Baseline, Month 30 ]The proportion of married adolescents (aged under 20) in each study arm will be examined.
- Change in decision making [ Time Frame: Baseline, Month 30 ]Qualitative questions on gender and rights will assess awareness of rights, progressive choices, negotiation skills, and decision making of adolescent girls. Information will be collected during interviews asking open ended questions.
- Change in Adolescent Sexual and Reproductive Health and Rights (ASRHR) [ Time Frame: Baseline, Month 30 ]Qualitative questions on ASRHR will assess the knowledge, progressive attitudes and practice of sexual and reproductive health rights among adolescent girls. Information will be collected during interviews asking open ended questions.
- Change in social norms [ Time Frame: Baseline, Month 30 ]Qualitative questions on social norms change will assess to what extent the beliefs have shifted in the community regarding what others do in terms of gender, rights (including ASRHR) and child, early and forced marriage (CEFM) and what others expect them to do in terms of gender, rights (including ASRHR) and CEFM. Information will be collected during interviews asking open ended questions.
- Change in movement building among adolescent girls [ Time Frame: Baseline, Month 30 ]Qualitative questions on girl-centered movement building will assess the cohesion, solidarity, leadership and mobilization skills of adolescent girls, as well as the adolescent girls' autonomous engagement with different networks, the community and government and non-government stakeholders. Information will be collected during interviews asking open ended questions.
- Change in gender attitudes among community adults [ Time Frame: Baseline, Month 30 ]Adults in the intervention communities will complete a 42-item questionnaire about gender attitudes. The instrument includes the domains of gender roles, roles of girls and women, manhood and masculinity, controlling behaviors, and attitudes condoning violence against girls. Responses are given on a scale from 1 to 4 where 1 = fully agree and 4 = fully disagree. Summed scores range from 42 to 168, where higher scores indicate greater change in social norms.
- Change in attitudes on ASRHR among community adults [ Time Frame: Baseline, Month 30 ]Adults in the intervention communities will complete a 16-item questionnaire about ASRHR attitudes. Responses are given on a scale from 1 to 4 where 1 = fully agree and 4 = fully disagree. Summed scores range from 16 to 64, where higher scores indicate greater change in social norms.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04015856
|Kathmandu, Nepal, 44600|
|Principal Investigator:||Kathryn Yount, PhD||Emory University|