Grandmothers Project - Change through Culture: Program for Girls' Holistic Development Quantitative Research Report

"...it appears that the GHD intervention is effectively shifting norms in ways that are likely to lead to sustained enabling environments for VYA girls."

Harmful social norms around gender roles, childbearing, female genital mutilation/cutting (FGM/C), gender-based violence (GBV), reproductive health (RH), and female education hinder the positive development of very young adolescent (VYA) girls in rural Senegal. Many programmes addressing these issues narrowly focus on changing attitudes and behaviours of VYA girls and occasionally, their caregivers. Yet the Grandmother Project - Change through Culture (GMP) recognises that sustained change to end these and other harmful practices, which are collectively influenced by other family members and community actors, can come about only when there is change in the social norms that sustain them. This report presents the results of a quantitative study designed to guide understanding and scale-up of the GMP's Girls' Holistic Development (GHD) programme, which promotes change in culturally embedded social norms and practices by both empowering girls and creating an enabling environment. The result of a partnership between GMP and Georgetown University's Institute for Reproductive Health (IRH), the study uses a realist evaluation approach to understand the processes of change and the effectiveness of the GHD programme for improving the well-being of VYAs.

GHD is detailed at Related Summaries, below but, in short, the activities of the GHD programme are participatory and catalyse social mobilisation of community leaders and groups. GMP specifically identified grandmothers as an underutilised cultural resource who can be levers for change for GHD in families and communities. Thus, the GHD programme features a series of community activities that involve three generations of community leaders (elders, adults, and adolescents) with the goal of developing community consensus on the need to modify prevailing norms and practices related to girls' education, marriage, pregnancy, and FGM/C. The community activities include: intergenerational forums; days of solidarity and dialogue with traditional and religious leaders; under-the-tree non-formal education learning activities with homogenous groups; teacher-grandmother workshops; grandmother leadership training; and all-women forums involving girls, mothers, and grandmothers.

As part of the United States Agency for International Development (USAID)-funded Passages Project, IRH worked with Cheikh Diop University's Institute for Training and Research in Population, Development, and Health Reproduction (IPDSR) to conduct a cross-sectional study to assess the effects of the GHD approach after 18 months of activity in the Némataba Commune in Senegal. Seven villages that had received the full intervention package were involved in the study, and seven non-intervention villages were purposively selected for comparison. From February to March 2019, surveys were conducted with all eligible VYA girls (12-16 years of age at endline) and grandmothers - women of an age where they could have biological grandchildren of VYA age - and a subset of VYA caregivers in selected villages. The study sample included 399 VYA girls, 196 grandmothers, and 205 caregivers. The study team developed measures for gender attitudes, social norms (through vignettes), self-efficacy, intergenerational communication, and target behaviours and behavioural intentions related to early marriage and pregnancy, girls' education, and FGM/C. Differences in these measures were assessed by comparing groups in intervention and comparison villages.

In short, the data demonstrate considerable positive effects of the intervention on intergenerational dialogue and support, self-efficacy of VYA girls, caregivers, and grandmothers, and on social norms related to FGM/C, girls' schooling, child marriage, and early pregnancy. (See the report for details - e.g., for a full table of social norms items as perceived by VYA girls, caregivers, and grandmothers on all of the behavioural and social norms outcomes, see Appendix 2.) Selected findings:

