Effectiveness of economic support, comprehensive sexuality education and community dialogue on early childbearing and sitting for grade nine exams among adolescent girls in rural Zambia: a cluster randomised trial

Adolescent pregnancies pose a risk to young mothers and their babies. In Zambia, one third of 18-year-old girls have given birth. Poverty, low secondary school enrolment, misinformation, and community norms contribute to early childbearing. We assessed the effectiveness of economic support alone and combined with comprehensive sexuality education (CSE) and community dialogue on childbearing and sitting for grade nine exams among girls. This cluster randomised trial had one control and two intervention arms. In 2016, 157 rural schools (units of randomisation) were included, and girls in grade seven were eligible. After recruitment, schools were stratified by district and randomised (ratio 31:63:63). In one arm, girls and their guardians were offered economic support. Another arm combined CSE and community dialogues with the economic support. The interventions were implemented for 27 months, and the participants were followed for another 2 years. The primary outcomes were birth within 8 months of the end of the intervention period, birth before the 18th birthday, and sitting for grade nine exams. The trial is registered with ISRCTN (ISRCTN12727868). Between 3rd March and 15th July 2016, 4922 girls were recruited, with 999 randomised to the control, 2004 to the economic and 1919 to the combined arm. The combined support gave a moderate reduction in the incidence of birth within eight months of the intervention period's end (risk difference (RD) −0.042 (95% CI −0.084, −0.0003), possibly a minimal reduction in birth before the 18th birthday (RD −0.010 (95% CI −0.053, 0.032), and a substantial increase in sitting for grade nine exams (RD 0.17 (95% CI 0.11, 0.22). The economic support alone tended to give slightly smaller effects. Our findings suggest that a combination of economic support, CSE and community dialogue may give small reductions in adolescent childbearing. The same interventions can increase completion of basic education. The Research Council of Norway, the University of Bergen and the Swedish International Development Cooperation Agency (SIDA).