• Access: 80.1% of VYA girls, 76.3% of their caregivers, and 85.7% of grandmothers in intervention villages reported involvement in at least one of the GHD intervention activities.
• Behavioural and social norms outcomes:
  • Early marriage: For example, when asked about their own involvement in the decision to marry them, 68.9% of unmarried VYA girls in intervention areas felt confident their family would ask their opinion on whether to be married. This confidence was statistically significantly (p<0.05) higher compared to unmarried VYA girls in comparison villages (56.2%). There was also a statistically significant difference (p<0.01) between unmarried VYA girls in intervention villages reporting they felt confident that their opinion would be listened to during decision-making (68.2%), compared to 53.7% of VYA girls in comparison villages. Furthermore, VYA girls in intervention villages were statistically significantly (p<0.05) more likely to perceive positive descriptive norms relating to early marriage, compared to girls in comparison villages. In addition, VYA girls in intervention villages were statistically significantly (p<0.05) more likely to perceive positive injunctive norms relating to early marriage, compared to girls in comparison villages.
  • Girls' education: For example, in intervention villages, 92.4% of caregivers were confident they will be able to achieve their desired level of schooling for their daughter, which was marginally statistically significantly (p<0.10) higher than caregivers of girls in comparison villages (79.8%). Furthermore, VYA girls in intervention villages were statistically significantly (p<0.05) more likely to perceive positive descriptive norms relating to girls staying in school, compared to girls in comparison villages. In addition, VYA girls in intervention villages were statistically significantly (p<0.05) more likely to perceive positive injunctive norms relating to girls staying in school, compared to girls in comparison villages.
  • Early pregnancy: For example, caregivers in intervention villages were statistically significantly (p<0.01) more likely to report they felt confident their daughter would have her first child at the age the caregiver prefers (59.7%), compared to 48.3% reporting the same in comparison villages. Similarly, caregivers in intervention villages were statistically significantly (p<0.01) more likely to report they will ask their daughter's opinion about the timing of her first pregnancy (77.8%), compared to only 47.8% of caregivers in comparison villages. Furthermore, grandmothers in intervention villages (70.4%) were statistically significantly (p<0.05) more likely to expect that the girl in a vignette would engage others in her family or community for support to achieve her pregnancy desires, compared to grandmothers in comparison villages (50.4%).
  • FGM/C: For example, caregivers in intervention villages were statistically significantly more likely to disagree that "cutting helps a girl stay a virgin until she is married" (64.6% vs. 47.5%; p<0.05), "uncut girls are not pure" (79.0% vs. 40.8%; p<0.01), "cutting is part of our tradition and culture" (17.5% vs. 5.6%; p<0.01), and "cutting teaches a girl obedience and respect" (65.8% vs. 50.0%; p<0.01) - compared to caregivers in comparison villages. Furthermore, very few grandmothers (5.4%) expected that the community would shame the caregiver in a vignette for trying to avoid FGM/C for their daughter, and this was statistically significantly (p<0.01) lower compared to expectations of negative sanctions (28.6%) on the part of grandmothers in comparison villages.
• Engagement of grandmothers in support & decision-making: For example, VYA girls in intervention villages were statistically significantly (p<0.05) more likely to expect a grandmother to be consulted/involved in decisions around her first pregnancy (33.0%), compared to 11.8% of girls in comparison villages. With regard to communication for advice and support, girls in intervention villages were statistically significantly (p<0.01) more likely to have talked about or asked advice from a grandmother in the previous year for marriage (42.4% vs. 10.0%), schooling (60.6% vs. 21.5%), and pregnancy (27.9% vs. 5.2%), compared to girls in comparison villages. Furthermore, 42.4% of VYA girls in intervention villages expected a grandmother to be consulted/involved in decisions around her marriage and 46.9% for decisions about her schooling. This was statistically significantly (p<0.01) higher compared to VYA girls in comparison villages (7.1% and 16.0%, respectively). Grandmothers in intervention villages were highly statistically significantly (p<0.01) more likely to perceive they are a valued part of their community (87.5%) than grandmothers in comparison villages (60.4%).
• Satisfaction with the intervention: Approximately 90% of grandmothers and caregivers perceived they have a stronger connection to their community, can speak their opinion more freely, and their opinion is considered and valued more after the GHD intervention compared to before. Approximately two-thirds of VYA girls perceived the same. In addition, VYA girls, their caregivers, and grandmothers in intervention villages were asked about their perceptions of whether the GHD programme led to changes in their thinking about early marriage, girls' education, early pregnancy, and FGM/C. For example, approximately three-quarters of VYA girls responded that the GHD intervention led them to think differently about: when girls should marry (73.9%), how long girls should stay in school (77.0%), when girls should have their first child (71.9%), and FGM/C (70.8%).

Owing to the short time frame of this intervention, the researchers did not expect to see (and did not see) large differences in prevalence of out-of-school girls, child marriage, or early pregnancy or differences in schooling, marriage, and fertility intentions when comparing intervention to comparison villages.

In short: "This research, whose findings are supportive of the GHD theory of change...and expected pathways to individual change, helps explain the social norms-behavioral change linkage. Activities that lead to greater community cohesion around girl child issues and collective community action supportive of girl-child outcomes contribute to behavior change of VYA girls..."

In pondering opportunities for future study, the researchers note that: "The GHD approach assumes that information alone does not adequately address the strong social influences of the family and community and that efforts that shift power dynamics within families and communities can contribute to positive shifts in norms and individual behavior. Approaches that aim to build social cohesion of communities should be tested in secondary towns where neighborhoods may be less socially cohesive to begin with, to assess how the intervention works in a different context."

In conclusion: "The results indicate that the GHD change strategies - elicting dialogue between generations of elders, parents and adolescents, on VYA girl issues and working through existing community structures to shift norms related to adolescent girls' reproductive health (RH) and life outcomes - are shifting norms to be supportive of keeping girls in school, delaying marriage and pregnancy, and avoiding FGM/C after only 18 months of GHD intervention. Training and supporting grandmothers and other community actors as change agents in VYA girls' lives is a unique opportunity to achieve behavior change through collective community action mechanisms, focusing on issues of interest to local communities. Overall, the research lends support to the relevance of norms-shifting interventions in social and behavior change (SBC) initiatives."